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j. Garner1, M. van den Berg2, B. Lange3, S. Vuu2, S. Lennon3
1Flinders University and Southern Adelaide Local Health Network, Adelaide, Australia, Physiotherapy, Adelaide, Australia, 2Flinders University, Clinical Rehabilitation, Adelaide, Australia, 3Flinders University, Physiotherapy, Adelaide, Australia
Background: Approximately one billion people are affected by neurological disorders worldwide, physiotherapists are recognized as core members of the interprofessional team involved in their care. Neurological assessment advocated as the basis of clinical reasoning to develop and evaluate an appropriate plan of care has been described in expert textbooks and some practice guidelines for specific client cohorts. Acquiring clinical reasoning skills is a key requirement for undergraduate education, and these skills are necessary to effectively treat patients once qualified. There is a lack of consensus in the literature related to what is assessed clinically by physiotherapists in people with neurological disorders.
Purpose: This systematic review aimed to identify the key domains that physiotherapists assess in people with neurological disorders while exploring how geographical location, clinical experience, health care setting, and type of neurological disorder may influence clinical assessment.
Methods: We searched six electronic databases (from 1996-2019) and grey literature. Studies were eligible for inclusion if participants were physiotherapists who assessed adults with neurological disorders in a clinical setting providing data about assessment domains. All study designs and settings were included.
Two reviewers independently applied inclusion criteria and extracted findings. The quality of the studies was assessed using appropriate McMaster Critical Appraisal tools. Results were analyzed using content analysis, and NVivo 12 software to code qualitative studies into pre-existing domains resulting from the quantitative studies.
Two reviewers independently applied inclusion criteria and extracted findings. The quality of the studies was assessed using appropriate McMaster Critical Appraisal tools. Results were analyzed using content analysis, and NVivo 12 software to code qualitative studies into pre-existing domains resulting from the quantitative studies.
Results: Nineteen studies composed of fourteen quantitative and five qualitative studies were selected for this review. There was some agreement on a limited number of domains: function (n=12); postural alignment and symmetry (n=11); gait (n=9); muscle strength (n=8); and balance (n=8).
Less than 50% (n=8) of the included studies looked broadly at neurological physiotherapy assessment practice with seven studies exploring only single aspects of assessment. Timing of assessment was described in less than 25% of studies. Just over half of the included studies reported on clinical reasoning. None of the studies referred to the WHO ICF framework. Five studies specifically explored the use of standardised outcome measures, which are only one aspect of assessment.
Five key themes were identified: clinical reasoning, clinical use of standardised measures, role of the senses, clinician experience and information gathering.
Less than 50% (n=8) of the included studies looked broadly at neurological physiotherapy assessment practice with seven studies exploring only single aspects of assessment. Timing of assessment was described in less than 25% of studies. Just over half of the included studies reported on clinical reasoning. None of the studies referred to the WHO ICF framework. Five studies specifically explored the use of standardised outcome measures, which are only one aspect of assessment.
Five key themes were identified: clinical reasoning, clinical use of standardised measures, role of the senses, clinician experience and information gathering.
Conclusion(s): There is some guidance emerging from this review about key domains and how the clinical reasoning process underpinning assessment should be applied in clinical practice.
There is little evidence to support what physiotherapists assess in practice, in different settings, around the world.
There is little evidence to support what physiotherapists assess in practice, in different settings, around the world.
Implications: This the first systematic review, to our knowledge, of physiotherapy assessment of people with neurological disorders. What should neurological physiotherapists assess? Are physiotherapists basing their treatment only on what they deem important to assess? Are physiotherapists treating what is important to their clients or their organisation and therefore focusing their assessment accordingly? What should physiotherapists teach students about neurological physiotherapy assessment? Further research is needed to explore this area further to develop a consensus around best practice.
Funding, acknowledgements: Unfunded, completed as part of a Masters by research
Keywords: Clinical, Neurological, Assessment
Topic: Neurology
Did this work require ethics approval? No
Institution: N/A
Committee: N/A
Reason: This study is a systematic review
All authors, affiliations and abstracts have been published as submitted.
