Current Practices of Physical and Occupational Therapists Regarding Spasticity Assessment and Treatment

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.

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

RATIONALE

There is a lack of consensus in the literature related to what is assessed clinically by physical therapists in people with neurological disorders.

AIMS

This mixed-methods systematic review aimed to identify domains that physiotherapists routinely assess in people with neurological conditions in clinical settings and explored factors influencing assessment domains including country, clinical setting, therapist experience and neurological condition.

METHOD

Five databases were searched from 1946 to 31st January 2023. Studies with any design reporting on domains assessed by a physiotherapist, in people with neurological conditions in any clinical setting, were included. Independent reviewers assessed eligibility and risk of bias using relevant McMaster critical appraisal tools. Data were extracted and synthesised following the Joanna Briggs Institute approach for mixed systematic reviews.

RESULTS

A total of 23 (16 quantitative, 7 qualitative) studies involving 3134 participants were included. The studies were rated as high (n = 14) or medium (n = 9) quality. The domains of function (n = 14); postural alignment and symmetry (n = 11); gait (n = 11); balance (n = 9), and muscle strength (n = 8) were most frequently included in assessments. Five key themes were identified from the qualitative studies: the clinical reasoning process, clinical use of standardised measures, utilisation of the senses, clinician experience and information gathering. There was minimal data on how country, clinical setting, therapist experience and neurological condition influence inclusion of assessed domains.

CONCLUSION

Five domains were most frequently included in assessment: function; postural alignment and symmetry; gait; muscle strength; and balance. This limited number of domains is in stark contrast to the full neurological physiotherapy assessment recommended by expert textbooks. Further research is needed to understand the reasons why this might be so.

Reliability of the Modified Ashworth Scale After Stroke for 13 Muscle Groups

OBJECTIVE

To evaluate the reliability of the protocol for administration of the Modified Ashworth Scale (MAS) for all commonly affected muscle groups after stroke.

DESIGN

A repeated-measures design was used in administration of MAS for 13 muscle groups on 2 assessment days. Intrarater reliability and interrater reliability (between 3 raters) was assessed.

SETTING

Inpatient rehabilitation.

PARTICIPANTS

30 patients, 1-19 months after stroke (age 55.1±13.5 years; N=30).

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURE

Intra- and interrater reliability of the muscle tone assessment protocol with MAS for 7 upper and 6 lower limb muscle groups compiled from previous studies; 1 modified and 4 originally described. The weighted kappa was calculated.

RESULTS

The most and the least frequently assigned MAS grades were 0 and 4, respectively. Agreement was the highest for grade 0 (49% within raters, 32% between raters). Intrarater reliability was good to excellent for upper limb (κ=0.71-0.94) and moderate to excellent for lower limb (κ=0.55-0.97) muscles. Interrater reliability was poor to good for upper limb (κ=0.25-0.66) and moderate for lower limb (κ=0.41-0.54) muscles.

CONCLUSIONS

The intrarater reliability of MAS was moderate for the hip flexors. The reliability results for the other 4 muscles studied anew after stroke were similar to the predetermined ones. The better intrarater reliability results confirmed previous findings. Because of the low interrater reliability, caution is needed in interpreting the results when reassessment is not possible by the same examiner. A well-described protocol for administering the MAS may lead to its standardization.