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Comparison of the content of two physiotherapy approaches for stroke

Division of Stroke Medicine, University of Nottingham, Nottingham, UK

Nadina B Lincoln

Elisabeth Robinson

School of Psychology, University of Nottingham, Nottingham, 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.

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