Abstract
Background: To facilitate improvement in participation, therapy needs to be transferred into everyday life of people with chronic stroke. Individualised, home based, self-training exercise programs should be oriented towards the potential of the person, be specific to their ability and impairment levels, avoid compensation strategies as far as possible and operate at the upper limit of the individual’s ability level. Objectives: To investigate the effectiveness of an individualised learning and exercise program based on the Bobath concept for facilitating personal goal achievement in people with chronic stroke. Method: Repeated measures design. Fifty-five people with chronic stroke were recruited from participants in Advanced Bobath training courses. During the five day course, participants learned individualised self-training programs, which they then carried out at home for three months, adapting their program according to their performance level. The primary outcome measure was the Canadian Occupational Performance Measure (COPM) - Performance domain. Secondary measures included the COPM satisfaction domain, World Health Organisation Disability Assessment Score-2 (WHO-DAS2), and Goal Attainment Score (GAS). Measurements were taken three months and immediately prior to the Bobath course and three months after the course. Results: COPM-Perfomance, COPM-Satisfaction and the WHODAS-2 showed a significant difference over the time points, with followup scores significantly greater than both baseline and preintervention (p<.001). Sixty eight percent of participants achieved their personal goals (GAS). Conclusion: The study indicates that an individualised self-training approach based on Bobath principles may enable the transfer of acquired proficiency into the personal goals of people with chronic stroke.
Highlights
There is growing interest in rehabilitation interventions extending beyond the subacute phase for stroke survivors [1, 2] underpinned by studies showing poor outcomes for quality of life and participation [3, 4]
Participants: People with chronic stroke who had agreed to participate in a five day Advanced Bobath training course for physiotherapists and occupational therapists were invited to participate in the study
In Advanced Bobath training courses certified by the International Bobath Instructor Training Association (IBITA), people with neurological diagnoses attend for daily 90 minute assessment and treatment sessions conducted by course participants, under the supervision tutors
Summary
There is growing interest in rehabilitation interventions extending beyond the subacute phase for stroke survivors [1, 2] underpinned by studies showing poor outcomes for quality of life and participation [3, 4]. In Bobath practice, interventions are necessarily individualised; this applies to the therapist/ patient interaction and development of self training programs. In this context, the question arises as to whether an individualized self training program, developed in accordance with Bobath principles, will bring about improvements in participation in stroke survivors. Objectives: To investigate the effectiveness of an individualised learning and exercise program based on the Bobath concept for facilitating personal goal achievement in people with chronic stroke. Conclusion: The study indicates that an individualised self-training approach based on Bobath principles may enable the transfer of acquired proficiency into the personal goals of people with chronic stroke
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