Stroke Rehabilitation in Europe

Abstract

Background and Purpose-Physiotherapy (PT) and occupational therapy (OT) are key components of stroke rehabilitation. Little is known about their content. This study aimed to define and compare the content of PT and OT for stroke patients between 4 European rehabilitation centers. Methods-In each center, 15 individual PT and 15 OT sessions of patients fitting predetermined criteria were videotaped.The content was recorded using a list comprising 12 therapeutic categories. A generalized estimating equation model was fitted to the relative frequency of each category resulting in odds ratios. Results-Comparison of PT and OT between centers revealed significant differences for only 2 of the 12 categories: ambulatory exercises and selective movements. Comparison of the 2 therapeutic disciplines on the pooled data of the 4 centers revealed that ambulatory exercises, transfers, exercises, and balance in standing and lying occurred significantly more often in PT sessions. Activities of daily living, domestic activities, leisure activities, and sensory, perceptual training, and cognition occurred significantly more often in OT sessions. Conclusion-This study revealed that the content of each therapeutic discipline was consistent between the 4 centers. PT and OT proved to be distinct professions with clear demarcation of roles. Key Words: occupational therapy Ⅲ physical therapy Ⅲ rehabilitation Ⅲ stroke S troke can result in life-altering changes to an individual's functional abilities. 1 Stroke rehabilitation includes treatment of these impairments and improves outcome. 2 Rehabilitation involves multidisciplinary teams, in which physiotherapy (PT) and occupational therapy (OT) are key components. 3 However, the content of both therapeutic disciplines is not clearly defined and frequently referred to as a "black box." 4 Several factors contribute to the notion of a "black box": (1) detailed characteristics of the applied interventions are not reported, 4 (2) interventions are complex and diverse, 5 (3) different approaches are used in neurological rehabilitation, 6,7 (4) therapists often rely on clinical experience rather than on theoretical frameworks, 8,9 (5) substantial clinical variation exists between patients with an identical diagnostic label, 9 and (6) physiotherapists and occupational therapists function in collaboration with other health care professionals. 9,10 In addition, there is some controversy over the uniqueness of each profession. Ballinger et al 11 reported that PT and OT for stroke patients were not homogeneous activities. However, Booth and Hewison 12 revealed that the majority of the therapists experience a role overlap.In the majority of previous studies, the content of either PT 13,14 or OT 15 was defined, and patients' specific impairments were not clearly reported. 11,13,14,16 However, to enable a valid identification and comparison of both therapeutic disciplines, both PT and OT should be defined for a welldefined patient group because patients with different lesions may require different inte...

Mapping the rehabilitation interventions of a community stroke team to the extended International Classification of Functioning, Disability and Health Core Set for Stroke

“…The interventions provided by each health profession align with traditional discipline roles, although there were a similar number of interventions provided by physiotherapy and occupational therapy for muscle functions (6.1% compared to 5.1%). This result supports a previous research finding that identified that both occupational therapists and physiotherapists provide intervention to improve selective movement, mobilization, exercise and sitting balance [31]. From reading the patient records it was evident that role division was occurring with occupational therapists treating upper limb impairment, and physiotherapists lower limb impairment.…”

Investigating Measures of Intensity During a Structured Upper Limb Exercise Program in Stroke Rehabilitation: An Exploratory Study

“…Lang and colleagues have used repetitions to quantify the intensity of upper limb exercise that occurs during rehabilitation 22 , and during inpatient hospital stays after stroke 23 . However, these observational studies focused on routine therapy sessions where many challenges in categorising the content, and hence intensity of these sessions, have arisen 22,24 . Repetitions have also been used in research of robot-assisted therapy 25 and video games 26 .…”

Movement changes due to hemiplegia in stroke survivors: a hermeneutic phenomenological study

“…It is one of the main roles of rehabilitation therapists to approach physical movement functions, for instance, exercises, balance, transfers, and ambulation. [9] In several studies about experiences of post-stroke people, it is reported that they experienced changes in their psychosocial and spiritual dimensions. For example, post-stroke older people reported a need for psychosocial, social and spiritual as well as physical rehabilitation.…”