Stroke: The Evidence for Physiotherapy
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Introduction[edit | edit source]
Physiotherapy is one of the key disciplines involved in Stroke Rehabiliitation as part of an interdiscpilinary team. According to Stokes and Stack (2012) the role of the physiotherapist is to enable individuals with stroke to achieve their optimal physical potential and functional independance [1]. This is achieved through the use of techniques to facilitate the relearning of movements, use of strategies to enhance adaptation, prevention of secondary complications and maintenance of ability and function. Various approaches to physical rehabilitation have been developed and used over the years, according to different ideas about how people recover after a stroke. New strategies to enhance recovery draw from a growing understanding of how types of training, progressive task-related practice of skills, exercise for strengthening and fitness, neurostimulation, and drug and biological manipulations can induce adaptations at multiple levels of the nervous system [2]. Often physiotherapists may follow one specific treatment approach, but Pollock et al (2014) suggest this practice is generally based on personal preference rather than scientific rationale. Considerable debate continues among physiotherapists about the relative benefits of different approaches; therefore it is important to bring together the research evidence and highlight what best practice ought to be in selecting these different approaches [3].
There are many examples of specific training strategies such as strength training or task-specific practice, which are effective at improving movement and function. There are also many clinical guidelines that provide a comprehensive review of all the available evidence to date for multidisciplinary management of individuals post-stroke [1].
Current evidence suggests that Physical Rehabilitation, comprising a selection of components from different approaches, is effective for recovery of function and mobility after stroke but no one approach has yet been determined to be any more (or less) effective in promoting recovery of function and mobility after stroke. Similarly conclusions in relation to dose of physical therapy is not yet robust as a result of substantial heterogeneity in reesarch. Therefore, current evidence indicates that physical rehabilitation should not be limited to compartmentalised, named approaches, but rather should comprise clearly defined, well-described, evidenced-based physical treatments, regardless of historical or philosophical origin [3]. In order to implement evidence-based practice, physiotherapists must incorporate a wide range of strategies that are supported by the current evidence base into their treatment programmes [4][3].
However, physiotherapists must also continue to rely on their clinical reasoning skills to select appropriate treatment techniques approprites to the needs and goals of their patients and carers as there are still many areas of clinical practice with no evidence or conflicting evidence. This is why accroding to Bernhardt & Legg, 2009, evidence-based practice is defined as the integration of best evidence with clinical expertise and patient values [5]. Evidence-based practice involves three components: evidence available, clinical judgement and service user values.
Guiding Principles
[edit | edit source]
Lennon and Bassile (2009) put forward eight guiding principles for neurological physiotherapy in order to provide a strong framework of evidence-based practice for development of your treatment plan [6].
Principle 1: The ICF[edit | edit source]
The ICF is a framework for describing functioning and disability in relation to a health condition. It provides a common language and framework for documenting information on the functional changes associated with physiotherapy interventions. The World Confederation of Physical Therapy (WCPT) adopted a motion supporting the implementation of the ICF in Physiotherapy in 2003 [7]. TheICF Core Sets were developed as a practical tool to facilitate the systematic and comprehensive description of functioning in clinical practice [8][9].
The ICF is a framework on which to approach patient care that shifts the conceptual emphasis away from negative connotations such as disability and places focus on the positive abilities of the individual at the patient level rather than the systems level. The ICF framework is a classification of the health components of functioning and disability and focuses on 3 Perspectives: Body, Individual, and Societal. These 3 perspectives underscore the importance of the interplay and influence of both internal and external factors to each individual’s condition of health[9].
The activities dimension covers the range of activities performed by an individual, while the participation dimension classifies the areas of life in which there are societal opportunities or barriers for each individual with the overall framework providing a mechanism to document the impact of the environment on a person’s functioning. Neurological physiotherapy may directly target both impairment and activity aiming to improvequality of life and increased participation in desired life roles [9][1].
- Sykes, C., An Introduction to the ICF , 2006, WCPT
- Sykes, C.,Using ICF in Clinical Practice , 2007, WCPT
- Brogardh, C. & Lexell, J., The use of ICF in the Neurorehabilitation Process , NeuroRehabilitation 36 (2015) 5–9
Principle 2: Team Work[edit | edit source]
A variety of health care professionals are involved in the provision of care and exchange of information with the patient and family members and therefore teamwork is key to coordinate the rehabilitation process and the roles of those involved. It is important to understand the holistic approach to rehabilitation following a neurological impairment and the role of the physiotherapist within the multidisciplinary/interdisciplinary environment [1][6]. It would appear that team working is an essential factor in improving patient outcomes post Stroke as was highlighted in the Stroke Unit Trialists Collaboration [10] which identified that patients who received organized stroke unit care provided in hospital by clinical specialists working in a coordinated team were more likely to survive their stroke, return home and become independent in looking after themselves.
- Tempest et al., Enhanced Clarity and Holism: The Outcome of Implementing the ICF with an Acute Stroke Multidisciplinary Team in England, 2013, Disability and Rehabilitation, 35:22, 1921-1925
Principle 3: Patient-Centred Care[edit | edit source]
Principle 4: Neural Plasticity[edit | edit source]
Principle 5: A Systems Model of Motor Control[edit | edit source]
Principle 6: Functional Movement Re-education[edit | edit source]
Principle 7: Skill Acquisition[edit | edit source]
Principle 8: Self Management (Self-Efficacy)[edit | edit source]
Sub Heading 3[edit | edit source]
Recent Related Research (from Pubmed)[edit | edit source]
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References[edit | edit source]
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- ↑ 1.0 1.1 1.2 1.3 Stokes M and Stack E. Physical Management for Neurological Rehabilitation - Third Edition. Elsevier Health Sciences; 2012.
- ↑ Dobkin BH, Dorsch A. New evidence for therapies in stroke rehabilitation. Current atherosclerosis reports. 2013 Jun 1;15(6):331.
- ↑ 3.0 3.1 3.2 Pollock A, Baer G, Campbell P, Choo PL, Forster A, Morris J, Pomeroy VM, Langhorne P. Physical rehabilitation approaches for the recovery of function and mobility following stroke. The Cochrane Library. 2014 Jan 1.
- ↑ Pollock A, Baer G, Pomeroy VM, Langhorne P. Physiotherapy treatment approaches for the recovery of postural control and lower limb function following stroke. The Cochrane Library. 2007 Jan 1.
- ↑ Bernhardt, J., Legg, L., 2009. Chapter 1.Evidence-based practice. In: Lennon, S., Stokes, M. (Eds.), Pocketbook of Neurological Physiotherapy. Elsevier Science, London,fckLRpp. 3–15.
- ↑ 6.0 6.1 Lennon, S., Bassile, C., 2009. Guiding Principles for neurological physio- therapy. In: Lennon, S., Stokes, M. (Eds.), Pocketbook of Neurological Physiotherapy. Elsevier Ltd, London, pp. 97–111.
- ↑ Escorpizo R, Stucki G, Cieza A, Davis K, Stumbo T, Riddle DL. Creating an interface between the International Classification of Functioning, Disability and Health and physical therapist practice. Phys Ther. 2010;90:1053-63.
- ↑ Kesselring J, Coenen M, Cieza A, Thompson A, Kostanjsek N, Stucki G. Developing the ICF Core Sets for multiple sclerosis to specify functioning. Mult Scler. 2008;14:252-4.
- ↑ 9.0 9.1 9.2 Rauch A, Cieza A, Stucki G. How to apply the International Classification of Functioning, Disability and Health (ICF) for rehabilitation management in clinical practice. Eur J Phys Rehabil. 2008;44(3):329-42.
- ↑ Stroke Unit Trialists Collaboration (SUTC), 2006. Organised inpatient (stroke unit) care for stroke(review). The Cochrane Library (3).
