Clinical Reasoning of Physical Therapists regarding In-hospital Walking Independence of Patients with Hemiplegia

Abstract

[Purpose] Physical therapists must often determine whether hemiparetic patients can walk independently. However, there are no criteria, so decisions are often left to individual physical therapists. The purpose of this study was to explore how physical therapists determine whether a patient with hemiplegia can walk independently in a ward. [Methods] The subjects were 15 physical therapists with experience of stroke patients’ rehabilitation. We interviewed them using semi-structured interviews related to the criteria of the states of walking in the ward of hemiparetic patients. The interviews were transcribed in full, and the texts were analyzed by coding and grouping. [Results] From the results of the interviews, PTs determined patients’ independence of walking in hospital by observation of behavior during walking or treatment. The majority of PTs focused on the patients’ state during walking, higher brain function, and their ability to balance. In addition, they often asked ward staff about patients’ daily life, and self-determination. [Conclusions] We identified the items examined by physical therapists when determining the in-hospital walking independence of stroke patients. Further investigation is required to examine which of these items are truly necessary.

Physiotherapy assessment in people with neurological conditions—Evidence for the most frequently included domains: A mixed‐methods systematic review

“…Seven qualitative studies were included in this review, and their characteristics are summarised in detail in Table 3. Studies were conducted in Canada, 44,46 Norway, 47 Australia, 48 Japan, 49 the United States 50 and Saudi Arabia. 51 All six studies used interviews to collect data.…”

“…48 Most studies investigated clinical reasoning as part of a physiotherapy assessment of people with neurological conditions (n = 6). 44,49 The number of physiotherapists included in the studies ranged from 10 47 to 33. 48 Age and sex were described in only three studies, with participants being predominantly female 46 and age ranging from 20 to 50 years and over, 49 ranging from 20 to 50 years and over.…”

Can the Amount of Interventions during the Convalescent Phase Predict the Achievement of Independence in Activities of Daily Living in Patients with Stroke? A Retrospective Cohort Study

“…35,36 In addition, regarding differences in disorders, many higher brain dysfunctions are known to interfere with ADL capability and walking. 37 Furthermore, a left-brain injury disorder has been known to produce lower ADL performance than a right brain injury. 38 Therefore, these studies indicate that ADL independence tends to be lower in patients with higher brain dysfunction and left cerebral hemorrhage.…”

Examination of Simple Outcome Measures and Cut-off Values Related to Walking Independence of Inpatients with Medical Diseases in Acute Care Hospitals

“…Previous studies have found that outcome measures such as lower-limb muscular strength, [1][2][3] balance, [4][5][6][7][8] walking speed, [9][10][11][12][13][14] and cognitive function 15,16) are related to walking independence in elderly persons and in patients with stroke disease. However, outcome measures related to walking independence in patients with medical diseases have not been reported.…”