Defining the Bobath concept using the Delphi technique

Background and Purpose . The Bobath concept, based on the work of Berta and Karel Bobath, offers therapists working in the field of neurological rehabilitation a framework for their clinical interventions. It is the most commonly used approach in the UK. Although they recognize that over the last half‐century the concept has undergone considerable developments, proponents of the Bobath concept have been criticized for not publishing these changes. The aim of the present study was to use the Delphi technique to enable experts in the field to define the current Bobath concept. Method . A four‐round Delphi study design was used. The sample included all members of the British Bobath Tutor's Association, who are considered experts in the field. Initial statements were identified from the literature, with respondents generating additional statements during the study. The level of agreement was determined using a five‐point Likert scale. The respondents were then provided with feedback on group opinions and given an opportunity to re‐rate each statement. The level of group consensus was set at 80%. Results . Fifteen experts took part. The response rate was 85% in the first round, and 93% in each subsequent round. Ten statements from the literature were rated with a further 12 generated by the experts. Thirteen statements achieved consensus for agreement and seven for disagreement. Conclusions . The Delphi study was an effective research tool, maintaining anonymity of responses and exploring expert opinions on the Bobath concept. The experts stated that Bobath's work has been misunderstood if it is considered as the inhibition of spasticity and the facilitation of normal movement, as described in some literature. They agreed that the Bobath concept was developed by the Bobaths as a living concept, understanding that as therapists' knowledge base grows their view of treatment broadens. Copyright © 2006 John Wiley & Sons, Ltd.     

Bobath理论与历史的变迁

Bobath理论是为中枢神经系统疾病患者开发的治疗与康复技术,可应用于成人及儿童。它最初源于Berta与Karel Bo-bath的临床经验以及当时的运动控制理论模型。这种整体性治疗技术经历了50多年的发展,今天已经以新的运动控制和运动学习理论模型为指导。它的理论框架将随着运动科学知识的更新而不断丰富、发展。     

Physiotherapy,based on the Bobath concept,may influence the gait pattern in persons with limb‐girdle muscle dystrophy: a multiple case series study

Background and Purpose. There are few studies on possible effects of physiotherapy for adults with muscular dystrophy. The aim of this study was to examine if treatment based on the Bobath concept may influence specific gait parameters in some of these patients. Methods. A single‐subject experimental design with A–B–A–A phases was used, and four patients, three with limb‐girdle muscular dystrophy (LGMD) and one with fascioscapulohumeral muscular dystrophy (FSHD), were included. The patients had 1 hour of individually tailored physiotherapy at each working day for a period of 3 weeks. Step length, step width and gait velocity were measured during the A–B–A–A phases by use of an electronic walkway. Walking distance and endurance were measured by use of the ‘6 minute walk test’. Results. The three LGMD patients, who initially walked with a wide base of support, had a narrower, velocity‐adjusted step width after treatment, accompanied with the same or even longer step length. These changes lasted throughout follow‐up. Moreover, two of the patients were able to walk a longer distance within 6 minutes after the treatment period. The fourth patient (with FSHD) had a normal step width at baseline, which did not change during the study. Conclusions. The results indicate that physiotherapy treatment based on the Bobath concept may influence the gait pattern in patients with LGMD. However, in order to evaluate the effectiveness of physiotherapy to patients with muscular dystrophies, we call for larger studies and controlled trials. Copyright © 2010 John Wiley & Sons, Ltd.     

Balance and gait improved in patients with MS after physiotherapy based on the Bobath concept

Background and Purpose . Patients with multiple sclerosis (MS) tend to have movement difficulties, and the effect of physiotherapy for this group of patients has been subjected to limited systematic research. In the present study physiotherapy based on the Bobath concept, applied to MS patients with balance and gait problems, was evaluated. The ability of different functional tests to demonstrate change was evaluated. Method . A single‐subject experimental study design with ABAA phases was used, and two patients with relapsing–remitting MS in stable phase were treated. Tests were performed 12 times, three at each phase: A (at baseline); B (during treatment); A (immediately after treatment); and A (after two months). The key feature of treatment was facilitation of postural activity and selective control of movement. Several performance and self‐report measures and interviews were used. Results . After intervention, improved balance was shown by the Berg Balance Scale (BBS) in both patients, and improved quality of gait was indicated by the Rivermead Visual Gait Assessment (RVGA). The patients also reported improved balance and gait function in the interviews and scored their condition as ‘much improved’. Gait parameters, recorded by an electronic walkway, changed, but differently in the two patients. Among the physical performance tests the BBS and the RVGA demonstrated the highest change, while no or minimal change was demonstrated by the Rivermead Mobility Index (RMI) and Ratings of Perceived Exertion (RPE). Conclusion . The findings indicate that balance and gait can be improved after physiotherapy based on the Bobath concept, but this should be further evaluated in larger controlled trials of patients with MS. Copyright © 2006 John Wiley & Sons, Ltd.     

上田法与Bobath法治疗偏瘫儿童上肢痉挛期的疗效评定

目的 探讨偏瘫儿童痉挛期在临床康复训练中降低患侧上肢肌张力，促进患肢及手的功能发育的方法。方法 32例符合条件的偏瘫儿随机分为上田组和Bobath组，每组16例，并在训练前1周进行功能检查评测，然后分别用上田法与Bobath法降低患侧上肢肌张力，抑制异常姿势痉挛控制后，两组均进行有选择的、不引起痉挛的作业活动来诱发和促进患肢及手的功能恢复，疗程为3个月。以上田敏偏瘫上肢功能评价法的详细分级与Burnnstrin偏瘫手的功能评价法进行评测。结果 通过治疗前后对照，上田组患肢肌张力降低程度和患肢及手的功能提高均明显优于Bobath组。结论 上田法在降低偏瘫儿童痉挛期上肢肌张力方面具有显著疗效。     

延续性Kegel 运动联合Bobath球训练对二胎顺产分娩产妇产后盆底康复的疗效观察

目的：探讨延续性Kegel 运动联合Bobath球训练对二胎顺产分娩产妇产后盆底肌康复的疗效。方法：顺产分娩足月单胎二胎产妇150例,随机分为观察组和对照组各75例,对照组给予常规产后护理,出院时嘱产后第2天开始做产后盆底肌恢复操。观察组在常规产后护理基础上实施延续性Kegel 运动联合Bobath球训练指导。产后6 个月后观察两组盆底康复锻炼的依从性、盆底肌肌力康复效果;产后1天及产后12个月观察两组产妇盆腔器官脱垂（S-POP-Q）及尿失禁发生率（ICI-Q-SF）;产后6个月及产后12个月进行女性性功能（FSFI）评价,比较两组性功能恢复情况。结果：盆底功能锻炼依从性、盆底综合肌力明显高于对照组（P＜0.01）;观察组产妇产后1天时,尿失禁和盆腔器官脱垂发生率与对照组比较,差异无统计学意义(P＞0.05),观察组产妇产后12个月时,尿失禁和盆腔器官脱垂发生率均低于对照组,(P<0.05);产后6个月,观察组FSFI各维度评分与对照组比较,性欲维度评分高于对照组(P<0.01),其余两组各维度差异无统计学意义(P＞0.05),产后12个月,FSFI各维度评分高于对照组 (P<0.05),但性交疼痛维度评分低于对照组(P<0.01)。结论：开展延续性Kegel 运动联合Bobath球训练能够提高二胎顺产分娩产妇盆底肌功能锻炼的依从性,减少尿失禁和盆腔脏器脱垂的发生,改善经产妇产后盆底功能,提高生活质量,康复效果显著。     

The reliability of the Leeds Movement Performance Index (LMPI): a new tool for neurological physiotherapy

Abstract

Background: Measuring movement performance in people with neurological damage requires a tool that reflects physiotherapy assessment and clinical reasoning. The Leeds Movement Performance Index (LMPI) was previously developed by a group of neurological physiotherapists to fulfill these requirements. Objective: To assess the reliability of the LMPI for use in neurological physiotherapy practice. Methods: Twelve senior neurological physiotherapists were trained to use the LMPI and then asked to measure the movement performance of five patients whose movement had been previously video-recorded for this purpose. A retest session was completed after two weeks. Data were analysed to establish internal and external reliability. Results: Internal reliability was assessed using Cronbach's alpha coefficient, applied to the entire scale (0.862) and to each item (range 0.795–0.892). External (inter-rater) reliability was assessed by a calculation of the intraclass correlation coefficient for scores awarded by multiple raters (0.959), with individual item reliability ranging from 0.874 to 0.968. External (test–retest) reliability was assessed by calculating the Spearman's rank correlation coefficient between scores obtained on two testing occasions (0.792) with values of individual items ranging from 0.397 to 0.674. A variance components analysis partitioned variance into components arising from between-patient variability (55.2%) between-therapist variability (7.8%) and between-testing variability (2.8%). Conclusions: Results indicate that the LMPI is a reliable measurement tool when used by senior neurological physiotherapists.     

Help-seeking behaviour: a concept analysis

The concept 'help-seeking behaviour' has gained popularity in recent years as an important vehicle for exploring and understanding patient delay and prompt action across a variety of health conditions. The term is used interchangeably with health seeking and is described as part of both illness behaviour and health behaviour. Concept clarification is required to aid nurses and other health-care professionals understanding of the attributes of help-seeking behaviour and to guide theory development, practice and research. The Walker and Avant method of concept analysis was used to guide the analysis. Help-seeking behaviour was shown to be a complex decision-making process instigated by a problem that challenges personal abilities. According to the literature, the process is characterized by the following attributes: problem focused, intentional action and interpersonal interaction. Help-seeking behaviour for a health problem can therefore be defined as a problem focused, planned behaviour, involving interpersonal interaction with a selected health-care professional.     

Developing a mid-range theory of patient advocacy through concept analysis

AIM: The aim of this paper is to clarify and refine the concept of patient advocacy through synthesizing the advocacy literature in nursing and to establish a theoretical basis for future studies on patient advocacy in nursing. BACKGROUND: Patient advocacy is an essential component of the Registered Nurse professional role. During the past 30 years, the patient advocacy role has become more important, but the concept of patient advocacy lacks a consistent definition and research into nurses' patient advocacy roles is limited. There have been few quantitative empirical studies on patient advocacy in nursing. METHOD: Walker and Avant's method of concept analysis was used as a guideline in examining the concept of patient advocacy through synthesizing the advocacy literature in English (1974-2006). FINDINGS: A mid-range theory of patient advocacy emerges during the process of synthesizing and analysing the advocacy literature. Three core attributes of the concept of patient advocacy are identified: (1) safeguarding patients' autonomy; (2) acting on behalf of patients; and (3) championing social justice in the provision of health care. They reflect nurses' patient advocacy roles at both macro- and micro-social levels. Antecedents of patient advocacy occur at both macro- and micro-social levels and call for nurses' advocacy roles in the healthcare system. Consequences produced by nurses' patient advocacy behaviours are contextual. Nurses' patient advocacy behaviours not only can positively influence the patients, other nurses and the nursing profession, but also can cause negative consequences for nurses who take action to advocate for patients. CONCLUSION: The proposed mid-range theory may be useful in guiding advocacy practice in nursing and in guiding research in the advocacy area. The proposed theory needs to be furthered refined and tested in the future.     

Relapse: a concept analysis

The concept of relapse has had many and varied applications in research literature. Great confusion exists in the application of the term to scientific measurement within the various studies. Therefore, an in-depth analysis of the generic term relapse was undertaken through the evolutionary approach offered by Rodgers and Knafl.