B. Scheffler1, F. Schimböck2, A. Schöler3, K. Rösner4, J. Spallek5, C. Kopkow6
1Brandenburg University of Technology Cottbus - Senftenberg, Department of Therapy Science I, Senftenberg, Germany, 2Brandenburg University of Technology, Nursing Science and Clinical Nursing, Senftenberg, Germany, 3Physiotherapie Schöler, Bötersen, Germany, 4Schön Klinik Hamburg Eilbek, Hamburg, Germany, 5Brandenburg University of Technology, Department of Public Health, Senftenberg, Germany, 6Brandenburg University of Technology, Department of Therapy Science I, Senftenberg, Germany
Background: The interdisciplinary “Rehabilitation of Mobility after Stroke (ReMoS)” guideline recommends evidence-based intervention for the improvement of walking ability, walking speed, walking distance and balance of people after stroke. To date it is unknown at which level physiotherapy is performed according to physiotherapy related ReMoS recommendations in Germany.
Purpose: The aims of this survey are to describe:
1) ReMoS guideline adherence of physiotherapists (PTs) and
2) barriers and facilitators of guideline use.
1) ReMoS guideline adherence of physiotherapists (PTs) and
2) barriers and facilitators of guideline use.
Methods: This anonym, open, cross-sectional online-survey was approved by the ethics committee of the Brandenburg University of Technology Cottbus-Senftenberg, Germany. It was conducted between 29th October and 10th December 2019 using the browser-based software “LimeSurvey”. The survey consisted of three sections:
1) self-reported use of ReMoS recommendations, rated as “never”, “sometimes”, “often” and “always”,
2) barriers and facilitators of guideline use on the basis of “The Barriers and Facilitators Assessment Instrument” (Peters et al., 2002) and
3) socio-demographic characteristics.
All PTs, working in German stroke rehabilitation, were invited to participate. A snowball sampling approach was used. The access link and two reminder were spread via E-Mail, QR-Code and social media. All questionnaires which were answered at least partially (confirmation of the eligibility criteria and one further item) were eligible for data analysis. Guideline compliance was defined as at least 80% of the respondents following the recommendation "often" or "always". Data were analysed using R and R Studio version 1.0.143.
1) self-reported use of ReMoS recommendations, rated as “never”, “sometimes”, “often” and “always”,
2) barriers and facilitators of guideline use on the basis of “The Barriers and Facilitators Assessment Instrument” (Peters et al., 2002) and
3) socio-demographic characteristics.
All PTs, working in German stroke rehabilitation, were invited to participate. A snowball sampling approach was used. The access link and two reminder were spread via E-Mail, QR-Code and social media. All questionnaires which were answered at least partially (confirmation of the eligibility criteria and one further item) were eligible for data analysis. Guideline compliance was defined as at least 80% of the respondents following the recommendation "often" or "always". Data were analysed using R and R Studio version 1.0.143.
Results: Answers from 170 PTs working in German stroke rehabilitation were included for data analysis. The respondents' mean age was 41.6 years (range 22 to 65), 69.4% (n = 68/98) of them were female and 61.3% (n = 57/93) had no academic degree. 51.5% (n = 50/97) of the respondents were working in a rehabilitation centre and had a mean job experience of 19.5 years (range 1 to 43). The ReMoS guideline was unknown to 52.9% (n = 55/104). Of all 46 recommendations only intensive walking training without treadmill to improve patients' balance was reported to be applied according to the ReMoS guideline by 84.3% (n = 86/102). Intensive walking training with technical support aiming to gain (75.1% (n = 121/161)) or to improve (69.9% (n = 101/144)) walking ability are used sometimes or never. Recommended interventions to improve walking distance and walking speed are not used regularly, too. The main enablers to use the ReMoS guideline were fitting PTs' daily work and PTs' knowledge to use it.
Conclusion(s): The research results add to the knowledge about actual conditions of physiotherapy in stroke rehabilitation, highlighting a gap between current physiotherapy practice in Germany and evidence-based recommendation.
Implications: The results underpin the necessity to improve knowledge of guidelines and tailored guideline implementation in order to advance guideline adherence of PTs working in German stroke rehabilitation.
Funding, acknowledgements: This is an unfunded research project.
Keywords: stroke, guidelines, physiotherapy
Topic: Neurology: stroke
Did this work require ethics approval? Yes
Institution: Brandenburg University of Technology Cottbus-Senftenberg
Committee: Ethics Commitee
Ethics number: EK2019-5
All authors, affiliations and abstracts have been published as submitted.
