Physiotherapy Assessment of People with Neurological Conditions in Australia: A National Survey

Overview

Journal Health Sci Rep

Specialty General Medicine

Date 2024 Jun 4

PMID 38831776

Authors

Jill Garner

Belinda Lange

Sheila Lennon

Maayken Van Den Berg

Affiliations

Soon will be listed here.

Abstract

Background And Purpose: Currently there are approximately one billion people worldwide affected by a neurological condition. These conditions may result in a variety of impairments that require assessment and management from a physiotherapist. However, there is a lack of consensus in the literature as to what domains physiotherapists working in clinical settings include in their assessment of this population, with only five domains identified in a recent systematic review. This study aimed to explore current physiotherapy assessments in people with neurological conditions, including barriers, enablers, and influencing factors.

Methods: A National online survey of Australian physiotherapists who assessed adults with neurological conditions in their clinical practice.

Results: A total of 212 respondents from all states in Australia completed the survey. The mean (SD) age was 35.7 (9.6) years, and the majority were female (85.4%). Respondents worked across various settings assessing stroke most frequently (58.0%). Study results demonstrated variability in assessment practice, with a number of assessment domains being assessed more commonly including balance, muscle strength, gait, falls and safety, function, goal setting, range of movement, pain, co-ordination, activity tolerance, postural alignment and symmetry, and the upper limb. Experienced physiotherapists and those in rural and remote settings included fewer domains in their assessments. On the other hand, physiotherapists in the community setting included certain domains more frequently than those in other settings. Barriers and enablers were related to therapist caseload, knowledge, and intrinsic patient factors.

Discussion: There is variability in domains assessed by Australian physiotherapists, with an emerging consensus for a number of assessment domains. Study results suggest that clinical experience, geographical location, and clinical setting may play a role in the assessment patterns observed.

Implications On Physiotherapy Practice: There is little evidence to support what physiotherapists assess in practice, in different settings, in different states within Australia. This study indicates that experience, geographical location, and clinical setting affect the number and types of domains included in the assessment. Further research is needed to develop a consensus on best practices.

References

Deutsch J, Gill-Body K, Schenkman M . Updated Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions. Phys Ther. 2022; 102(3). DOI: 10.1093/ptj/pzab281. View

Van Duijnhoven H, Heeren A, Peters M, Veerbeek J, Kwakkel G, Geurts A . Effects of Exercise Therapy on Balance Capacity in Chronic Stroke: Systematic Review and Meta-Analysis. Stroke. 2016; 47(10):2603-10. DOI: 10.1161/STROKEAHA.116.013839. View

Checketts M, Mancuso M, Fordell H, Chen P, Hreha K, Eskes G . Current clinical practice in the screening and diagnosis of spatial neglect post-stroke: Findings from a multidisciplinary international survey. Neuropsychol Rehabil. 2020; 31(9):1495-1526. DOI: 10.1080/09602011.2020.1782946. View

Seale J, Utsey C . Physical therapist's clinical reasoning in patients with gait impairments from hemiplegia. Physiother Theory Pract. 2019; 36(12):1379-1389. DOI: 10.1080/09593985.2019.1567889. View

Tyson S, Hanley M, Chillala J, Selley A, Tallis R . The relationship between balance, disability, and recovery after stroke: predictive validity of the Brunel Balance Assessment. Neurorehabil Neural Repair. 2007; 21(4):341-6. DOI: 10.1177/1545968306296966. View

Lahelle PT MSc PhD candidate A, Oberg PT PhD G, Normann PT PhD B . Physiotherapy assessment of individuals with multiple sclerosis prior to a group intervention - A qualitative observational and interview study. Physiother Theory Pract. 2018; 36(3):386-396. DOI: 10.1080/09593985.2018.1488022. View

Winward C, Halligan P, Wade D . Current practice and clinical relevance of somatosensory assessment after stroke. Clin Rehabil. 1999; 13(1):48-55. DOI: 10.1177/026921559901300107. View

Demers M, Blanchette A, Mullick A, Shah A, Woo K, Solomon J . Facilitators and barriers to using neurological outcome measures in developed and developing countries. Physiother Res Int. 2018; 24(1):e1756. DOI: 10.1002/pri.1756. View

Pattison K, Brooks D, Cameron J, Salbach N . Factors Influencing Physical Therapists' Use of Standardized Measures of Walking Capacity Poststroke Across the Care Continuum. Phys Ther. 2015; 95(11):1507-17. PMC: 4625060. DOI: 10.2522/ptj.20140267. View

10.

Tyson S, Watson A, Moss S, Troop H, Dean-Lofthouse G, Jorritsma S . Development of a framework for the evidence-based choice of outcome measures in neurological physiotherapy. Disabil Rehabil. 2007; 30(2):142-9. DOI: 10.1080/09638280701216847. View

11.

Patten S, Marrie R, Carta M . Depression in multiple sclerosis. Int Rev Psychiatry. 2017; 29(5):463-472. DOI: 10.1080/09540261.2017.1322555. View

12.

Tyson S, Desouza L . A clinical model for the assessment of posture and balance in people with stroke. Disabil Rehabil. 2003; 25(3):120-6. DOI: 10.1080/0963828021000013944. View

13.

Takahashi J, Takami A, Wakayama S . Clinical Reasoning of Physical Therapists regarding In-hospital Walking Independence of Patients with Hemiplegia. J Phys Ther Sci. 2014; 26(5):771-5. PMC: 4047249. DOI: 10.1589/jpts.26.771. View

14.

Garner J, Van Den Berg M, Lange B, Vuu S, Lennon S . Physiotherapy assessment in people with neurological conditions-Evidence for the most frequently included domains: A mixed-methods systematic review. J Eval Clin Pract. 2023; 29(8):1402-1424. DOI: 10.1111/jep.13909. View

15.

Kleynen M, Moser A, Haarsma F, Beurskens A, Braun S . Physiotherapists use a great variety of motor learning options in neurological rehabilitation, from which they choose through an iterative process: a retrospective think-aloud study. Disabil Rehabil. 2016; 39(17):1729-1737. DOI: 10.1080/09638288.2016.1207111. View

16.

Ibeneme S, Anyachukwu C, Nwosu A, Ibeneme G, Bakare M, Fortwengel G . Symptoms of Poststroke Depression among Stroke Survivors: An Appraisal of Psychiatry Needs and Care during Physiotherapy Rehabilitation. Scientifica (Cairo). 2016; 2016:5646052. PMC: 4846762. DOI: 10.1155/2016/5646052. View

17.

Ashburn A . A physical assessment for stroke patients. Physiotherapy. 1982; 68(4):109-13. View

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(6):254-62. DOI: 10.1080/096382801750110892. View

19.

Blanchette A, Demers M, Woo K, Shah A, Solomon J, Mullick A . Current Practices of Physical and Occupational Therapists Regarding Spasticity Assessment and Treatment. Physiother Can. 2018; 69(4):303-312. PMC: 5754181. DOI: 10.3138/ptc.2016-54. View

20.

Normann B, Sorgaard K, Salvesen R, Moe S . Clinical guidance of community physiotherapists regarding people with MS: professional development and continuity of care. Physiother Res Int. 2013; 19(1):25-33. DOI: 10.1002/pri.1557. View