Neurological conditions and community-based physical activity: physical therapists’ belief and actions

Louise Declerck; Mathilde Gillot; Charlotte Goffaux; Jean-François Kaux; Gaetan Stoquart

doi:10.33393/aop.2024.2733

Authors

Louise Declerck Neuromusculoskeletal Lab, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels - Belgium
Mathilde Gillot Neuromusculoskeletal Lab, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels - Belgium
Charlotte Goffaux Neuromusculoskeletal Lab, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels - Belgium https://orcid.org/0009-0003-6002-3570
Jean-François Kaux ReFORM IOC Research Centre for Prevention of Injury and Protection of Athlete Health, Liège - Belgium and Physical Medicine and Sport Traumatology Department, SportS2, FIFA Medical Centre of Excellence, FIMS Collaborative Centre of Sports Medicine, University and University Hospital of Liege, Liège - Belgium
Gaetan Stoquart Neuromusculoskeletal Lab, Institut de Recherche Expérimentale et Clinique, UCLouvain, Brussels - Belgium and Physical and Rehabilitation Medicine Department, Cliniques Universitaire Saint-Luc, Brussels - Belgium

DOI:

https://doi.org/10.33393/aop.2024.2733

Keywords:

Health promotion, Neurological rehabilitation, Physical activity, Physical therapists

Abstract

Introduction: Physical therapists (PTs) are key actors in physical activity (PA) promotion. However, it remains unclear whether PTs in community settings promote community-based PA such as adapted physical activity (APA) and adaptive sports (AS) to their patients with neurological conditions (NCs). The main purposes were to evaluate the beliefs PTs have of APA and AS, and to explore actions they undertake to promote it to their patients with NCs.

Methods: An online survey was created specifically for the study. PT associations and institutions were contacted and licensed PTs working in community-based settings, treating at least one patient with a NC, were invited to participate. Questionnaires were analyzed only if all mandatory questions had been answered.

Results: A total of 165 questionnaires were analyzed. PTs reported prioritizing active treatment. They viewed APA and AS as beneficial for their patients with NCs; however, its promotion remained largely infrequent due to a number of barriers. The PTs’ own level of PA seemed to significantly influence their beliefs of the benefits of APA and AS (p = 0.001), while being specialized in neurologic physical therapy enabled the PTs to increase frequency of promotion (p = 0.003).

Conclusion: Though community-based PTs are aware of the importance of PA for individuals with NCs, they face difficulties in promoting it to their patients. However, these difficulties are reduced among PTs who are specialized in neurologic physical therapy. Efforts should be made toward educating PTs to neurological pathologies and their specificities when it comes to PA.

Downloads

Download data is not yet available.

References

Carr J, Shepherd R. The changing face of neurological rehabilitation. Braz J Phys Ther. 2006;10(2). https://doi.org/10.1590/S1413-35552006000200003

Martin Ginis KA, van der Ploeg HP, Foster C, et al. Participation of people living with disabilities in physical activity: a global perspective. Lancet. 2021;398(10298):443-455. https://doi.org/10.1016/S0140-6736(21)01164-8 PMID:34302764

Bull FC, Al-Ansari SS, Biddle S, et al. World Health Organization 2020 guidelines on physical activity and sedentary behaviour. Br J Sports Med. 2020;54(24):1451-1462. https://doi.org/10.1136/bjsports-2020-102955 PMID:33239350

Nadeau SE. A paradigm shift in neurorehabilitation. Lancet Neurol. 2002;1(2):126-130. https://doi.org/10.1016/S1474-4422(02)00044-3 PMID:12849517

Selph SS, Skelly AC, Wasson N, et al. Physical activity and the health of wheelchair users: a systematic review in multiple sclerosis, cerebral palsy, and spinal cord injury. Arch Phys Med Rehabil. 2021;102(12):2464-2481.e33. https://doi.org/10.1016/j.apmr.2021.10.002 PMID:34653376

Saunders DH, Sanderson M, Hayes S, et al. Physical fitness training for stroke patients. Cochrane Database Syst Rev. 2020;3(3):CD003316. PMID:32196635

Hayes S, Galvin R, Kennedy C, et al. Interventions for preventing falls in people with multiple sclerosis. Cochrane Database Syst Rev. 2019;11(11):CD012475; Epub ahead of print. https://doi.org/10.1002/14651858.CD012475.pub2 PMID:31778221

Mehrholz J, Kugler J, Storch A, Pohl M, Hirsch K, Elsner B. Treadmill training for patients with Parkinson’s disease. Cochrane Database Syst Rev. 2015;2015(9):CD007830; Epub ahead of print. https://doi.org/10.1002/14651858.CD007830.pub4 PMID:26363646

Ortega-Hombrados L, Molina-Torres G, Galán-Mercant A, Sánchez-Guerrero E, González-Sánchez M, Ruiz-Muñoz M. Systematic review of therapeutic physical exercise in patients with amyotrophic lateral sclerosis over time. Int J Environ Res Public Health. 2021;18(3):1074. https://doi.org/10.3390/ijerph18031074 PMID:33530383

Lai B, Lee E, Kim Y, et al. Leisure-time physical activity interventions for children and adults with cerebral palsy: a scoping review. Dev Med Child Neurol. 2021;63(2):162-171. https://doi.org/10.1111/dmcn.14751 PMID:33241561

Spielman LJ, Little JP, Klegeris A. Physical activity and exercise attenuate neuroinflammation in neurological diseases. Brain Res Bull. 2016;125:19-29. https://doi.org/10.1016/j.brainresbull.2016.03.012 PMID:27021169

Motl RW, Pilutti LA. Is physical exercise a multiple sclerosis disease modifying treatment? Expert Rev Neurother. 2016;16(8):951-960. https://doi.org/10.1080/14737175.2016.1193008 PMID:27219279

Winstein CJ, Stein J, Arena R, et al; American Heart Association Stroke Council, Council on Cardiovascular and Stroke Nursing, Council on Clinical Cardiology, and Council on Quality of Care and Outcomes Research. Guidelines for adult stroke rehabilitation and recovery: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2016;47(6):e98-e169. https://doi.org/10.1161/STR.0000000000000098 PMID:27145936

Haselkorn JK, Hughes C, Rae-Grant A, et al. Summary of comprehensive systematic review: rehabilitation in multiple sclerosis: Report of the Guideline Development, Dissemination, and Implementation Subcommittee of the American Academy of Neurology. Neurology. 2015;85(21):1896-1903. https://doi.org/10.1212/WNL.0000000000002146 PMID:26598432

Keus S, Munneke M, Graziano M, et al. European Physiotherapy Guideline for Parkinson’s Disease. 2014;191. https://www.parkinsonnet.nl/app/uploads/sites/3/2019/11/eu_guideline_parkinson_guideline_for_pt_s1.pdf. Accessed November 2023.

Martin Ginis KA, van der Scheer JW, Latimer-Cheung AE, et al. Evidence-based scientific exercise guidelines for adults with spinal cord injury: an update and a new guideline. Spinal Cord. 2018;56(4):308-321. https://doi.org/10.1038/s41393-017-0017-3 PMID:29070812

Carroll DDC-LE, Courtney-Long EA, Stevens AC, et al; Centers for Disease Control and Prevention (CDC). Vital signs: disability and physical activity—United States, 2009-2012. MMWR Morb Mortal Wkly Rep. 2014;63(18):407-413. PMID:24807240

Butler EN, Evenson KR. Prevalence of physical activity and sedentary behavior among stroke survivors in the United States. Top Stroke Rehabil. 2014;21(3):246-255. https://doi.org/10.1310/tsr2103-246 PMID:24985392

Casey B, Coote S, Galvin R, Donnelly A. Objective physical activity levels in people with multiple sclerosis: meta-analysis. Scand J Med Sci Sports. 2018;28(9):1960-1969. https://doi.org/10.1111/sms.13214 PMID:29762863

de Hollander EL, Proper KI. Physical activity levels of adults with various physical disabilities. Prev Med Rep. 2018;10:370-376. https://doi.org/10.1016/j.pmedr.2018.04.017 PMID:29755934

Joseph C, Conradsson D, Hagströmer M, Lawal I, Rhoda A. Objectively assessed physical activity and associated factors of sedentary behavior among survivors of stroke living in Cape Town, South Africa. Disabil Rehabil. 2018;40(21):2509-2515. https://doi.org/10.1080/09638288.2017.1338761 PMID:28625084

Fini NA, Holland AE, Keating J, Simek J, Bernhardt J. How physically active are people following stroke? Systematic review and quantitative synthesis. Phys Ther. 2017;97(7):707-717. https://doi.org/10.1093/ptj/pzx038 PMID:28444348

van den Berg-Emons RJ, Bussmann JB, Haisma JA, et al. A prospective study on physical activity levels after spinal cord injury during inpatient rehabilitation and the year after discharge. Arch Phys Med Rehabil. 2008;89(11):2094-2101. https://doi.org/10.1016/j.apmr.2008.04.024 PMID:18996237

Moffat F, Paul L. Barriers and solutions to participation in exercise for moderately disabled people with multiple sclerosis not currently exercising: a consensus development study using nominal group technique. Disabil Rehabil. 2019;41(23):2775-2783. https://doi.org/10.1080/09638288.2018.1479456 PMID:29958016

Rimmer JH, Riley B, Wang E, Rauworth A, Jurkowski J. Physical activity participation among persons with disabilities: barriers and facilitators. Am J Prev Med. 2004;26(5):419-425. https://doi.org/10.1016/j.amepre.2004.02.002 PMID:15165658

Shirazipour CH, Evans MB, Leo J, Lithopoulos A, Martin Ginis KA, Latimer-Cheung AE. Program conditions that foster quality physical activity participation experiences for people with a physical disability: a systematic review. Disabil Rehabil. 2020;42(2):147-155. https://doi.org/10.1080/09638288.2018.1494215 PMID:30324815

Kunstler BE, Cook JL, Freene N, et al. Physiotherapist-led physical activity interventions are efficacious at increasing physical activity levels: a systematic review and meta-analysis. Clin J Sport Med. 2018;28(3):304-315. https://doi.org/10.1097/JSM.0000000000000447 PMID:29064864

Keith RA, Cowell KS. Time use of stroke patients in three rehabilitation hospitals. Soc Sci Med. 1987;24(6):529-533. https://doi.org/10.1016/0277-9536(87)90342-X PMID:3589748

Williams TL, Smith B, Papathomas A. Physical activity promotion for people with spinal cord injury: physiotherapists’ beliefs and actions. Disabil Rehabil. 2018;40(1):52-61. https://doi.org/10.1080/09638288.2016.1242176 PMID:27917686

Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES). J Med Internet Res. 2004;6(3):e34. https://doi.org/10.2196/jmir.6.3.e34 PMID:15471760

Cellule Planification de l’Offre des Professions des Soins de Santé. Statistiques Annuelles des professionnels des soins de santé en Belgique. Bruxelles: Service public fédéral (SPF) Santé publique, Sécurité de la Chaîne alimentaire et Environnement. https://organesdeconcertation.sante.belgique.be/sites/default/files/documents/statan_2018_fr_2.pdf. Accessed November 2023.

Nulty DD. The adequacy of response rates to online and paper surveys: what can be done? Assess Eval High Educ. 2008;33(3):301-314. https://doi.org/10.1080/02602930701293231

Daniel W. Biostatistics : a foundation for analysis in the health sciences. 7th ed. John Wiley & Sons; 1999.

Maisonneuve H, Fournier J-P. Construire une enquête et un questionnaire. E-respect[].2012;1(2):15-21.

Sammut R, Griscti O, Norman IJ. Strategies to improve response rates to web surveys: a literature review. Int J Nurs Stud. 2021;123:104058. https://doi.org/10.1016/j.ijnurstu.2021.104058 PMID:34454334

Schober P, Boer C, Schwarte LA. Correlation coefficients: appropriate use and interpretation. Anesth Analg. 2018;126(5):1763-1768. https://doi.org/10.1213/ANE.0000000000002864 PMID:29481436

Harris SR, Winstein CJ. The past, present, and future of neurorehabilitation: from NUSTEP through IV STEP and beyond. Pediatr Phys Ther. 2017;29(suppl 3):S2-S9. https://doi.org/10.1097/PEP.0000000000000376 PMID:28654472

Aweto HA, Oligbo CN, Fapojuwo OA, Olawale OA. Knowledge, attitude and practice of physiotherapists towards promotion of physically active lifestyles in patient management. BMC Health Serv Res. 2013;13(1):21. https://doi.org/10.1186/1472-6963-13-21 PMID:23316902

Shirley D, van der Ploeg HP, Bauman AE. Physical activity promotion in the physical therapy setting: perspectives from practitioners and students. Phys Ther. 2010;90(9):1311-1322. https://doi.org/10.2522/ptj.20090383 PMID:20651009

Mohan N, Collins E, Cusack T, O’Donoghue G. Physical activity and exercise prescription: senior physiotherapists’ knowledge, attitudes and beliefs. Physiother Pract Res. 2012;33(2):71-80. https://doi.org/10.3233/PPR-2012-0001

Boakye H, Quartey J, Baidoo NAB, Ahenkorah J. Knowledge, attitude and practice of physiotherapists towards health promotion in Ghana. S Afr J Physiother. 2018;74(1):443. https://doi.org/10.4102/sajp.v74i1.443 PMID:30214948

Tuna H, Bozan O, Elibol N, Unver B. Are the physical activity habits of Turkish physiotherapists associated with their physical activity promotion and counseling? Physiother Theory Pract. 2022;38(1):189-200. https://doi.org/10.1080/09593985.2020.1729909 PMID:32096415

Mulligan H, Fjellman-Wiklund A, Hale L, Thomas D, Häger-Ross C. Promoting physical activity for people with neurological disability: perspectives and experiences of physiotherapists. Physiother Theory Pract. 2011;27(6):399-410. https://doi.org/10.3109/09593985.2010.519015 PMID:20946071

Kennedy W, Curtin C, Bowling A. Access to physical activity promotion for people with neurological conditions: are physical therapists leading the way? Disabil Health J. 2024;17(1):101517. https://doi.org/10.1016/j.dhjo.2023.101517 PMID:37673784

Morris JH, Oliver T, Kroll T, Joice S, Williams B. From physical and functional to continuity with pre-stroke self and participation in valued activities: a qualitative exploration of stroke survivors’, carers’ and physiotherapists’ perceptions of physical activity after stroke. Disabil Rehabil. 2015;37(1):64-77. https://doi.org/10.3109/09638288.2014.907828 PMID:24694303

Zubala A, MacGillivray S, Frost H, et al. Promotion of physical activity interventions for community dwelling older adults: a systematic review of reviews. PLoS One. 2017;12(7):e0180902. https://doi.org/10.1371/journal.pone.0180902 PMID:28700754

Eisele A, Schagg D, Göhner W. Exercise promotion in physiotherapy: a qualitative study providing insights into German physiotherapists’ practices and experiences. Musculoskelet Sci Pract. 2020;45:102104. https://doi.org/10.1016/j.msksp.2019.102104 PMID:32056829

Freene N, Cools S, Bissett B. Are we missing opportunities? Physiotherapy and physical activity promotion: a cross-sectional survey. BMC Sports Sci Med Rehabil. 2017;9(1):19. https://doi.org/10.1186/s13102-017-0084-y PMID:29214025

Prout EC, Mansfield A, McIlroy WE, Brooks D. Patients’ perspectives on aerobic exercise early after stroke. Disabil Rehabil. 2017;39(7):684-690. https://doi.org/10.3109/09638288.2016.1161833 PMID:27017969

Watson PK, Eitivipart AC, Davis GM, Arora M, Middleton JW, De Oliveira CQ. Effects of behaviour change interventions on physical activity in people with spinal cord injury: a systematic review and meta-analysis. Psychol Sport Exerc. 2023;67:102408. https://doi.org/10.1016/j.psychsport.2023.102408 PMID:37665869

Zhu S, Sherrington C, Jennings M, et al. Current practice of physical activity counselling within physiotherapy usual care and influences on its use: a cross-sectional survey. Int J Environ Res Public Health. 2021;18(9):4762. https://doi.org/10.3390/ijerph18094762 PMID:33947018

Declerck L, Stoquart G, Lejeune T, Vanderthommen M, Kaux J-F. Barriers to development and expansion of adaptive physical activity and sports for individuals with a physical disability in sports clubs and centres. Sci Sports. 2021;36(3):202-209. https://doi.org/10.1016/j.scispo.2020.12.002

Albert FA, Crowe MJ, Malau-Aduli AEO, Malau-Aduli BS. Physical activity promotion: a systematic review of the perceptions of healthcare professionals. Int J Environ Res Public Health. 2020;17(12):4358. https://doi.org/10.3390/ijerph17124358 PMID:32570715

Giouridis N, Williams TL, Tomasone JR. Physical activity promotion to persons with spinal cord injury by health and exercise professionals: a scoping review. J Spinal Cord Med. 2023;46(1):126-145. https://doi.org/10.1080/10790268.2021.1977061 PMID:34747675

Rethorn ZD, Covington JK, Cook CE, Bezner JR. Physical activity promotion attitudes and practices among outpatient physical therapists: results of a national survey. J Geriatr Phys Ther. 2021;44(1):25-34. https://doi.org/10.1519/JPT.0000000000000289 PMID:33347041

Bowen PG, Mankowski RT, Harper SA, Buford TW. Exercise is medicine as a vital sign: challenges and opportunities. Transl J Am Coll Sports Med. 2019;4(1):1-7. https://doi.org/10.1249/TJX.0000000000000076 PMID:30828640