Managing Mobility After Stroke: Education Of Physiotherapists, Physiotherapy Students And Patients

Abstract

Stroke is a major cause of disability worldwide. The inability to walk and low levels of physical activity after stroke lead to poor participation in the community, reduced quality of life and increased risk of recurrent stroke. The aim of this thesis, therefore, was to enhance mobility after stroke by increasing knowledge of physiotherapists about walking outcome after stroke; increasing physiotherapy student skills in training walking after stroke; and finally by increasing physical activity in stroke survivors via self-management. Study 1, a systematic review, found that 60% of non-ambulatory stroke survivors in rehabilitation regained independent walking at 3 months which increased to 65% by 6 months after stroke. In an acute unit only 39% of non-ambulatory stroke survivors regained independent walking at 3-months and this increased to 69% at 6 months. Study 2 examined the effect of e-learning in teaching physiotherapy students the practical skills related to training walking after stroke compared with usual teaching. The results indicated e-learning improved physiotherapy students’ ability to effectively implement and provide a rationale for the practical skills. Students perceived the e-learning resource to be very useful. Study 3, a feasibility study, found that a 3-month self-management program was feasible for increasing physical activity, self-efficacy for exercise, walking ability, participation and quality of life. Cardiovascular risks were unchanged. Physiotherapists should utilise the increased knowledge regarding prognosis of walking after stroke to provide accurate education and goal setting for patients, and to effectively allocate resources during rehabilitation. Physiotherapists working in higher education should consider the use of e-learning to enhance learning of practical skills in physiotherapy students. Finally, educating and empowering stroke survivors via self-management, may be a promising strategy for increasing physical activity.