A Refresh will make sure the Clean Operating system files are put in place. but it does nothing to solve the files that are installed with your applications and programs. The OS does not know which files your programs installed and in what folders/directories they are contained within. You can Refresh windows 10, but all the files and folders associated with your applications will still be bloated, I found that the majority of the slowdown and bloat is from program files and not necessarily windows operating system files.
People install programs/freeware/trialware to try them all the time and remove them, almost half of them do not get removed properly, they leave ghost files and folders on your hard drive, they change drivers, etc. I had a stubborn program that would refuse to uninstall no matter how hard I tried and a stupid nag screen would come on every time I reboot, but since im smart with computers I was able to go into the registry and ini files and remove the junk and ghost folders I was able to fix it up but your average pc user does not necessarily know how to do this nor has the patience