Updated Integrated Framework for Making Clinical Decisions Across the Lifespan and Health Conditions

Physiotherapy assessment of people with neurological conditions in Australia: A national survey

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.

Effects of a Physical Therapist Intervention on GPS Indicators of Community Mobility in Older Adults: A Secondary Analysis of a Randomized Controlled Trial

OBJECTIVE

The authors compared the effects of a standard strength and endurance intervention with a standard plus timing and coordination training intervention on community mobility measured using global positioning systems (GPS) among community-dwelling older adults in this secondary analysis of a randomized controlled trial.

METHODS

Participants were randomized to a standard or a standard plus timing and coordination training program. Community mobility was measured using the Life Space Assessment (LSA) and GPS indicators of community mobility at baseline, as well as at 12 (immediately after the intervention), 24, and 36 weeks. Linear mixed models were used for analysis.

RESULTS

There were 166 participants with GPS data at baseline, including 81 in the standard plus group and 85 in the standard group. The groups did not differ in participant characteristics or GPS measures at baseline. There were no significant within-group changes in GPS indicators of community mobility or LSA score over time, nor between-group differences of the same.

CONCLUSION

There were no significant changes in community mobility with either intervention or between-intervention differences. These findings suggest that interventions targeting physical function alone may not be sufficient to improve community mobility or participation in older adults. Future research should focus on the development of multifaceted interventions targeted to improve real-world participation.

IMPACT

The studied interventions did not significantly change community mobility measured using GPS-derived community mobility measures or self-report measures in older adults, suggesting that more comprehensive interventions may be needed to target improvements in community mobility.

Patient's assessment and prediction of recovery after stroke: a roadmap for clinicians

BACKGROUND AND PURPOSE

In neurorehabilitation clinical practice, assessment is usually more oriented to evaluate patient's present status, than to plan interventions according to predicted outcomes. Therefore, we conducted an extensive review of current prognostic models available in the literature for recovery prediction of many functions and constructs, after stroke. We reported results in the form of a practical guide for clinicians, with the aim of promoting the culture of early clinical assessment for patient stratification, according to expected outcome. To define a roadmap for clinicians, a stepwise sequence of five actions has been developed, from collecting information of past medical history to the adoption of validated prediction tools. Furthermore, a clinically-oriented organization of available prediction tools for recovery after stroke have been proposed for motor, language, physiological and independency functions. Finally, biomarkers and online resources with prognostic value have been reviewed, to give the most updated state of the art on prediction tools after stroke.

RECOMMENDATIONS FOR CLINICAL PRACTICE

Clinical assessment should be directed both towards the objective evaluation of the present health status, and to the prediction of expected recovery. The use of specific outcome measures with predictive value is recommended to help clinicians with the definition of sound therapeutic goals.

Clinical Assessment of Chronic Musculoskeletal Pain-A Framework Proposal Based on a Narrative Review of the Literature

The assessment of chronic musculoskeletal pain (CMP) is a challenge shared by several health professionals. Fragmented or incomplete assessment can cause deleterious consequences for the patient's function. The objective of this paper was to propose a framework for clinical assessment of CMP based on the current literature and following the conceptual model of the International Classification of Functioning and Health (ICF). We propose that the ICF rationale may help to guide the processes, acting as a moderator of the clinical assessment, since it changes the perspective used to obtain and interpret findings during anamnesis and physical examination. Additionally, updated specific knowledge about pain, including that of pain domains and mechanisms, along with effective patient-clinician communication may act as a mediator of CMP assessment. We conduct the readers through the steps of the clinical assessment of CMP using both the proposed moderator and mediators and present a clinical example of application. We suggest that the proposed framework may help clinicians to implement a CMP assessment based on the biopsychosocial model using a critical and updated rationale, potentially improving assessment outcomes, i.e., clinical diagnosis.