Physiotherapy assessment in people with neurological conditions-Evidence for the most frequently included domains: A mixed-methods systematic review.

Rationale: There is a lack of consensus in the literature related to what is assessed clinically by physical therapists in people with neurological disorders.

Aims: This mixed-methods systematic review aimed to identify domains that physiotherapists routinely assess in people with neurological conditions in clinical settings and explored factors influencing assessment domains including country, clinical setting, therapist experience and neurological condition.

Method: Five databases were searched from 1946 to 31st January 2023. Studies with any design reporting on domains assessed by a physiotherapist, in people with neurological conditions in any clinical setting, were included. Independent reviewers assessed eligibility and risk of bias using relevant McMaster critical appraisal tools. Data were extracted and synthesised following the Joanna Briggs Institute approach for mixed systematic reviews.

Results: A total of 23 (16 quantitative, 7 qualitative) studies involving 3134 participants were included. The studies were rated as high (n = 14) or medium (n = 9) quality. The domains of function (n = 14); postural alignment and symmetry (n = 11); gait (n = 11); balance (n = 9), and muscle strength (n = 8) were most frequently included in assessments. Five key themes were identified from the qualitative studies: the clinical reasoning process, clinical use of standardised measures, utilisation of the senses, clinician experience and information gathering. There was minimal data on how country, clinical setting, therapist experience and neurological condition influence inclusion of assessed domains.

Conclusion: Five domains were most frequently included in assessment: function; postural alignment and symmetry; gait; muscle strength; and balance. This limited number of domains is in stark contrast to the full neurological physiotherapy assessment recommended by expert textbooks. Further research is needed to understand the reasons why this might be so.