Factors influencing physiotherapy decisions between restorative and compensatory gait rehabilitation: an Italian multicenter study

TL;DR

This study explores what influences physiotherapists to choose restorative or compensatory gait rehabilitation for people with neurological disorders.

Contribution

The study identifies specific clinical and functional factors that predict the use of restorative gait rehabilitation in neurological patients.

Findings

Restorative rehabilitation was more common in subacute phase patients with lower impairment and higher functional independence.

Similar physiotherapy treatments were used for both restorative and compensatory approaches.

Key predictors included disease phase, impairment level, and functional independence.

Abstract

This study aimed to investigate the factors that influence physiotherapists’ decision in choosing restorative or compensatory rehabilitation during gait training in people with neurological disorders (PwNDs) and the different treatments used in the approaches.

This cross-sectional analysis used the baseline data from an observational cohort study. We analyzed data from 83 PwNDs (65 people after stroke, 5 with multiple sclerosis, and 13 with Parkinson’s disease) who underwent at least 10 sessions of physiotherapy (PT) focusing on gait function. Performance was quantified using the modified Dynamic Gait Index (MDGI), three impairment domains of Fugl–Meyer Assessment for lower extremity (mFM-LL), Activities-specific Balance Confidence (ABC), modified Barthel Index (mBI), Mini-Mental State Examination (MMSE), and Motivational Index (MI). Forty-three physiotherapists completed a treatment report form categorizing the rehabilitation approach and specifying treatments used (e.g., resistance training and proprioceptive exercises).

Fifty-six subjects underwent restorative rehabilitation approach. The univariate predictors of restorative approach were being in the subacute phase with a disease onset of less than 180 days, (odds ratio [95%CI]; 3.27[1.19–9.24]), mFM-LL (1.25[1.11–1.44]), MMSE (0.85[0.67–1.00]), and number of sessions (1.03[1–1.01]). The backward stepwise analysis revealed an association between restorative and subacute phase (36.32[4.11–545.50]), mFM-LL (3.11[1.55–9.73]), mBI (1.79[1.08–3.77]), MMSE (0.46[0.25–0.71]), and the interaction between mFM-LL and mBI (0.99[0.98–1.00]). No statistically significant association between treatments used and approach was found (p = 0.46).

The restorative approach was more commonly used to improve gait. The main variables associated with this approach were: being in the subacute phase of the disease, a low level of impairment, and a high level of functional independence at baseline. However, few differences were found between the treatments used for the restorative or compensatory approaches, as similar PT treatments were used for both.

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