Facilitators and barriers to using neurological outcome measures in developed and developing countries.

OBJECTIVE: To identify and compare factors influencing the use of standardized outcome measures by neurological physical therapists working in representative developed (Canada) and developing (India) countries. METHODS: A self-administered web-based questionnaire on facilitators and barriers to using neurological outcome measures was sent by email to neurological physical therapists in Canada and India. Frequencies of responses to each question were computed. Differences between countries were assessed using two-proportion z test. RESULTS: Of 317 respondents, the use of standardized outcome measures was higher for Indian (96.7%) compared with Canadian physical therapists (89.2%). Among the most highly reported facilitators, three were common for both countries (known validity and reliability, outcome measures learned in professional training, and recommended in clinical practice guidelines). Three highly reported barriers were also common for India and Canada (lack of time, relying on judgement for clinical decisions, and unavailability of the assessment tools). Nevertheless, there were differences in the percentages of barriers and facilitators between countries. CONCLUSION: Understanding the factors influencing the uptake of outcome measures among neurological physical therapists working in a developed (Canada) and a developing country (India) can help identify whether strategies should or should not be modified to facilitate knowledge translation in different geographical, professional, or social contexts.

Current Practices of Physical and Occupational Therapists Regarding Spasticity Assessment and Treatment.

Purpose: The purpose of this study was to understand current trends in rehabilitation practice regarding spasticity assessment and treatment. Method: The clinical practices of Canadian physiotherapists and occupational therapists in assessing and treating spasticity were investigated using a self-administered, Web-based questionnaire (cross-sectional design). Experienced clinicians developed the questionnaire, which surveyed socio-demographic characteristics, work environment, and clinician satisfaction with spasticity assessments and preferences for treatment. Results: A total of 317 clinicians (204 physiotherapists and 113 occupational therapists) completed the questionnaire. The majority of participants reported that using valid and reliable outcome measures to assess spasticity was important (91.1%). Most clinicians indicated using a combination of spasticity assessments, and their level of satisfaction with these assessments was very high. All clinicians believed that spasticity should be evaluated by rehabilitation professionals, and most indicated that it should be assessed by more than one professional. Although 83.8% indicated that spasticity should be tested on admission, a much lower percentage believed that it should be evaluated throughout rehabilitation. Most clinicians (92.2%) reported using multiple treatment modalities for spasticity. Conclusions: This study is the first to document clinicians' practices regarding spasticity assessment and treatment. A better understanding of current trends in physiotherapy and occupational therapy will help in tailoring strategies to improve practice.

Objectif : comprendre les tendances actuelles des pratiques de réadaptation en matière d'évaluation et de traitement de la spasticité. Méthodologie : les chercheurs ont exploré les pratiques cliniques des physiothérapeutes et des ergothérapeutes canadiens pour évaluer et traiter la spasticité au moyen d'un questionnaire virtuel autoadministré (étude transversale). Des cliniciens d'expérience ont préparé le questionnaire, qui sondait les caractéristiques sociodémographiques, le milieu de travail et la satisfaction des cliniciens à l'égard des évaluations de la spasticité et des préférences thérapeutiques. Résultats : au total, 317 cliniciens (204 physiothérapeutes et 113 ergothérapeutes) ont rempli le questionnaire. La majorité des participants (91,1 %) ont déclaré qu'il était important d'utiliser des mesures de résultats valides et fiables pour évaluer la spasticité. La plupart des cliniciens ont indiqué utiliser une combinaison d'évaluations de la spasticité et être hautement satisfaits de la qualité de ces évaluations. Tous les cliniciens ont mentionné que la spasticité devrait être évaluée par des professionnels de la réadaptation, et la plupart ont précisé qu'elle devrait l'être par plus d'un professionnel. Bien que 83,8 % aient indiqué que la spasticité devrait être évaluée à l'admission, un pourcentage beaucoup plus faible a mentionné qu'elle devrait l'être tout au long de la réadaptation. La plupart des cliniciens (92,2 %) ont déclaré utiliser de multiples modalités thérapeutiques pour intervenir auprès d'individus présentant de la spasticité. Conclusions : la présente étude est la première à porter sur les pratiques des cliniciens en matière d'évaluation et de traitement de la spasticité. Une meilleure compréhension des tendances actuelles en physiothérapie et en ergothérapie contribuera à adapter des stratégies afin d'améliorer la pratique.