Department of Physiotherapy of Alfred Health, Melbourne, Australia.
Acquired Brain Injury Unit, Caulfield Hospital, Alfred Health, Caulfield, Australia.
Physiother Theory Pract. 2022 Sep;38(9):1198-1206. doi: 10.1080/09593985.2020.1839986. Epub 2020 Nov 19.
Muscle weakness is well established as the primary impairment that affects walking after stroke and strength training is an effective intervention to improve this muscle weakness. Observation of clinical practice however has highlighted an evidence-practice gap in the implementation of evidence-based strength training guidelines. : To explore perceived barriers and facilitators that influence Australian physiotherapy practices when prescribing strength training with stroke survivors undergoing gait rehabilitation. : Semi-structured interviews were conducted with a convenience sample of physiotherapists currently providing rehabilitation services to patients following stroke in Australia. Interviews were transcribed verbatim and line-by-line thematic analysis was undertaken to create themes and sub-themes. : Participants were 16 physiotherapists (12 females) with 3 months - 42 years experience working with people after stroke. Major themes identified were1) patient factors influence the approach to strength training; 2) interpretation and implementation of strength training principles is diverse; and 3) workplace context affects the treatment delivered. Physiotherapists displayed wide variation in their knowledge, interpretation and implementation of strength training principles and strength training exercise prescription was seldom evidence or guideline based. Workplace factors included the clinical preference of colleagues, and the need to modify practice to align with workforce resources. : Implementation of strength training to improve walking after stroke was diverse. Therapist-related barriers to the implementation of effective strength training programs highlight the need for improved knowledge, training and research engagement. Limited resourcing demonstrates the need for organizational prioritization of stroke education and skill development. Narrowing the evidence-practice gap remains a challenge.
肌肉无力是中风后影响行走的主要障碍，力量训练是改善肌肉无力的有效干预措施。然而，临床观察突出了实施基于证据的力量训练指南方面存在证据-实践差距。本研究旨在探讨影响澳大利亚物理治疗师在为接受步态康复的中风幸存者开具力量训练处方时的感知障碍和促进因素。采用便利抽样法，对正在澳大利亚为中风患者提供康复服务的物理治疗师进行半结构式访谈。对访谈进行逐字转录，并进行线性主题分析，以创建主题和子主题。参与者为 16 名物理治疗师（12 名女性），具有 3 个月至 42 年的中风后患者治疗经验。主要主题包括：1）患者因素影响力量训练方法；2）对力量训练原则的解释和实施存在差异；3）工作场所环境影响治疗效果。物理治疗师在力量训练原则的知识、解释和实施方面存在很大差异，力量训练运动处方很少基于证据或指南。工作场所因素包括同事的临床偏好，以及需要调整实践以适应劳动力资源的需求。实施力量训练以改善中风后行走的方法多种多样。治疗师在实施有效力量训练计划方面存在障碍，这突显了需要提高知识、培训和研究参与度。资源有限表明需要组织优先考虑中风教育和技能发展。缩小证据-实践差距仍然是一个挑战。
