Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice

Abstract

Background and objective: Serious pathologies of the neck can potentially result in cranial nerve palsy. Knowledge about cranial nerve examination (CNE) seems sparse, and its use is still unknown. We aim to investigate the knowledge, skills, and utilization of CNE of Italian physiotherapists. Materials and Methods: An online cross-sectional survey. Results: 396 completed the survey, reaching the required sample size. Although Italian physiotherapists consider CNE relevant (mean ± SD = 7.6/10 ± 2.0), over half of all responders (n = 229 (57.8%)) were not trained in the fundamentals and around a third did not use it in their daily practice (n = 138 (34.8%)). Additionally, participants were unconfident and insecure in conducting (n = 152 (38.4%) and n = 147 (37.1%)), interpreting (n = 140 (35.4%) and n = 164 (41.4%)), and managing the CNE (n = 141 (35.6%) and n = 154 (38.9%)). Possessing a musculoskeletal specialization was associated with an increased value attributed to clinical practice guidelines and reduced the lack of confidence in conducting, interpreting, and managing the CNE (respectively, n = 35 (25.5%), p = 0.0001; n = 32 (23.4%) p = 0.0002; n = 32 (23.4%) p = 0.0002). Working in a direct access setting significantly increased the considered relevance of guidelines and the concerns about arterial (p = 0.004) and other serious pathologies (p = 0.021). Pain and visual disturbances were considered the main indicators to CNE, demonstrating limited knowledge of signs and symptoms’ indicating CNE. Participants considered specific training in CNE as relevant (mean ± SD = 7.6/10 = 2.1). Conclusions: a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of cranial nerve examination. Given the number of physiotherapists who work in first contact roles, this is a professional concern.

Assessing cardiovascular parameters and risk factors in physical therapy practice: findings from a cross-sectional national survey and implication for clinical practice

“…Of the 764 different IP addresses that provided consent and accessed the survey, 387 completed the questionnaire (5.2%, n=387/7398). Although available for a very short period, our sample was in line with previous Italian surveys, and reached the required sample size [42][43][44].…”

Knowledge, beliefs, and attitudes of spinal manipulation: a cross-sectional survey of Italian physiotherapists

“…Five hundred seventy-five (575) Italian physiotherapists completed the survey, accounting for 7.8% of the 7398 target population. Although available for a short period, our sample was in line with previous Italian surveys, and reached the required response rate [48][49][50]. Four hundred respondents were male (69.6%; 95%CI…”

“…The achievement of the required sample size confirms the willingness of physiotherapists to participate on this topic. Furthermore, although we did not send personal invitations, the publication of several reminders helped to reach a number of Italian physiotherapists in line with previous surveys [48][49][50]. Where the purpose of a study is to gain a general sense of a belief or attitude, a lower level of precision may be acceptable, and hence a smaller sample size may be drawn [47].…”

“…This study is built on existing surveys and adds scope to explore the differences with prior studies on this topic [27,28]. One key strength is the rigorous survey's developmental process in line with previous published surveys [27,28,[48][49][50]. However, the content and face validity of the questionnaire could have been improved by statistical testing.…”

Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis

“…Accordingly, there is a need to inform the health providers, in order to implement the current guidelines routinely, with the final goal to promote early access to active treatment approaches for WAD patients (e.g., exercises), as well as to objectivize the associated impairments [81] and address the negative prognostic factors (e.g., fear avoidance, maladaptive beliefs) [82,84]. However, for certain well-selected patients with WAD [85][86][87][88], and, accordingly, for patient clinical presentations and preferences, an intermittent use of the collar for a short period and during the acute stage could be potentially indicated when appropriately combined with education and active approaches [24,53,70]. To encourage Italian public administrators and national council representatives, we created and implemented, in the article, an infographic based on the latest guidelines for public use (Supplement 1 in Supplementary Materials), where we suggest a road map based on our previous experience in an Italian ED, where musculoskeletal specialized physical therapists were commissioned to train the staff and organize a management change in patients with WAD [84].…”