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Comparison of the content of two physiotherapy approaches for stroke
P M van Vliet1, N B Lincoln, E Robinson
1Division of Stroke Medicine, University of Nottingham, UK. p.van-vliet@nottingham.ac.uk
Objective:
To identify similarities and differences between a Bobath-based (BB) and a movement science-based (MSB) approach.
Design:
Direct observation by a trained observer was used to record behaviours during treatments.
Setting:
An acute stroke ward.
Subjects:
Twenty-two stroke patients.
Interventions:
Behaviours were recorded during 12 treatment sessions by three therapists, for each treatment approach. Physical and communication behaviours were recorded in pre-defined categories. The equipment used was recorded and a semi-structured interview conducted with the therapist after treatment to identify follow-up actions by the therapist.
Main Outcome Measures:
Frequency of occurrence of each category was compared between the approaches.
Results:
Treatment in the BB group contained more social conversation (p = 0.004), and more use of physiotherapy equipment (p = 0.02) and a physiotherapy assistant (p = 0.01). In the MSB group there was more detailed feedback given to the patient (p = 0.002) more use of everyday objects in training (p = 0.001), therapists more frequently listed specific components as the patient's main problems (p = 0.003) and relatives were involved more in positioning to stretch muscles (p = 0.03). Training walking was given more emphasis in the BB group and training of sit-to-stand in the MSB group.
Conclusions:
The study indicates that there are differences in content between the Bobath-based and movement science-based approaches to treatment.