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Published on: January 10, 2013
Physical Therapists' Use of Functional Electrical Stimulation for Clients With Stroke: Frequency, Barriers, and
Nolan Auchstaetter1, Juliana Luc2, Stacey Lukye3
1N. Auchstaetter, MScPT, School of Physical Therapy, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan, Canada.
Background:
Best practice guidelines for stroke rehabilitation recommend functional electrical stimulation (FES) to improve gait and upper extremity function. Whether these guidelines have been implemented in practice is unknown.
Objective:
The purposes of this study were: (1) to determine the frequency with which physical therapists use FES to address common therapeutic goals poststroke and (2) to identify the barriers to and facilitators of FES use.
Design:
This was a cross-sectional, survey study.
Methods:
A valid and reliable online survey was sent to Canadian physical therapists. Questions about demographic characteristics, FES use, knowledge of FES literature, and barriers and facilitators were posed. Closed-ended questions were analyzed with descriptive statistics and index scoring to produce summary scores. Pearson or point-biserial correlation coefficients correlated FES use with demographic variables. Open-ended questions about barriers and facilitators were analyzed by 3 researchers using a conventional content analysis.
Results:
Two hundred ninety-eight physical therapists responded. Use of FES for clients with stroke was low for all therapeutic goals queried (improve walking, arm function, muscle strength and endurance, and sensation; prevent shoulder subluxation; and decrease spasticity). However, 52.6% of the respondents stated that they would like to increase their use of FES. More than 40% of the respondents were unsure of the strength of the evidence supporting FES for stroke care. Physical therapists with postgraduate FES training were more likely to use FES (r=.471, P<.001). A lack of access to resources, such as time, equipment, and training, was the most frequently cited barrier to FES use.
Limitations:
As an observational study, cause-and-effect relationships for FES use cannot be identified.
Conclusions:
Functional electrical stimulation is not widely used by physical therapists in stroke rehabilitation. Improving access to resources-in particular, continuing education-may facilitate the implementation of FES into clinical practice.
