What do acute stroke physiotherapists do to treat postural control and mobility? An exploration of the content of therapy in the UK

Abstract

Objective: To investigate the content of acute stroke physiotherapy to treat postural control and mobility problems.

Design: Stroke physiotherapists recorded the interventions used to treat postural control and mobility during treatment sessions. They recorded five sessions for at least five patients each. Descriptive statistics assessed the frequency with which the interventions were used.

Setting: Hospital-based acute stroke care.

Subjects: Thirty-six acute stroke physiotherapists recorded 2374 interventions in 364 treatment sessions for 76 patients.

Main measures: The Stroke Physiotherapy Intervention Recording Tool.

Results: Facilitation techniques were the most frequently used interventions (n = 1258, 53%) with exercise (n = 115, 5%), teaching others how to help the patient (n = 99, 4%) and provision of equipment (n = 63, 3%) the least frequently used.

Conclusions: Acute stroke physiotherapists primarily use therapist-led ‘hands-on’ interventions to treat postural control and mobility problems. Interventions to promote activity or practice outside the treatment session are infrequently used.

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References

Department of Health. National stroke strategy. London, Department of Health, 2007.

Indredavik B. , Bakke F. , Slørdahl S. , Rokseth R. , Håheim L.

Treatment in a combined acute and rehabilitation stroke unit which aspects are most important?

Stroke 1999; 30: 917-23.

Tyson S. , Connell LA , Busse ME , Lennon S. What is Bobath? A survey of UK stroke physiotherapists’ perceptions of the content of the Bobath Concept to treat postural control and mobility problems after stroke. Disabil Rehabil 2009 ; 31: 448-57.

Tyson S. , Selley A. The development of the Stroke Physiotherapy Intervention Recording Tool (SPIRIT) . Disabil Rehabil 2004; 26: 1184-88.

Tyson S. , Selley A. A content analysis of physiotherapy for postural control in people with stroke: an observational study. Disabil Rehabil 2006 ; 28: 865-72.

Brandstater M. , Shutter L. Rehabilitation interventions during acute care of stroke patients. Top Stroke Rehabil 2002; 9: 48-56.

Lennon S. Physiotherapy practice in stroke rehabilitation: a survey. Disabil Rehabil 2003; 25: 455-61.

Stroke Unit Trialists’ Collaboration. Organised inpatient (stroke unit) care for stroke. Cochrane Database Syst Rev 2007; (4): CD000197. 9 Bernhardt J. , Dewey H. , Collier J. et al. A Very Early Rehabilitation Trial (AVERT). Int J Stroke 2006; 1: 169-71.

Bernhardt J. , Dewey H. , Thrift A. , Collier J. , Donnan G. A Very Early Rehabilitation Trial for Stroke (AVERT) Phase II safety and feasibility . Stroke 2008; 39: 390.

10.

Tyson S. , Kent R. Orthotics devices after stroke and other non-progressive brain lesions . Cochrane Database Syst Rev 2009; 1.

11.

Tyson S. , Rogerson L. Assistive walking devices in non-ambulant patients undergoing rehabilitation after stroke: The effects on functional mobility, walking impairments and patients’ opinion. Arch Phys Med Rehabil (in press).

12.

Tyson SF , Thornton HM The effects of a hinged ankle-foot orthosis in hemiplegic gait: objective measures and users’ opinion. Clin Rehabil 2001; 15: 53-58.

13.

Kwakkel G. Impact of intensity of practice after stroke: issues for consideration . Disabil Rehabil 2006; 28: 823-30.

14.

Van Peppen RPS. Towards evidence-based physiotherapy for patients with stroke. Utrecht University and Hogeschool Utrecht , 2008.

15.

Van Peppen RPS , Hendriks HJM , Van Meeteren NLU , Helders PJM , Kwakkel G. The development of a clinical practice stroke guideline for physiotherapists in the Netherlands: A systematic review of available evidence. Disabil Rehabil 2007; 29: 767-83.

16.

De Wit L. , Putman K. , Dejaeger E. et al. Use of time by stroke patients: a comparison of four European rehabilitation centers. Stroke 2005; 36: 1977-83.

17.

De Wit L. , Putman K. , Schuback B. et al. Motor and functional recovery after stroke: a comparison of 4 European rehabilitation centers. Stroke 2007; 38: 2101-107.

18.

Lennon S. , Baxter D. , Ashburn A. Physiotherapy based on the Bobath concept in stroke rehabilitation: a survey within the UK. Disabil Rehabil 2001 ; 23: 254-62.

19.

Raine S. The current theoretical assumptions of the Bobath concept as determined by the members of BBTA. Physiother Theory Pract 2007; 23: 137-52.

20.

International Bobath Instructors Training Association. Theoretical assumptions and clinical practice. IBITA, January 2007.

21.

Lennon S. The Bobath concept: A critical review of the theoretical assumptions that guide physiotherapy practice in stroke rehabilitation. Phys Ther Rev 1996; 1: 35-45.

22.

Lennon S. , Ashburn A. The Bobath concept in stroke rehabilitation: a focus group study of the experienced physiotherapists’ perspective. Disabil Rehabil 2000; 22: 665-74.

23.

Raine S. Defining the Bobath concept using the Delphi technique. Physiother Res Int 2006; 11: 4-13.