How are balance and mobility problems after stroke treated in England? An observational study of the content, dose and context of physiotherapy.

OBJECTIVE

To describe the dose, intensity and context of physiotherapy for balance and mobility problems after stroke.

DESIGN

Process mapping to describe the context and non-participant observation of therapy sessions to describe the dose and content of therapy.

SETTING

Four inpatient stroke units in North-West England.

PARTICIPANTS

Therapy staff and previously mobile stroke survivors who were treating, or receiving treatment for balance and mobility problems in the participating units.

RESULTS

Two units were stand-alone rehabilitation units; two offered a service at the weekends. One had no access to community-based rehabilitation. All had dedicated treatment facilities but often did not use them because of lack of space and difficulty transporting patients. Twenty-two patients participated and 100 treatment sessions were observed. Practicing walking, sit-to-stand and transfers were the most frequent objectives and interventions usually with the therapist(s) physically facilitating the patient's movements. The dose of practise was low; mean repetitions of sit-to-stand per session was 5 (SD 6.4); mean time spent upright per session was 11.24 (SD = 7) minutes, and mean number of steps per session was 202 (SD 118). The mean number of staff per patient was 2.1 (SD = 0.6, mode = 2), usually involving two qualified therapists. Falls prevention or management, wheelchair skills and bed mobility were not practised.

CONCLUSION

Stroke physiotherapy for balance and mobility problems features low-dose, low-intensity therapist-led practice, mainly of walking and sit-to-stand. Staff:patient ratios were high. Therapists need to organize treatment sessions to maximize the intensity of functional task practice.