Community Physiotherapy Service Research Articles

A case study exploration of Parkinson's disease

This article will explore the case of an 82-year-old woman, who was referred by primary care into community physiotherapy service with a 12–18-month history of reducing mobility, rapid shuffling gait, and three falls in the last 6 months. After careful clinical history-taking and examination, a diagnosis of Parkinson's disease was given. This article will deliberate the aetiology and epidemiology of Parkinson's disease; it will discuss the presenting symptoms and why these were deemed more in keeping with Parkinson's rather than other considered differentials. The treatment and management offered will also be explored and the evidence relating to these decisions will be reflected upon.

Survey of people with Myalgic Encephalomyelitis (ME) to explore their use and experiences of physiotherapy services in the UK

Purpose: 250,000 people live with Myalgic Encephalitis (ME) in the UK, this compares to 100,000 living with Multiple Sclerosis. In 2019, a survey by MEAction of 1906 people with ME, identified that over 50% of people who attended specialists ME clinics, employing physiotherapists, were unsatisfied with the services. People with ME (PwME) are also seen in regular musculoskeletal, community, neurological and paediatric physiotherapy services but the views of PwME related to these services are not known. The aim of this present survey, therefore, was to identify the experiences of PwME of physiotherapy services throughout all areas of physiotherapy practice.

People with physical disabilities in Sri Lanka are in need for the service of community physiotherapists

Background: Physiotherapists have long been recognized as important providers of services for people with disability. In Sri Lanka the concept of community physiotherapy has not emerged yet. The present study aimed to identify the need for ‘community physiotherapy service’ in Kandy district, Sri Lanka. Methods: A community service projection community based rehabilitation, of three years was conducted by the department of physiotherapy, faculty of allied health sciences, University of Peradeniya, Sri Lanka in 2017-2019 in collaboration with department of social service and social welfare of Kandy district secretariat, Sri Lanka.Results: One hundred and seventy participants with physical disabilities were included in the study 94 (55.29%) were males (mean age; 33.57 (SD ±23.17) and 76 (44.71%) were females (mean age; 33.14 (SD ±24.98). The pediatric population was 41.76% (N=71) followed by 38.82% of adults (N=66) and 19.41% of elderly patients (N=33) of the total population. The highest number of PWD had pediatric conditions (39.41%), followed by musculoskeletal (31.76%), neurological (15.88%), geriatric (8.82%) and cardio-respiratory (4.12%) conditions. The majority (55.88%) of all the people with disabilities who visited the clinics were in need for further physiotherapy consultation and follow up.Conclusions: In Kandy district of Sri Lanka alone, number of people with physical disabilities who are in need of continuous physiotherapy follow ups is high compared to services already available. Conducting a successful community-based rehabilitation program in Sri Lanka as a whole, require having a specialized health care practitioner to the primary health care team; ‘a community physiotherapist’.

Immediate Effects of two Isometric Calf Muscle Exercises on Mid-portion Achilles Tendon Pain

The objectives of this randomized, cross-over pilot study were to determine whether isometric plantarflexion exercises resulted in an immediate change in Achilles tendon pain during a loading task, and whether this differed in knee extension or flexion. Eleven participants with mid-portion Achilles tendinopathy were recruited from NHS community physiotherapy services and local running clubs. Participants were then randomized to complete an isometric calf muscle exercise with the knee fully extended or flexed to 80°. Participants switched to the alternate exercise after a minimum seven-day period. Achilles tendon pain during a specific, functional load test was measured on a 11-point numeric pain rating scale (NPRS) pre- and post-intervention. There was a small, immediate, mean reduction in pain following isometric plantar flexion performed in both knee extension (1.6, 95%CI 0.83 to 2.45, p=0.001) and knee flexion (1.3, 95%CI 0.31 to 2.19, p=0.015). There were no significant differences between the two positions. A non-significant, potentially clinically relevant finding was a 20% larger reduction in symptoms in knee extension versus flexion (p=0.110). In conclusion, isometric plantarflexion holds gave an approximately 50% immediate reduction in Achilles tendon pain with a functional load test. There were no significant differences between the two positions and both were well tolerated.

Physio4FMD: protocol for a multicentre randomised controlled trial of specialist physiotherapy for functional motor disorder

BackgroundPatients with functional motor disorder (FMD) experience persistent and disabling neurological symptoms such as weakness, tremor, dystonia and disordered gait. Physiotherapy is usually considered an important part of treatment; however, sufficiently-powered controlled studies are lacking. Here we present the protocol of a randomised controlled trial (RCT) that aims to evaluate the clinical and cost effectiveness of a specialist physiotherapy programme for FMD.Methods/designThe trial is a pragmatic, multicentre, single blind parallel arm randomised controlled trial (RCT). 264 Adults with a clinically definite diagnosis of FMD will be recruited from neurology clinics and randomised to receive either the trial intervention (a specialist physiotherapy protocol) or treatment as usual control (referral to a community physiotherapy service suitable for people with neurological symptoms). Participants will be followed up at 6 and 12 months. The primary outcome is the Physical Function domain of the Short Form 36 questionnaire at 12 months. Secondary domains of measurement will include participant perception of change, mobility, health-related quality of life, health service utilisation, anxiety and depression. Health economic analysis will evaluate the cost impact of trial and control interventions from a health and social care perspective as well as societal perspective.DiscussionThis trial will be the first adequately-powered RCT of physical-based rehabilitation for FMD.Trial registrationInternational Standard Randomised Controlled Trials Number ISRCTN56136713. Registered 27 March 2018.

Characteristics and determinants of community physiotherapy utilization and supply

BackgroundDemand for Physiotherapy is on the rise due to increasing ageing population and consequent disability and morbidity. However, the costs of healthcare in developing countries are rising, and healthcare resources are limited making the supply of Physiotherapy services challenging in rural communities. Availability of Physiotherapy may help to reduce the burden of disability and enhance efficiency of healthcare systems. This study investigated the characteristics and associations of utilization and supply of community Physiotherapy in Nigeria.MethodsCross-sectional survey of 336 consenting community dwelling individuals from three selected communities in Nigeria was carried out. A three-section validated self-developed questionnaire which sought information on socio-demographics, utilization and supply of community Physiotherapy, as well as how to improve community Physiotherapy services was used. A household was used as the primary sampling unit in the study. Inferential and Descriptive statistics were used to assess the data.ResultsLifetime, 12-month and point utilization of physiotherapy was 21.7, 7.4 and 2.7% respectively. Physiotherapy utilization was significantly associated with level of education (p = 0.007), belief on pain as “spiritual” (p = 0.020) and religious belief (p = 0.001). The respondents with primary, secondary and tertiary education were 14.3, 13.9 and 26 times more likely to utilize physiotherapy services, respectively. Those who ‘agree’ or were ‘not sure’ that their religious belief was against physiotherapy were 92 and 83% less likely to utilize physiotherapy services, respectively compared with those who ‘disagree’. Availability and supply of Physiotherapy services were mostly at the township teaching hospital (47.9%) and private hospitals (20.5%). The supply of Physiotherapy services within the communities was mostly on temporary basis (24.7%) and through visiting Physiotherapists (21.4%). Physiotherapy services utilized was mainly exercise (46.6%) and soft tissue mobilization (41.1%). Travel costs (32.6%), time constraints (27.9%) and work commitments (24.8%) were the constraints for Physiotherapy utilization while positive beliefs and higher education improved Physiotherapy utilization.ConclusionsUtilization and supply of Physiotherapy services in Nigerian rural community was low. Low utilization of Physiotherapy services in Nigerian rural communities were most significantly influenced by low educational status and beliefs about pain.

Evaluating the effectiveness of home exercise programmes using an online exercise prescription tool in children with cerebral palsy: protocol for a randomised controlled trial

IntroductionChildren with cerebral palsy (CP) and other neurodevelopmental disabilities often receive a home programme of exercises to assist in reaching their therapy goals. Adherence to exercise programmes is necessary to...

Producing a data-inputting and analysis calculator to facilitate the implementation and standardisation of outcome measures in a community physiotherapy service

Purpose: The advantages for using patient-reported outcome measures (PROMS) have been well documented in the literature. The need for physiotherapists to use standardised PROMS has been recognised and is recommended in clinical guidelines. Although the importance of standardising the use of PROMS within the physiotherapy profession is well recognised, it has largely failed to be delivered in practice. A number of barriers for implementation of standardised outcome measures has been reported including the lack of knowledge and the lack of instructions in relation to the application, scoring and interpretation of the outcome measure(s).

Integrating a NHS community physiotherapy and musculoskeletal clinical assessment service: a service evaluation

Integrating a NHS community physiotherapy and musculoskeletal clinical assessment service: a service evaluation

The Functional Fitness MOT Test Battery for Older Adults: Protocol for a Mixed-Method Feasibility Study.

BackgroundIncreasing physical activity (PA) brings many health benefits, but engaging people in higher levels of PA after their 60s is not straightforward. The Functional Fitness MOT (FFMOT) is a new approach which aims to raise awareness about the importance of components of fitness (strength, balance, flexibility), highlight benefits of PA, engages older people in health behavior change discussions, and directs them to local activity resources. This battery of tests combined with a brief motivational interview has not been tested in terms of feasibility or effectiveness.ObjectiveTo assess whether the FFMOT, provided in a health care setting, is appealing to older patients of a community physiotherapy service and to understand the views and perceptions of the older people undergoing the FFMOT regarding the intervention, as well as the views of the physiotherapy staff delivering the intervention. Secondary aims are to assess the feasibility of carrying out a phase 2 pilot randomized controlled trial of the FFMOT, in the context of a community physiotherapy service, by establishing whether enough patients can be recruited and retained in the study, and enough outcome data can be generated.MethodsA mixed-methods feasibility study will be conducted in two physiotherapy outpatient clinics in the United Kingdom. A total of 30 physically inactive, medically stable older adults over the age of 60 will be provided with an individual FFMOT, comprising a set of six standardized, validated, age-appropriate tests aimed at raising awareness of the different components of fitness. The results of these tests will be used to provide the participants with feedback on performance in comparison to sex and age-referenced norms. This will be followed by tailored advice on how to become more active and improve fitness, including advice on local opportunities to be more active. Subsequently, participants will be invited to attend a focus group to discuss barriers and motivators to being more active, health behavior change, and the scope for individuals to improve their PA levels. To inform the design of a future trial, descriptive (eg, recruitment and retention rates), quantitative (Community Healthy Activities Model Program for Seniors; CHAMPS physical activity questionnaire), and qualitative data (focus group discussions, semi-structured staff interviews) will be collected.ResultsRecruitment and enrolment for the trial started in September 2015. Follow-up will be completed in June 2016. Results are expected to be available at the end of 2016.DiscussionAllied health professionals play a key role in encouraging older adults to increase their PA, but with little evidence on how best to do this within their clinical practice. The purpose of this feasibility study is to examine the introduction of a new service: The FFMOT. The views and perceptions of the older people undergoing the FFMOT and relating to its delivery in clinical practice will be explored. Data, which will inform the feasibility of a randomized controlled trial of effectiveness of the FFMOT in promoting improved PA, will be reported.Trial RegistrationInternational Standard Randomized Controlled Trial Number (ISRCTN): ISRCTN38950042; http://www.isrctn.com/ISRCTN38950042

Characteristics of supply and demand in community physiotherapy services

Characteristics of supply and demand in community physiotherapy services

Primum non nocere: shared informed decision making in low back pain--a pilot cluster randomised trial.

BackgroundLow back pain is a common and disabling condition leading to large health service and societal costs. Although there are several treatment options for back pain little is known about how to improve patient choice in treatment selection. The purpose of this study was to pilot a decision support package to help people choose between low back pain treatments.MethodsThis was a single-centred pilot cluster randomised controlled trial conducted in a community physiotherapy service. We included adults with non-specific low back pain referred for physiotherapy. Intervention participants were sent an information booklet prior to their first consultation. Intervention physiotherapists were trained to enhance their skills in shared informed decision making. Those in the control arm received care as usual. The primary outcome was satisfaction with the treatment received at four months using a five-point Likert Scale dichotomised into “satisfaction” (very satisfied or somewhat satisfied) and “non-satisfaction” (neither satisfied nor dissatisfied, somewhat dissatisfied or very dissatisfied).ResultsWe recruited 148 participants. In the control arm 67% of participants were satisfied with their treatment and in the intervention arm 53%. The adjusted relative risk of being satisfied was 1.28 (95% confidence interval 0.79 to 2.09). For most secondary outcomes the trend was towards worse outcomes in the intervention group. For one measure; the Roland Morris Disability Questionnaire, this difference was clinically important (2.27, 95% confidence interval 0.08 to 4.47). Mean healthcare costs were slightly lower (£38 saving per patient) within the intervention arm but health outcomes were also less favourable (0.02 fewer QALYs); the estimated probability that the intervention would be cost-effective at an incremental threshold of £20,000 per QALY was 16%.ConclusionWe did not find that this decision support package improved satisfaction with treatment; it may have had a substantial negative effect on clinical outcome, and is very unlikely to prove cost-effective. That a decision support package might have a clinically important detrimental effect is of concern. To our knowledge this has not been observed previously. Decision support packages should be formally tested for clinical and cost-effectiveness, and safety before implementation.Trial registrationCurrent Controlled Trials ISRCTN46035546 registered on 11/02/10.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2474-15-282) contains supplementary material, which is available to authorized users.

A physiotherapy telephone assessment and advice service for patients with musculoskeletal problems can improve the process of care while maintaining clinical effectiveness

Does a physiotherapy telephone assessment and advice service (PhysioDirect) affect physical health and improve the process of care in patients with musculoskeletal problems? Randomised controlled trial with concealed allocation and blinded outcome assessment. Four community physiotherapy services drawing patients from 94 general practices in England. Adults referred by a general practitioner or self-referred to physiotherapy for a musculoskeletal problem were eligible for inclusion. Referral from a consultant and an inability to communicate in English were key exclusion criteria. Randomisation of 2256 participants at a ratio of 2:1 allocated 1513 to PhysioDirect and 743 to the usual care physiotherapy. PhysioDirect participants were invited to telephone a physiotherapist for initial assessment and advice followed by further telephone advice and face-to-face physiotherapy if necessary. After the initial call most participants were sent written advice about self management and exercises. The usual-care comparison group joined a waiting list for face-to-face physiotherapy management. The primary outcome was change in physical health, measured with the physical component summary (PCS) measure from the SF-36 questionnaire at 6 weeks and 6 months. Secondary clinical outcome measures included the Measure Yourself Medical Outcomes Profile, global improvement in the main problem, and questions about satisfaction from the General Practice Assessment Questionnaire; and measures of process of care, including number of appointments, and waiting time. Primary outcome data were obtained from 85% of participants at 6 months. There was no difference in the SF-36 PCS measure between the PhysioDirect and comparison groups at 6 months (Mean difference (MD) = -0.01, 95% CI -0.80 to 0.79) and 6 weeks (MD 0.42, 95% CI -0.28 to 1.12). There were no differences between the groups in other clinical outcomes at 6 months, but there were small improvements in the PhysioDirect group at 6 weeks in the global improvement score (MD 0.15 units, 95% CI 0.02 to 0.28) and in the Measure Yourself Medical Outcomes Profile score (MD -0.19 units, 95%CI -0.30 to -0.07). 47% of PhysioDirect participants were managed entirely by telephone, and they had fewer face-to- face appointments (mean 1.9 vs 3.1), and a shorter wait for physiotherapy treatment (median 7 vs 34 days) than the comparison group. PhysioDirect participants were less satisfied with the service than the comparison group (MD -3.8%, 95% CI -7.3 to -0.3). Providing an initial telephone physiotherapy service for patients with musculoskeletal problems that reduced waiting time and required fewer appointments was as effective as providing face-to-face physiotherapy, but was associated with slightly lower patient satisfaction.

A pragmatic randomised controlled trial of the effectiveness and cost-effectiveness of ‘PhysioDirect’ telephone assessment and advice services for physiotherapy

As a result of long delays for physiotherapy for musculoskeletal problems, several areas in the UK have introduced PhysioDirect services in which patients telephone a physiotherapist for initial assessment and treatment advice. However, there is no robust evidence about the effectiveness, cost-effectiveness or acceptability to patients of PhysioDirect. To investigate whether or not PhysioDirect is equally as clinically effective as and more cost-effective than usual care for patients with musculoskeletal (MSK) problems in primary care. Pragmatic randomised controlled trial to assess equivalence, incorporating economic evaluation and nested qualitative research. Patients were randomised in 2 : 1 ratio to PhysioDirect or usual care using a remote automated allocation system at the level of the individual, stratifying by physiotherapy site and minimising by sex, age group and site of MSK problem. For the economic analysis, cost consequences included NHS and patient costs, and the cost of lost production. Cost-effectiveness analysis was carried out from the perspective of the NHS. Interviews were conducted with patients, physiotherapists and their managers. Four community physiotherapy services in England. Adults referred by general practitioners or self-referred for physiotherapy for a MSK problem. Patients allocated to PhysioDirect were invited to telephone a senior physiotherapist for initial assessment and advice using a computerised template, followed by face-to-face care when necessary. Patients allocated to usual care were put on to a waiting list for face-to-face care. Primary outcome was the Short Form questionnaire-36 items, version 2 (SF-36v2) Physical Component Score (PCS) at 6 months after randomisation. Secondary outcomes included other measures of health outcome [Measure Yourself Medical Outcomes Profile, European Quality of Life-5 Dimensions (EuroQol health utility measure, EQ-5D), global improvement, response to treatment], wait for treatment, time lost from work and usual activities, patient satisfaction. Data were collected by postal questionnaires at baseline, 6 weeks and 6 months, and from routine records by researchers blind to allocation. A total of 1506 patients were allocated to PhysioDirect and 743 to usual care. Patients allocated to PhysioDirect had a shorter wait for treatment than those allocated to usual care [median 7 days vs 34 days; arm-time ratio 0.32, 95% confidence interval (CI) 0.29 to 0.35] and had fewer non-attended face-to-face appointments [incidence rate ratio 0.55 (95% CI 0.41 to 0.73)]. The primary outcome at 6 months' follow-up was equivalent between PhysioDirect and usual care [mean PCS 43.50 vs 44.18, adjusted difference in means -0.01 (95% CI -0.80 to 0.79)]. The secondary measures of health outcome all demonstrated equivalence at 6 months, with slightly greater improvement in the PhysioDirect arm at 6 weeks' follow-up. Patients were equally satisfied with access to care but slightly less satisfied overall with PhysioDirect compared with usual care. NHS costs (physiotherapy plus other relevant NHS costs) per patient were similar in the two arms [PhysioDirect £ 198.98 vs usual care £ 179.68, difference in means £ 19.30 (95% CI -£ 37.60 to £ 76.19)], while QALYs gained were also similar [difference in means 0.007 (95% CI -0.003 to 0.016)]. Incremental cost per QALY gained was £ 2889. The probability that PhysioDirect was cost-effective at a £ 20,000 willingness-to-pay threshold was 88%. These conclusions about cost-effectiveness were robust to sensitivity analyses. There was no evidence of difference between trial arms in cost to patients or value of lost production. No adverse events were detected. Providing physiotherapy via PhysioDirect is equally clinically effective compared with usual waiting list-based care, provides faster access to treatment, appears to be safe, and is broadly acceptable to patients. PhysioDirect is probably cost-effective compared with usual care.

Exploring Wait List Prioritization and Management Strategies for Publicly Funded Ambulatory Rehabilitation Services in Ontario, Canada: Further Evidence of Barriers to Access for People with Chronic Disease

Timely access to publicly funded health services is a priority issue across the healthcare continuum in Canada. The purpose of this study was to examine wait list management strategies for publicly funded ambulatory rehabilitation services in Ontario, Canada. Ambulatory rehabilitation services were defined as community occupational therapy (OT) and physiotherapy (PT) services. A mailed self-administered questionnaire was sent to all 374 Ontario publicly funded sites. Descriptive statistics were used to explore management strategies. The response rate was 57.2%. Client acuity was the most common method used to prioritize access across all settings. The most frequently reported methods to manage wait lists included teaching self-management strategies (85.0%), implementing attendance policies (69.5%) and conducting wait list audits (67.3%). Ambulatory rehabilitation settings have implemented a number of strategies for wait list management. The results of this study suggest that an increasing number of Ontarians encounter barriers when accessing publicly funded ambulatory rehabilitation services.

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

Wait Times for Publicly Funded Outpatient and Community Physiotherapy and Occupational Therapy Services: Implications for the Increasing Number of Persons with Chronic Conditions in Ontario, Canada

Timely access to publicly funded health services has emerged as a priority policy issue across the continuum of care from hospitals to the home and community sector. The purpose of this study was to examine wait lists and wait times for publicly funded outpatient and community occupational therapy (OT) and physical therapy (PT) services. A mailed self-administered questionnaire was sent in December 2005 to all publicly funded sites across Ontario that deliver outpatient or community OT or PT services (N = 374). Descriptive statistics were used to describe the study sample and to examine wait lists and wait times by setting and client condition. Overall response rate was 57.2% (n = 214). More than 10,000 people were reported to be waiting for OT or PT services across Ontario. Of these, 16% (n = 1,664) were waiting for OT and 84% (n = 8,842) for PT. Of those waiting for OT, 59% had chronic conditions and half were waiting for home care rehabilitation services. Of those waiting for PT, 73% had chronic conditions and 81% were waiting at hospital outpatient departments. Individuals with chronic conditions experience excessive wait times for outpatient and community OT and PT services in Ontario, particularly if they are waiting for services in hospital outpatient departments.

Propuesta de medidas de intervención para gestionar las ausencias de pacientes en salas de fisioterapia

Aim To identify causes of physiotherapy sessions lost in community services. We purpose interventions to manage these absences. Methods A quality improvement group was performed, and the number of physiotherapy sessions lost was monitored in three community physiotherapy services. A control chart was done to detect external causes of instability. Internal causes were detected using a descriptive study. Results We studied 465 patients who began treatment. 61,1 % of them lost some treatment session. In this group 22,9 % accumulated more than 5 absences. Number of sessions lost by the own patient responsibility range from 9,8 to 13,8 %. Patients from 45 to 64 years old present the large number of absences (42,3 %). Conclusions We found some out of control points in the control chart. The typical patient who presents the large number of absences to treatment sessions is a 45 to 64 years old and has a neurological, soft tissue or traumatic illness anyway after surgical procedure.

Community physiotherapy for children with cystic fibrosis: A family satisfaction survey

Background and purpose Input of a specialist physiotherapist is integral to the management of children with cystic fibrosis (CF). In recent years, many regional centres have developed specialist physiotherapy posts based in the community. The aim of this study was to ascertain the effectiveness of the community physiotherapy service in Newcastle upon Tyne, from the families' point of view. Methods The current service was reviewed and a questionnaire was developed and sent to all families with a child/children attending the regional paediatric centre for full care. It was adapted from a standardised patient satisfaction survey and included both open and closed questions. Results One hundred and six questionnaires were sent with a response rate of 50%. Eighty-nine percent of respondents had been reviewed by the community physiotherapist. Ninety-one percent were satisfied with the overall service provided. They felt involved in the treatment plan (94%) and understood the reasons for follow up visits (92%). Eighty-five percent of respondents had a contact number for the community physiotherapist. Comments from parents were generally positive. Many families requested increased input in the home as they found it more beneficial than review in the clinic setting. Conclusions There was a high rate of satisfaction with specialist physiotherapy support in the community for children with CF among families who responded to the patient satisfaction survey.

The reliability of balance, mobility and self-care measures in a population of adults with a learning disability known to a physiotherapy service

To estimate the reliability of three measures of balance, mobility and activity for use in clinical and research physiotherapy, with adults with a learning disability. Prospective study to investigate test-retest and inter-rater reliability. Participants' homes and day centres. The Berg Balance Scale (BBS), the Rivermead Mobility Index (RMI) and the Barthel Activities of Daily Living Index (BI). Of the 181 adults known to the Nottingham Community Physiotherapy Service for Adults with Learning Disabilities, 64 with a known Rivermead Mobility score of less than three were excluded. Of 117 randomized, a further 21 were found to fail this criteria, 27 had acute medical, social or behavioural problems, 22 were unable to participate or refused: therefore 47 entered the study. Participants were visited in their own homes by two researchers on two occasions, one week apart and rated independently by each rater. Agreement was assessed with the kappa statistic (kappa) and percentage agreement for each item in each scale, and described using standard classification. Intraclass correlation coefficients for inter-rater and test-retest total scores and average differences of total scores, their standard deviations and limits of agreement, were calculated. For inter-rater observations, the Barthel Index and the Rivermead Mobility Index had almost perfect agreement (kappa = 0.86-1.00 and 0.89-1.00 respectively), with the Berg Balance Scale having substantial to almost perfect agreement (kappa = 0.74-1.00). For test-retest comparisons, both the Barthel Index and the Rivermead Mobility Index demonstrated moderate to almost perfect agreement (kappa = 0.57-1.00 and 0.45-1.00 respectively). Kappa scores for the Berg Balance Scale varied from low to almost perfect agreement (kappa = 0.37-1.00). The Berg Balance Scale, Rivermead Mobility Index and Barthel Activities of Daily Living Index are all reliable clinical and research tools for physiotherapists working with adults with learning disabilities.