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Patients', Carers' and Physiotherapists' Perceptions of Final-stage Rehabilitation of Elderly Stroke Patients
treatment received between assessments. The initial gains in mobility at discharge are small but consistent, whereas at six months the gains - although larger - are more variable. The pattern of improvement in mobility supports the belief that having been taught basic information and skills t o improve mobility, subsequent practice in the home environment facilitated further improvement. This mobility index has proved a satisfactory method for recording functional data. Since the conclusion of the study it is now routinely incorporated in the patients’ notes. Currently all patients are assessed at admission and discharge with copies being placed in the medical chart. It is also envisaged that quantitative data such as these should be of value for admission panels when allocating placements in care, and hopefully help ensure priority is given t o those most in need. Accurate assessment of need should help w i t h resources management and specialty costing.
Conclusion We conclude that physiotherapy is important in the treatment of elderly patients attending a day hospital and results in both short- and long-term improvement in mobility. This study supports the hypothesis that physiotherapy is effective in a day hospital setting. The value of recording
the functional ability of elderly patients has been found t o be of benefit. The mobility index has proved a satisfactory method for recording function data. ACKNOWLEDGMENT We gratefully acknowledge the assistance of Sister M Thompson and all the staff of the geriatric day hospital, and thank Dr C C Patterson for statistical advice. REFERENCES Age Concern (1989). Residentialand Nursing Homes, Age Concern Northern Ireland. Department of Health and Social Services, Northern Ireland (1981). Past Sixty-five - Who cares! A report on health and personal social services, DHSS, p 6, 2.6. MacFarlane, J P R, Collings, T, Graham, K and Maclntosh J C (1979). ‘Cost benefit‘, Age and Ageing, Supplement, 80-86. Macknnon, W J, Ghoch, U K and Ritchie, R T (1985). ’How does a Day Hospital Work?’, Health Bulletin, 43, 109-116. Qureshi K and Hodkinson, H M (1974). ’Evaluation of a ten-question mental test in institutionalised elderly’, Age and Ageing, 3, 152-157. Squires, A, Dolbear, R, Smoker, S and Williams, R (1987). ‘Evaluation of physiotherapy in a day unit‘, Physiotherapy, 73,11, 596-598. Tucker, M A, Davison, J G and Ogle, S J (1984). ‘Day hospital rehabilitation - Effectiveness and cost in the elderly: A randomised controlled trial‘, British Medical Journal, 289, 1209-12.
Abstract of Higher Degree Dissertation A full list of Fellowship and higher degree dissertations and theses is available from Robert Donkers in the Education Department. Dissertations housed at the CSP may be viewed by appointment. For access t o dissertations housed elsewhere, please contact the institution concerned. (They are not normally available for loan.)
Patients’, Carers’ and Physiotherapists’ Perceptions of Final-stage Rehabilitation of Elderly Stroke Patients KAY STACHURA M S BA ~ MCSP Research: Master of Science, Department of Psychology, University of Stirling, 1990 Housed at: The University of Stirling
THE practice of physiotherapy involves the implementation of appropriate physical techniques to alleviate a variety of problems. The techniques used almost universally by physiotherapists in the United Kingdom to facilitate normal movement after strokes are based on neurophysiological principles. A review of the literature identified the importanceof psychosocialinfluences in rehabilitation and the various factors associated with ageing which can compromise elderly patients’ physical rehabilitation potential. This study examined the perceptions of the main groups involved in the physical rehabilitation of elderly stroke patients and the problems physiotherapistsattempted to treat as part of their input.
physiotherapy, December 1990, vol76, no 12
The study comprised two sections. A longitudinal clinical study involving 16 patients, their carers and their physiotherapists, and a survey of 34 randomly chosen physiotherapists working in geriatric day hospitals. The findings of the clinical study revealed some statistically significant differences in the various groups’ perceptions of certain aspects of patients‘ physical functioning. These differences in perceptions occurred mostly between the physiotherapists and carers. In addition, some patients and carers were shown to perceive strokes in musculoskeletal rather than neurological terms. The physiotherapists’ survey showed that physiotherapistsdeal primarily with the physical components of rehabilitation and that the main emphasis of treatment is on the acquisition of physical skills. The need for improved communications was a feature of both sections of the study. It appears from the population examined that patients and carers do not always share the same frames of reference as physiotherapists regarding certain aspects of the rehabilitation process. Furthermore, physiotherapists appear to deal predominantly with the acquisition of motor skills rather than their implementation in a social context. Although physiotherapists might implicitly modify the non-tangible elements of their treatment programme to accommodate the needs of their elderly patients, they do not necessarily record these factors. Recommendations for future clinical practice and the education of physiotherapists are made.
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Conclusion We conclude that physiotherapy is important in the treatment of elderly patients attending a day hospital and results in both short- and long-term improvement in mobility. This study supports the hypothesis that physiotherapy is effective in a day hospital setting. The value of recording
the functional ability of elderly patients has been found t o be of benefit. The mobility index has proved a satisfactory method for recording function data. ACKNOWLEDGMENT We gratefully acknowledge the assistance of Sister M Thompson and all the staff of the geriatric day hospital, and thank Dr C C Patterson for statistical advice. REFERENCES Age Concern (1989). Residentialand Nursing Homes, Age Concern Northern Ireland. Department of Health and Social Services, Northern Ireland (1981). Past Sixty-five - Who cares! A report on health and personal social services, DHSS, p 6, 2.6. MacFarlane, J P R, Collings, T, Graham, K and Maclntosh J C (1979). ‘Cost benefit‘, Age and Ageing, Supplement, 80-86. Macknnon, W J, Ghoch, U K and Ritchie, R T (1985). ’How does a Day Hospital Work?’, Health Bulletin, 43, 109-116. Qureshi K and Hodkinson, H M (1974). ’Evaluation of a ten-question mental test in institutionalised elderly’, Age and Ageing, 3, 152-157. Squires, A, Dolbear, R, Smoker, S and Williams, R (1987). ‘Evaluation of physiotherapy in a day unit‘, Physiotherapy, 73,11, 596-598. Tucker, M A, Davison, J G and Ogle, S J (1984). ‘Day hospital rehabilitation - Effectiveness and cost in the elderly: A randomised controlled trial‘, British Medical Journal, 289, 1209-12.
Abstract of Higher Degree Dissertation A full list of Fellowship and higher degree dissertations and theses is available from Robert Donkers in the Education Department. Dissertations housed at the CSP may be viewed by appointment. For access t o dissertations housed elsewhere, please contact the institution concerned. (They are not normally available for loan.)
Patients’, Carers’ and Physiotherapists’ Perceptions of Final-stage Rehabilitation of Elderly Stroke Patients KAY STACHURA M S BA ~ MCSP Research: Master of Science, Department of Psychology, University of Stirling, 1990 Housed at: The University of Stirling
THE practice of physiotherapy involves the implementation of appropriate physical techniques to alleviate a variety of problems. The techniques used almost universally by physiotherapists in the United Kingdom to facilitate normal movement after strokes are based on neurophysiological principles. A review of the literature identified the importanceof psychosocialinfluences in rehabilitation and the various factors associated with ageing which can compromise elderly patients’ physical rehabilitation potential. This study examined the perceptions of the main groups involved in the physical rehabilitation of elderly stroke patients and the problems physiotherapistsattempted to treat as part of their input.
physiotherapy, December 1990, vol76, no 12
The study comprised two sections. A longitudinal clinical study involving 16 patients, their carers and their physiotherapists, and a survey of 34 randomly chosen physiotherapists working in geriatric day hospitals. The findings of the clinical study revealed some statistically significant differences in the various groups’ perceptions of certain aspects of patients‘ physical functioning. These differences in perceptions occurred mostly between the physiotherapists and carers. In addition, some patients and carers were shown to perceive strokes in musculoskeletal rather than neurological terms. The physiotherapists’ survey showed that physiotherapistsdeal primarily with the physical components of rehabilitation and that the main emphasis of treatment is on the acquisition of physical skills. The need for improved communications was a feature of both sections of the study. It appears from the population examined that patients and carers do not always share the same frames of reference as physiotherapists regarding certain aspects of the rehabilitation process. Furthermore, physiotherapists appear to deal predominantly with the acquisition of motor skills rather than their implementation in a social context. Although physiotherapists might implicitly modify the non-tangible elements of their treatment programme to accommodate the needs of their elderly patients, they do not necessarily record these factors. Recommendations for future clinical practice and the education of physiotherapists are made.
795