Rehabilitation Methodology and Strategies: A Study Guide for Physiotherapists

93 Pages·2021·1.228 MB·English

by  Giuseppe Verde

Rehabilitation
Methodology
and Strategies
A Study Guide
for Physiotherapists
Giuseppe Verde
123
Rehabilitation Methodology and Strategies
Giuseppe Verde
Rehabilitation
Methodology and
Strategies
A Study Guide for Physiotherapists
Giuseppe Verde
Sciacca (AG), Italy
English translation of the original Italian edition published by Ri.O Editore S.r.l., Milan, 2017
ISBN 978-3-030-88503-8 ISBN 978-3-030-88504-5 (eBook)
https://doi.org/10.1007/978-3-030-88504-5
© The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature
Switzerland AG 2022
This work is subject to copyright. All rights are solely and exclusively licensed by the Publisher, whether
the whole or part of the material is concerned, specifically the rights of reprinting, reuse of illustrations,
recitation, broadcasting, reproduction on microfilms or in any other physical way, and transmission or
information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar
methodology now known or hereafter developed.
The use of general descriptive names, registered names, trademarks, service marks, etc. in this publication
does not imply, even in the absence of a specific statement, that such names are exempt from the relevant
protective laws and regulations and therefore free for general use.
The publisher, the authors and the editors are safe to assume that the advice and information in this book
are believed to be true and accurate at the date of publication. Neither the publisher nor the authors or the
editors give a warranty, expressed or implied, with respect to the material contained herein or for any
errors or omissions that may have been made. The publisher remains neutral with regard to jurisdictional
claims in published maps and institutional affiliations.
This Springer imprint is published by the registered company Springer Nature Switzerland AG
The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Preface
Started in 2009 and finished in 2016, this research was first published in the Italian
language in 20171.
The term “Rehabilitation” looks like a large umbrella that gives shelter to a vast
amount of literature about single pathologies that often draw the following conclu-
sion—“further studies are required to gain more definitive knowledge”; an overview
of the matter through an exploration of rehabilitation methodology and strategies
may then be useful both for professionals and physiotherapy students.
My personal view is that the various methods and strategies of rehabilitation can
be of help to the patients when these approaches become instruments to enhance
services; in fact from their objective validity they become valuable when they solve
the orthopedic, neurologic, post-traumatic, and heart-lung problems of the patients.
In our professional practice there is also a risk of “indifference in the therapeutic
choice”—every Physiotherapist is required to act according to science and con-
science, by using objective and scientific criteria with an initial assessment and a
control of what is going to put into practice.
As Physiotherapists, we strive to gain a better understanding with the intention
of trying to solve the problems of disabled patients, by using coherent operative
modalities.
The aim of this study is to review the literature available in the topic of methodol-
ogy, methods, strategies, and techniques used in rehabilitation (together with a mild
attempt of comparing them) to ascertain both the common aspects and the diver-
gences, so as to build a system of knowledge that will turn out to be useful to
Physiotherapists in the light of the classic and recent neurophysiology.
According to Bisiacchi and Tressoldi2, the state of the art in Rehabilitation is by
no means defined, probably because it is still a young health science and if any
rehabilitator should refer to what is at their disposal in the best work evidence data
bank, such as Cochrane Library, they would not get much about the best ascertained
effectiveness.
1 The Author of the text is the same—G. Verde, Metodologia della Riabilitazione. Studio di revi-
sione per Fisioterapisti, published as ebook by RiO. The present work is a faithful, though partial,
translation of it, made by me.
2 P. Bisiacchi, P. Tressoldi, Metodologia della riabilitazione delle funzioni cognitive.
v
vi Preface
The aim of this piece of research into Rehabilitation was to synthesize the differ-
ent methods used under this umbrella term. Some topics contain only general infor-
mation—I apologize with the experts of the sectors as I preferred to keep this little
knowledge inside, instead of neglecting it completely.
Methodology of Rehabilitation is a matter of teaching in the Degree Course of
Physiotherapy because it is part of the core curriculum, which is the central knowl-
edge necessary to a student during their educational process—in fact it is said that
there can be many methods in Rehabilitation but one methodology should be looked
for, so as to plan a heuristic exercise.
The term “technique” lost its original and positive meaning (téchne = art). Today,
Physiotherapists cannot limit their work to techniques only—the use of such tech-
niques should be founded on science, as this is the main aspect that qualifies them
as health professionals. This study is a review of the current thinking about
Rehabilitation limited to studies coming mainly from the English-speaking coun-
tries with a need to search specific spaces for the therapeutic exercise, which is an
operative instrument for a Physiotherapist engaged in carrying out rehabilitative
goals, characterized by a practice generated from a theoretical reasoning and fol-
lowed by hypothesis checking, in order to produce motor recovery in the patients.
Finally, it may be useful to point out similarities and differences among some
terms such as methodology, method, strategy, and technique that are often present
in this text3.
The term methodology is defined as the complex of criteria and critical consider-
ations of techniques generally used in a scientific survey by means of methodical
principles and technical actions; the term method stands for a series of intellectual
operations, by means of which the human mind organizes its reasoning with estab-
lished links and relations among concepts.
The term technique indicates the scientific application of the method, as well as
the establishment of procedures, through which to verify and ascertain the disci-
pline and its results.
In short, the term methodology refers to the knowledge and principles through
which to organize any discipline with a reasonable method; in some cases, the term
methodology refers to a complex of rules that regulate actions which in Rehabilitation
must be translated into a temporary planning, according to its particular aiming, that
is research of functionality and autonomy in favor of a subject who shows little or
nothing of it.
Etymologically, the term method supposes the choice of a direction (meta-odos)
so as to fulfill our goal, a choice that should be driven by objective criteria, the effi-
cacy of which must be verified and shared by other subjects. In this sentence, it is
clear that methodical actions can be improved or corrected, as knowledge can be
always improved with registered actions (read paragraph 4.3 about Rehabilitation
3 The need of a common language in the field of rehabilitation, as described in the Introduction to
ICF, is outlined by C.M. Allan et al., A conceptual model for interprofessional education: the
international classification of functioning, disability and health (ICF), in J Interprof Care, 20
June 2006.
Preface vii
Directory). The term technique refers to the methodical application that can drive to
a standard of effectiveness and efficacy.
We understand the unsatisfied reply of an aged rehabilitator who wished himself
not to have to read any more the expression according to which “other scientific
studies are required to make any further research on the topic,” a research that will
not probably take place. Other works recognize “the small number of the studied
sample of people.” This way of reasoning must be followed by a final recommenda-
tion for Physiotherapists—we must verify the validity of theories that are at the base
of the rehabilitative techniques with an aim to guarantee correct treatments4.
Reminder
Methodology is the logic of the scientific inquiry—method and science cannot be
separated. In Rehabilitation, every effort must be made in order to pass from tech-
niques to method, that is to a scientific thought, in order to design a modus operandi
in favor of the patient, by using strategies recognized by the professional rules and
logical procedures—from this, a useful rehabilitative exercise is expected to be born
from the Physiotherapist’s reasoning. Methodology implies a logic organization of
the intervention which means rationality in an organized and verifiable knowledge.
Strategy is a number of approaches to the patient, rationally based and organized
but not always anchored to a scientifically strong theory, hence not scientifically
investigated. An initial assessment is necessary, in order to evidence the state of the
patient so as to give or retire the required help. Today, there is a tendency to unify
all strategies under the articulated umbrella of methodology, provided that the
Physiotherapist will verify the methodology used, as clearly stated in the Italian
Profile of Physiotherapist (Ministerial Decree n. 741/1994).
Technique is a way to solve any patient's problem or problems according to his
rehabilitative needs. The term has lost the original meaning (the Greek word techne
means art): today, Physiotherapists should go on towards art in the exercise, that is
a knowledge in which to find the main act characterizing the health professionals of
the sector—the rehabilitative exercise.
Scientifically, the way in which we solve a determined problem can be called
technique. A list of techniques does not mean a sort of their cataloging but only a
proposal to understand them and an attempt to make any possible comparison
among them: in medicine, and even more in rehabilitation, it is difficult to gain a
definitive reply.
This study is intended as a review of the knowledge of today’s rehabilitative
thought, possibly at the light of what research offers. This study does not supply any
statistical data, as it is a preliminary survey about “rehabilitative exercise,” as a main
instrument in favor of motor recovery. It will endeavor to explore the research within
the English language, with a focus on Evidence Based Medicine (EBM), and
4 S. Boccardi, Physiotherapists and research, in Italian Journal of Physiotherapy, n. 1, Mar.
2011: 37.
viii Preface
Evidence Based Practice (EBP)—a big challenge for those interested in the scien-
tific exercise of watching, measuring, and reproducing.
The present work tries also to draw an historical profile of those techniques and
strategies that have characterized the rehabilitative world in the last seventy years.
It is a little but meaningful contribution to the daily work of Physiotherapists
with any invitation to study and to make research. I will gratefully keep into high
account every suggestion, critic, and integration that I will receive both from col-
leagues and students at the hereunder address [email protected].
Sciacca (AG), Italy Giuseppe Verde
Contents
1 Physiotherapist’s Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.1 The Bologna Process . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1
1.2 Higher Education . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 2
2 Inquiry on Rehabilitation Methods . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.1 Rehabilitation According to Brunnström . . . . . . . . . . . . . . . . . . . . . . . 3
2.2 Rehabilitation According to Vojta . . . . . . . . . . . . . . . . . . . . . . . . . . . . 3
2.3 Rehabilitation According to Kabat . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4
2.4 Rehabilitation According to Bobath . . . . . . . . . . . . . . . . . . . . . . . . . . . 5
2.4.1 Principles of Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 6
2.5 Rehabilitation According to Doman-Delacato . . . . . . . . . . . . . . . . . . . 7
2.6 Rehabilitation According to Perfetti. . . . . . . . . . . . . . . . . . . . . . . . . . . 7
3 Rehabilitation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.1 Relaxation Techniques . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
3.2 Functional Bandage and Kinesiotaping . . . . . . . . . . . . . . . . . . . . . . . . 12
3.3 Stretching . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
3.4 Techniques of Joint Release . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13
3.5 Kinesitherapy in the Water . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 14
3.6 Constraint-Induced Therapy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16
4 Treatment Plan . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.1 Clinical Reasoning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
4.2 Rehabilitation Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
4.3 Rehabilitation Directory . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18
5 Guidelines and International Classifications . . . . . . . . . . . . . . . . . . . . . . 21
5.1 Guidelines . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21
5.1.1 Evidence Grading (According to NICE) . . . . . . . . . . . . . . . . . 22
5.2 International Classifications . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
5.2.1 ICF . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23
5.2.2 IHTSDO (International Health Terminology Standards
Development Organization) . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.2.3 MeSH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.2.4 SNOMED CT. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
ix
x Contents
5.3 Assessment and Measuring Scales . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24
5.4 Role of Physiotherapist . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26
6 Scientific Professional Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
6.1 Scientific Trial Based Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . 29
6.2 Problems of Scientific Practice . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
6.3 Outcomes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
6.4 Posters and Reports . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
7 Scientific Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
7.1 Data Banks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35
7.1.1 AMSTAR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36
7.1.2 BNI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
7.1.3 CAHE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
7.1.4 CENTRAL . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
7.1.5 CINAHL. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
7.1.6 CIRRIE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
7.1.7 COCHRANE Collaboration. . . . . . . . . . . . . . . . . . . . . . . . . . . 37
7.1.8 DARE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
7.1.9 EBSCO . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
7.1.10 EMBASE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
7.1.11 EPOC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
7.1.12 EQUATOR . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
7.1.13 ERIC . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
7.1.14 MEDLINE . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
7.1.15 Medical Subject Headings . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
7.1.16 NLH . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
7.1.17 OSTMED . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39
7.1.18 PEDro . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
7.1.19 Physiotherapy Choices . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
7.1.20 PubMed . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
7.1.21 REHABDATA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
7.1.22 TRiP . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
7.1.23 WHOLIS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40
7.2 Research Centers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41
7.3 Typology of Studies According to EBP . . . . . . . . . . . . . . . . . . . . . . . . 42
8 Suggestions for Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
8.1 Proposed Terminology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45
8.2 Methodology of Research . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
8.3 Commented Webliography . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47
8.4 Research Journals . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54
9 Various Domains of Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
9.1 Neurologic Rehabilitation . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57
9.2 Orthopedic and Traumatologic Rehabilitation . . . . . . . . . . . . . . . . . . . 58
9.2.1 Post-traumatic Blocks . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59