Incorporating Research Technology into the Clinical Assessment of Balance and Mobility: Perspectives of Physiotherapists and People with Stroke

Abstract

Purpose: To describe the perspectives of people with stroke and their physiotherapists on the use of biomechanics technology to assess balance and mobility. Methods: This qualitative study used semi-structured interviews with patients with stroke and a focus group with their physiotherapists. Coding of interview and focus-group data used a line-by-line inductive approach, with qualitative software to develop codes into themes. Results: The quantitative data from the assessment were seen as beneficial to providing patients with insight into balance and mobility problems. Physiotherapists found that the assessment confirmed clinical reasoning and aided in precise evaluation of progress but expressed mixed opinions as to whether treatment choice was influenced. Patients would have liked more communication regarding the purpose of the assessment. Patients also stated that trust in their physiotherapists helped them overcome anxieties and that confidence was gained through exposure to more challenging balance assessments. Physiotherapists advocated for the use of a harness system to safely incorporate reactive balance control assessment and training into practice. Conclusion: Both patients and therapists saw value in the quantitative data provided by the assessment. Regardless of the technology used, patients value a strong physiotherapistpatient relationship. Ongoing collaboration between clinicians and researchers should guide the evolution of technology into clinically useful tools.Key Words: patient outcome assessment, technology; postural balance; stroke. RÉ SUMÉObjectif : Dé crire les vues des gens ayant subi une attaque et de leurs physiothé rapeutes au sujet du recours à la biomé canique pour l'é valuation de l'é quilibre et de la mobilité . Mé thodes : Dans cette é tude qualitative, on a mené des interviews semi-structuré es auprè s de patients ayant subi un accident vasculaire cé ré bral et organisé un groupe de discussion avec leurs physiothé rapeutes. Pour coder les donné es de ces interviews et de ce groupe, on a procé dé par induction ligne à ligne en se servant d'un logiciel qualitatif pour convertir les codes en thè mes. Ré sultats : On a jugé que les donné es quantitatives de cette é valuation pouvaient é clairer les patients sur les problè mes d'é quilibre et de mobilité . Les physiothé rapeutes ont constaté que l'é valuation confirmait le raisonnement clinique et contribuait à une appré ciation pré cise des progrè s, mais leurs opinions é taient partagé es en matiè re d'incidence sur le choix de traitement. Les patients auraient voulu plus de communication sur le but de l'é valuation. Ils ont aussi dit que la confiance dans leurs physiothé rapeutes les aidait à vaincre leurs anxié té s et que cette confiance s'acqué rait par une exposition à des é valuations d'é quilibre plus exigeantes. Les physiothé rapeutes pré conisaient l'emploi d'un systè me de harnais pour une inté gration en toute sé curité à leur pratique de l'é valuation et de la formation en maîtrise ré active de l'é quilibre. Co...

Clinical implementation of a reactive balance control assessment in a sub-acute stroke patient population using a ‘lean-and-release’ methodology

“…unstable medical status, recent surgery, low exercise tolerance, musculoskeletal disorder or pain), may have influenced the choice to use the assessment or not, or timing of its implementation. Patient preferences or anxiety may have contributed to therapists' clinical decision-making [19]. Alternatively, it is possible that the present results underestimate the potential clinical use: that many NoREACT patients were clinically appropriate for assessment, but other factors specific to the therapist or practice environment posed as barriers.…”

“…Alternatively, it is possible that the present results underestimate the potential clinical use: that many NoREACT patients were clinically appropriate for assessment, but other factors specific to the therapist or practice environment posed as barriers. Therapist time constraints have previously been cited as barriers to completing balance and gait assessments [8,19]. It may be noteworthy that, at time of discharge, the mean clinical scores of functional balance, disability and mobility for NoREACT patients were equal to, or surpassed, the REACT patients' admission scores.…”

“…Patient responses including need for assistance, decreased foot clearance and attempts to step with the blocked limb have been linked to falls post-stroke [5,6]. Further, physiotherapists have advocated for the use of a harness system to safely incorporate reactive balance control assessment and training into practice [19], suggesting support for its clinical use. It is also noteworthy that inexpensive technological measures (e.g.…”

“…The collaboration between both clinicians and researchers, in developing and adapting the lean-and-release assessment for clinical care [19], most likely influenced its clinical uptake. Strong clinical:research partnerships can promote research utilization and foster best practices [32].…”

“…An assessment, that integrates technological (e.g. forceplates, pressure-sensitive mats) and clinical measures to assess balance and gait, was collaboratively developed [19]. The lean-and-release assessment is one component of the larger assessment.…”