Department of Physiotherapy, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University and Southern Adelaide Local Health Network, Adelaide, South Australia, Australia.
Department of Clinical Rehabilitation, Caring Futures Institute, College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia.
J Eval Clin Pract. 2023 Dec;29(8):1402-1424. doi: 10.1111/jep.13909. Epub 2023 Aug 3.
There is a lack of consensus in the literature related to what is assessed clinically by physical therapists in people with neurological disorders.
This mixed-methods systematic review aimed to identify domains that physiotherapists routinely assess in people with neurological conditions in clinical settings and explored factors influencing assessment domains including country, clinical setting, therapist experience and neurological condition.
Five databases were searched from 1946 to 31st January 2023. Studies with any design reporting on domains assessed by a physiotherapist, in people with neurological conditions in any clinical setting, were included. Independent reviewers assessed eligibility and risk of bias using relevant McMaster critical appraisal tools. Data were extracted and synthesised following the Joanna Briggs Institute approach for mixed systematic reviews.
A total of 23 (16 quantitative, 7 qualitative) studies involving 3134 participants were included. The studies were rated as high (n = 14) or medium (n = 9) quality. The domains of function (n = 14); postural alignment and symmetry (n = 11); gait (n = 11); balance (n = 9), and muscle strength (n = 8) were most frequently included in assessments. Five key themes were identified from the qualitative studies: the clinical reasoning process, clinical use of standardised measures, utilisation of the senses, clinician experience and information gathering. There was minimal data on how country, clinical setting, therapist experience and neurological condition influence inclusion of assessed domains.
Five domains were most frequently included in assessment: function; postural alignment and symmetry; gait; muscle strength; and balance. This limited number of domains is in stark contrast to the full neurological physiotherapy assessment recommended by expert textbooks. Further research is needed to understand the reasons why this might be so.
在物理治疗师对神经障碍患者进行临床评估的内容方面，文献中缺乏共识。
本混合方法系统评价旨在确定物理治疗师在临床环境中对神经障碍患者进行常规评估的领域，并探讨影响评估领域的因素，包括国家、临床环境、治疗师经验和神经疾病。
从 1946 年至 2023 年 1 月 31 日，对 5 个数据库进行了搜索。纳入任何设计的研究，这些研究报告了在任何临床环境中对神经疾病患者进行评估的领域。独立评审员使用相关的麦克马斯特批判性评估工具评估合格性和偏倚风险。使用乔安娜布里格斯研究所（Joanna Briggs Institute）的混合系统评价方法提取和综合数据。
共纳入 23 项（16 项定量，7 项定性）研究，涉及 3134 名参与者。这些研究的质量被评为高（n=14）或中（n=9）。在评估中最常包括的领域是功能（n=14）；姿势对齐和对称性（n=11）；步态（n=11）；平衡（n=9）和肌肉力量（n=8）。从定性研究中确定了 5 个关键主题：临床推理过程、标准化测量的临床应用、感觉的利用、临床医生经验和信息收集。关于国家、临床环境、治疗师经验和神经疾病如何影响评估领域的纳入，仅有很少的数据。
在评估中最常包括的领域是功能；姿势对齐和对称性；步态；肌肉力量；和平衡。这与专家教科书推荐的全面神经物理治疗评估相比，所包括的领域数量非常有限。需要进一步研究以了解可能导致这种情况的原因。
