Comparison of the content of two physiotherapy approaches for stroke

Objective: To identify similarities and differences between a Bobath-based (BB) and a movement science-based (MSB) approach. Design: Direct observation by a trained observer was used to record behaviours during treatments. Setting: An acute stroke ward. Subjects: Twenty-two stroke patients. Interventions: Behaviours were recorded during 12 treatment sessions by three therapists, for each treatment approach. Physical and communication behaviours were recorded in pre-defined categories. The equipment used was recorded and a semi-structured interview conducted with the therapist after treatment to identify follow-up actions by the therapist. Main outcome measures: Frequency of occurrence of each category was compared between the approaches. Results: Treatment in the BB group contained more social conversation (P=0.004), and more use of physiotherapy equipment (p=0.02) and a physiotherapy assistant (p=0.01). In the MSB group there was more detailed feedback given to the patient (p=0.002) more use of everyday objects in training (p=0.001), therapists more frequently listed specific components as the patient's main problems (p=0.003) and relatives were involved more in positioning to stretch muscles (p=0.03). Training walking was given more emphasis in the BB group and training of sit-to-stand in the MSB group. Conclusions: The study indicates that there are differences in content between the Bobath-based and movement science-based approaches to treatment.