Muscle strengthening in stroke rehabilitation: knowledge of and barriers to its use by UK neuro-physiotherapists

Deficits in muscle strength are common after stroke and have a strong relationship to functional limitations experienced by stroke patients. Resistance muscle strengthening has been advocated in stroke rehabilitation, yet uptake in clinical practice appears limited. What constitutes muscle strengthening and the barriers and challenges preventing clinicians from implementing its use has not been investigated. This study provides an insight into the clinical decision making process by neuro-physiotherapists, factors that influence their decision to undertake strength training in stroke rehabilitation and the potential barriers to the implementation of muscle strength training. A cross-sectional survey of 700 neuro-physiotherapists registered with the Association of Physiotherapists in Neurology (ACPIN) was conducted with a response rate of 57.2% (N = 401). The results showed 87.5% (N = 351) respondent neuro-physiotherapists undertake muscle strengthening χ2 = 3.16, df = 3, p = 0.37. Factors that influenced the use of muscle strengthening included reading of literature (χ2 = 31.9, df = 1, p < 0.05); attending continuous professional development programmes (χ2 = 86.2, df = 1, p < 0.05); and specialism of practice (χ2 = 66.65, df = 5, p < 0.05); while years of practice, and the number of patients managed weekly had a weak positive association. Comparative analysis showed that factors that constitute barriers to the use of muscle strengthening included: lack of time, excess work load, reduced staff, and poor cognitive abilities of the patients. It was also observed that neuro-physiotherapists were inclined to use an eclectic management approach in stroke rehabilitation, rather than a single based treatment approach. Key Words: Muscle weakness, Muscle strength training, Knowledge, Clinical decision making, Barriers, Evidence-Based Practice.