Article

OBJECTIVE: To describe the dose, intensity and context of physiotherapy for
balance and mobility problems after stroke. DESIGN:
Process mapping to describe
the context and non-participant observation of therapy sessions to describe the
dose and content of therapy. SETTING: Four inpatient stroke units in North-West
England. PARTICIPANTS: Therapy staff and previously mobile stroke survivors who
were treating, or receiving treatment for balance and mobility problems in the
participating units. RESULTS: Two units were stand-alone rehabilitation units;
two offered a service at the weekends. One had no access to community-based
rehabilitation. All had dedicated treatment facilities but often did not use them
because of lack of space and difficulty transporting patients. Twenty-two
patients participated and 100 treatment sessions were observed. Practicing
walking, sit-to-stand and transfers were the most frequent objectives and
interventions usually with the therapist(s) physically facilitating the patient's
movements. The dose of practise was low; mean repetitions of sit-to-stand per
session was 5 (SD 6.4); mean time spent upright per session was 11.24 (SD = 7)
minutes, and mean number of steps per session was 202 (SD 118). The mean number
of staff per patient was 2.1 (SD = 0.6, mode = 2), usually involving two
qualified therapists. Falls prevention or management, wheelchair skills and bed
mobility were not practised. CONCLUSION: Stroke physiotherapy for balance and
mobility problems features low-dose, low-intensity therapist-led practice, mainly
of walking and sit-to-stand. Staff:patient ratios were high. Therapists need to
organize treatment sessions to maximize the intensity of functional task
practice.

Langue : ANGLAIS