And we wonder why there are so many stroke forums and websites set up by survivors trying to understand stroke rehabilitation. I doubt the US is any better, no survivor has ever posted any understanding by their doctors or therapists on stroke rehab.
http://informahealthcare.com/doi/abs/10.3109/09593989409036399
As in the Swedish study, although the respondents were able to describe their treatment choices, they had difficulty explaining the underlying theoretical basis for their choice. Difficulty providing a scientific and rational explanation for intervention may have implications for the future development of physiotherapy as a clinical science.
In a survey of Swedish physiotherapists working in neurology, the treatment of individuals following stroke was found to be essentially praxis-oriented (What?)(Nilsson and Nordholm, 1992). The present study replicated the Swedish survey in order to compare the responses of Australian physiotherapists with those of their Swedish colleagues. The questionnaire, designed to establish choice of treatment, factors influencing and theoretical bases for the choice of treatment, and attitudes towards new methods, was sent to the 331 members of the Neurology Special Interest Group of the Australian Physiotherapy Association. The response rate was 72%. Respondents viewed experience working with patients as the most important factor influencing current choice of treatment. As in the Swedish study, although the respondents were able to describe their treatment choices, they had difficulty explaining the underlying theoretical basis for their choice. Difficulty providing a scientific and rational explanation for intervention may have implications for the future development of physiotherapy as a clinical science.
This study comes to the same conclusion Determinants of research use in clinical decision making among physical therapists providing services post-stroke: a cross-sectional study
We're screwed, doctors say they know nothing, therapists don't have any basis for their therapies. We are all completely on our own. I think we are all going to have to go to medical school ourselves. Wait, that won't work either, the instructors probably don't have any clue either. Ok, survivors set up their own school and training and we get medical staff to pay us for our knowledge in stroke rehab.
And I bet I have a better understanding of the theoretical basis of stroke rehab than those physiotherapists. Read my posting on What my doctor should have told me about stroke recovery
I'm actually about to start med school post-ruptured-aneurysm.
ReplyDelete@ Karl, Good luck - you'll be a better doctor for stroke survivors than many others. @Dean, Congrats to you and Peter for being selected as writing top medical blogs. Although Peter has explained it to me, I don't have a grasp on the underlying basis for my leg Bioness working; I just trust that he does, and I'm plowing forward.
ReplyDeleteI agree 100 percent that the survivors need to receive more education. I am a speech therapist and I work with stroke survivors. I think you are oversimplifying things a bit when you say that therapists have no theoretical basis for their treatment. What I do is based off of research. Not everything works for everybody. I have also found that many therapists and doctors are quick to say that there is no research to support certain treatments (in the case of Speech therapy they love to attack cognitive and oral-motor rehab). Frequently they are wrong. Not everything I do results in gains for my clients but a lot of it does. I think the part that is frustrating is how long it takes. Cognitive-communication disorders especially take a lot of therapy and time and the idiotic insurance industry in the U.S. Refuses to recognize that. Also, there are some more holistic and Eastern treatments that can be quite beneficial for stroke survivors. Insurance frequently won't cover them. Here is a list of some of them. Can you tell me your thoughts on the following treatments?
ReplyDeleteAcupuncture
Acupressure
Myofascial release
Music therapy
Meditation
It may not have come out in this post but if we truly had evidence-based therapies we would have objective starting and ending points, along with %recovery chances, and wouldn't be conflating therapy with what would occur anyway with spontaneous recovery. Maybe we still do need therapy but that hasn't been proven yet.
DeleteEastern therapies are even worse, with no real good scientific backing.
Acupuncture can't be proven from any Chinese study since the standard treatment for all strokes in China is acupuncture - no way to tell what is caused by acupuncture vs. spontaneous recovery. I have 15 posts on acupuncture detailing the various attempts to prove its usefulness.
Acupressure may have a better chance just because its been proven that sensation recovery helps motor recovery.
You can probably tell I don't believe in magical energy meridians.
Myofascial, same comments as acupressure. I had this and thought it was wonderful, no way of knowing if it helped recovery.
Music, I have 6 posts on music, its been proven to help in the acute phase for years now.
Meditation, I would only suggest this if you are using it for mental imagery, unless you need it to calm down your anxiety that your doctor caused. The nocebo effect.