Current practice of physical therapists in outpatient stroke rehabilitation: a cross-sectional survey in Baden-Württemberg and Thuringia / Arbeitsweise von Physiotherapeut*innen in der ambulanten Schlaganfallrehabilitation: eine Querschnittsumfrage in Baden-Württemberg und Thüringen

Abstract

Objective Guidelines recommend task-oriented training and the use of standardized assessments to improve stroke-related mobility deficits. However, the German outpatient physical therapy prescription catalogue does not include these recommendations resulting in a possible gap between guideline recommendations and clinical practice. Therefore, the purpose of this study was to describe physical therapy practice patterns of stroke-related mobility deficits in the outpatient setting exemplified by the states Baden-Württemberg and Thuringia. Methods Using an online survey, physical therapists treating people with stroke in outpatient settings in Baden-Württemberg and Thuringia were recruited. The questionnaire was developed using a multi-step procedure. Using a case vignette and open-ended questions, preferred evaluation and treatment methods were assessed. Data were analyzed using content analysis and descriptive statistics. Results Data from 63 physical therapists were included in the analysis. Answers to the open questions showed a wide range of different citations. Of 186 citations on evaluation methods, 28 (15,1 %) were classified as “standardized assessments”, while 158 citations (84,9 %) were classified as “basic physical therapy evaluation (non-standardized)”. Standardized assessments were cited by 25% of participants. Of 182 citations on treatment methods, 69 (35,2%) were classified as “traditional therapies”. These traditional therapies were cited by 81 % of participants. Task-oriented training was not cited. Discussion Despite the small sample size our data confirm the insufficient guideline use in German physical therapy and contribute results on practice patterns in outpatient stroke settings. These results will be used to initiate theory-based implementation strategies aiming to optimize physical therapy for people with stroke.

Standardized tools for assessing balance and mobility in stroke clinical practice guidelines worldwide: A scoping review

“…Previous systematic reviews have identified multiple measures of sitting balance used for people after stroke (90), with over 60 different measures of standing balance in the adult population (69), and over 30 measures of mobility for older adults (91). We found that the assessment tools included in at least 70% of CPGs (i.e., BBS, 6MWT, TUG, and 10mWT) are consistent with the tools most frequently used in clinical practice as indicated by clinician surveys conducted in Canada (92)(93)(94), Colombia (95), Ghana (27), and Germany (32). Moreover, our analyses considering CPGs by country income level showed that the BBS, 6MWT, TUG, and 10mWT, are currently recommended by CPGs from middle-and high-income countries.…”

“…The use of standardized assessment tools in physical therapy practice is inconsistent (27)(28)(29)(30)(31)(32). Common barriers to the use of standardized assessment tools are lack of time, insufficient knowledge, lack of description of how to administer standardized assessment tools, and low perceived value of some instruments (24, 28,29,[31][32][33][34][35][36]. Additionally, the context in which PTs practice, such as the income level of a country, influences practice experiences (33).…”

“…The use of standardized assessment tools in physical therapy practice is inconsistent ( 27 – 32 ). Common barriers to the use of standardized assessment tools are lack of time, insufficient knowledge, lack of description of how to administer standardized assessment tools, and low perceived value of some instruments ( 24 , 28 , 29 , 31 – 36 ).…”

Barrieren und Förderfaktoren für die Implementierung eines Konzepts zur Förderung evidenzbasierten Arbeitens in der Physiotherapie – Eine Mixed-Methods-Studie

“…In Bezug auf die Gesundheitsfachberufe zählt Deutschland zu den Ländern mit einer relativ kurzen akademischen und wissenschaftlichen Tradition [22]. Dementsprechend zeigen aktuelle Ergebnisse aus Deutschland eine mäßige Umsetzung von EBP und leitlinienorientierter Therapie [23,24].…”