Tyson S F, Selley A B
Centre for Rehabilitation and Human Performance Research, University of Salford, UK.
Disabil Rehabil. 2007 Mar 15;29(5):395-401. doi: 10.1080/09638280600841158.
The Bobath concept is the predominant stroke physiotherapy approach in the UK but there is little literature about its operationalization. The aim of this study was to assess the effect of perceived adherence to the Bobath concept on interventions used by physiotherapists to treat postural control problems after stroke. The physiotherapists' experience, clinical grade and the type of patients treated were also compared.
The design was a cross sectional survey involving 11 NHS Trusts. The participants were 35 stroke physiotherapists who recorded the treatment of 132 patients in 644 sessions using the Stroke Physiotherapy Intervention Recording Tool. Descriptive statistics, independent t-tests and Chi-squares were used in the analysis to describe the physiotherapists and patients, and compare the effects of perceived adherence to the Bobath concept on intervention choice, clinical grade, experience and the type of patient treated.
Most physiotherapists perceived their practice to be eclectic but the interventions used followed a traditional Bobath model. Perceived adherence to the Bobath concept had little effect on the choice of intervention. The only significant difference was that 'preparation for treatment' techniques were used more frequently by 'strongly Bobath' physiotherapists then 'eclectic' physiotherapists. There were no other significant differences, nor were there any differences in the physiotherapists' clinical grade, post-graduate training or the type of patient treated except that 'eclectic' physiotherapists' patients were older. Most of the 'strongly Bobath' physiotherapists were experienced and most of the 'eclectic' physiotherapists were novices (p<0.023).
Although most physiotherapists perceived themselves to be eclectic, their actual practice followed a traditional Bobath model; recent developments of the Bobath concept were not incorporated into clinical practice. The reasons for the mismatch between physiotherapists' perception and their actual practice are discussed.
在英国，Bobath概念是中风物理治疗的主要方法，但关于其实施的文献很少。本研究的目的是评估在治疗中风后姿势控制问题时，物理治疗师对Bobath概念的认知依从性对所采用干预措施的影响。同时还比较了物理治疗师的经验、临床级别以及所治疗患者的类型。
该设计为横断面调查，涉及11个国民保健服务信托基金。参与者为35名中风物理治疗师，他们使用中风物理治疗干预记录工具在644次治疗中记录了132名患者的治疗情况。分析中使用描述性统计、独立t检验和卡方检验来描述物理治疗师和患者，并比较对Bobath概念的认知依从性对干预选择、临床级别、经验和所治疗患者类型的影响。
大多数物理治疗师认为自己的实践是折衷的，但所采用的干预措施遵循传统的Bobath模式。对Bobath概念的认知依从性对干预选择影响不大。唯一显著的差异是，“强烈遵循Bobath”的物理治疗师比“折衷派”物理治疗师更频繁地使用“治疗准备”技术。没有其他显著差异，物理治疗师的临床级别、研究生培训或所治疗患者的类型也没有差异，只是“折衷派”物理治疗师的患者年龄更大。大多数“强烈遵循Bobath”的物理治疗师经验丰富，而大多数“折衷派”物理治疗师是新手（p<0.023）。
尽管大多数物理治疗师认为自己是折衷的，但他们的实际实践遵循传统的Bobath模式；Bobath概念的最新发展未纳入临床实践。讨论了物理治疗师认知与实际实践不匹配的原因。
