Disability and Rehabilitation, March 2007; 29(5): 395 – 401

RESEARCH PAPER

The effect of perceived adherence to the Bobath concept

on physiotherapists’ choice of intervention used to treat
postural control after stroke

S. F. TYSON1 & A. B. SELLEY2

1
Centre for Rehabilitation and Human Performance Research, University of Salford, and 2Department of Geriatric Medicine,
Disabil Rehabil Downloaded from informahealthcare.com by RMIT University on 10/07/13

Hope Hospital, Salford, UK

Accepted May 2006

Abstract
Purpose. The Bobath concept is the predominant stroke physiotherapy approach in the UK but there is little literature about
its operationalization. The aim of this study was to assess the effect of perceived adherence to the Bobath concept on
interventions used by physiotherapists to treat postural control problems after stroke. The physiotherapists’ experience,
For personal use only.

clinical grade and the type of patients treated were also compared.
Methods. The design was a cross sectional survey involving 11 NHS Trusts. The participants were 35 stroke
physiotherapists who recorded the treatment of 132 patients in 644 sessions using the Stroke Physiotherapy Intervention
Recording Tool. Descriptive statistics, independent t-tests and Chi-squares were used in the analysis to describe the
physiotherapists and patients, and compare the effects of perceived adherence to the Bobath concept on intervention choice,
clinical grade, experience and the type of patient treated.
Results. Most physiotherapists perceived their practice to be eclectic but the interventions used followed a traditional
Bobath model. Perceived adherence to the Bobath concept had little effect on the choice of intervention. The only significant
difference was that ‘preparation for treatment’ techniques were used more frequently by ‘strongly Bobath’ physiotherapists
then ‘eclectic’ physiotherapists. There were no other significant differences, nor were there any differences in the
physiotherapists’ clinical grade, post-graduate training or the type of patient treated except that ‘eclectic’ physiotherapists’
patients were older. Most of the ‘strongly Bobath’ physiotherapists were experienced and most of the ‘eclectic’
physiotherapists were novices (p50.023).
Conclusions. Although most physiotherapists perceived themselves to be eclectic, their actual practice followed a traditional
Bobath model; recent developments of the Bobath concept were not incorporated into clinical practice. The reasons for the
mismatch between physiotherapists’ perception and their actual practice are discussed.

Keywords: Stroke, physiotherapy, Bobath

updated via an oral tradition on post-graduate

Introduction
Stroke physiotherapy is known to be effective for
people with stroke [1 – 3] but there is little informa-
tion about its content so that in research studies it is
often described in terms of the treatment approach
used such as ‘following the Bobath concept’. This is
not surprising, as clinical physiotherapists describe
their practice in terms of treatment approaches
[4 – 6], but there is little literature about the
operationalization of the approaches. This is at least
partly because in the UK physiotherapy approaches
for people with stroke have mainly been taught and
courses with little supporting published work. This
lack of information has been a source of criticism of
stroke physiotherapy research and clinical practice
for many years [1,7,8 – 10] as it makes it difficult to
replicate studies and to apply research findings into
clinical practice. The main methodological barriers
to stroke physiotherapy research have been identified
as a lack of clear definition and description of
the philosophy or theoretical basis of the treatment
approaches, of the interventions used and how they
should be applied, and the lack of a system to record
their interventions used [7]. In recent years however,

Correspondence: Dr Sarah F. Tyson, Centre for Rehabilitation and Human Performance Research, Allerton Annexe, University of Salford, Frederick Rd
Campus, Salford, M6 6PU, UK. Tel: þ44 0161 295 7028. E-mail: s.tyson@salford.ac.uk
ISSN 0963-8288 print/ISSN 1464-5165 online ª 2007 Informa UK Ltd.
DOI: 10.1080/09638280600841158
 396 S. F. Tyson & A. B. Selley
some of these barriers have been overcome. In a
series of studies, Lennon and co-workers have
defined and described contemporary Bobath (the
predominant physiotherapy approach for people with
stroke in the UK [4 – 6]). They examined its under-
lying theory, content and physiotherapists’ per-
ceptions of how it had developed in recent years
[6,11 – 13]. Also a system to define, describe and
record the interventions used during physiotherapy
has recently been developed for one aspect of
physiotherapy; the restoration of postural control
(sitting, balance, standing balance or stepping/
walking). The Stroke Physiotherapy Intervention
Recording Tool (SPIRIT) [14] is a valid, trustworthy
checklist of interventions used to treat postural
control problems. Physiotherapists tick off the
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interventions used after treating the patient, using
timed units to indicate the duration of the interven-
tion. Interventions are divided into eight categories;
(i) preparation for treatment (mobilizations and
facilitated movements); (ii) balance and walking acti-
vities; (iii) Practising functional tasks; (iv) preventing
complications; (v) exercise; (vi) teaching activities for
independent practice; (vii) and teaching carers and
other healthcare professionals (HCPs) how to assist
For personal use only.
the patient and, (viii) provision of and/or training in
the use of equipment. Full details about the SPIRIT
and how to use it can be downloaded from www.
healthcare.saford.ac.uk/crhpr.
These developments make it possible for the details
of stroke physiotherapy to be explored; to unpack the
‘black box’. In a paper reporting an earlier part of
this study the authors described the content of
physiotherapy to restore postural control after stroke
and the effect of patient related factors on the
interventions used [15]. The aim of this study is to
relate the physiotherapists’ perceptions of the phy-
siotherapy approach they used to the interventions
they actually used during treatment. The specific
research questions we aimed to address were:
. Are there any differences in the interventions
used between physiotherapists who perceive
their practice to follow the Bobath concept
or those who perceive their practice to be
‘eclectic’?
. Can any differences in intervention choice be
explained by differences in job related variables
(experience, clinical grade, post-graduate train-
ing) or the types of patients treated?
Method
A cross-sectional survey design was used. All physio-
therapists treating stroke patients in 11 hospitals
around Greater Manchester took part. Participating
physiotherapists were of any grade but treated people
with stroke at least once a week in a hospital-based
setting. They used the SPIRIT to record the content
of five consecutive physiotherapy sessions for five
patients. Any patients were included so long as their
treatment was primarily for a postural control prob-
lem (limited sitting balance, standing balance or
stepping/walking). Patients were of any age, severity
of stroke, stage of recovery, with any combination of
comorbidity and stroke-related impairments. Parti-
cipants were asked not to ‘cherry pick’ either patients
or treatment sessions in any way. The physiothera-
pists also completed a short questionnaire about their
clinical experience, clinical grade, perceived adher-
ence to the Bobath concept, and post-graduate
training. Perceived adherence to the Bobath Concept
was assessed on a 5-point Likert scale. Physiothera-
pists were asked to indicate which of the following
choices most accurately reflected their practice:
5 ¼ Completely I am a Bobath purist
4 ¼ Strongly My work is strongly based
on the Bobath concept
although I occasionally use
other methods
3 ¼ Mostly My work is based on the
Bobath concept but I do
use other methods
2 ¼ Not Much My work is based on other
methods but is influenced
by the Bobath concept a little
1 ¼ Not at all I do not use the Bobath concept
Scores of 1 – 3 were categorized as ‘eclectic’ and
scores of 4 – 5 were categorized as ‘strongly Bobath’
or Bobath ‘purist’. Experience was categorized
according to the physiotherapists’ grade. Junior and
senior II physiotherapists were classified as ‘novices’
and senior I and Clinical Specialists/ Superintendent
IV physiotherapists were classified as ‘experienced’.
Ethical approval was sought but it was deemed
unnecessary by Salford Local Research Ethics
Committee as the study merely involved the doc-
umentation of everyday practice without any addi-
tional testing or investigation. Descriptive statistics
were used to describe the physiotherapists and
patients. Independent t-tests were used to compare
groups of ratio data and Chi-squared tests were used
to compare nominal data.
Results
A total of 644 treatment sessions for 132 patients
were recorded. The patients’ mean age was 68.9
years (SD 13.9 range 30 – 92). The median time
since stroke was five weeks (IQR 3,9 weeks with two
outliers at one year and three years). Fifty-five (45%)
had right hemiplegia, 64 (53%) had left hemiplegia,
 The effect of Bobath on physiotherapy intervention choice 397

side was unrecorded for two patients. Twenty-six
(22%) were being treated primarily for sitting bal-
ance, 35 (29%) for standing balance and 59 (49%) for
stepping/walking. The frequency with which different
interventions were used has been described in detail
previously [15] but are summarized in Table I.
Thirty-five physiotherapists participated in the
study. Most (n ¼ 26, 77%) felt that their practice
was ‘‘based on the Bobath concept although they
also used other methods’’ (categorized as ‘eclectic’).
One participant felt their practice was ‘‘based on
other methods and they used the Bobath concept a
little’’ (categorized as ‘eclectic’). Seven (21%) were
stronger advocates of the Bobath concept, their prac-
tice was ‘‘strongly based on the Bobath concept but
they occasionally used other methods’’ (categorized
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‘purists’). Twenty-five (73%) had attended post-
graduate courses in the Bobath concept: 16 on
introductory weekend courses; 6 on the basic three-
week course and three had attended an advanced
course. Ten (29%) had attended other post-graduate
training in neurological physiotherapy. There were
no statistical differences between ‘strongly Bobath’
and ‘eclectic’ physiotherapists in the training in
the Bobath concept they had received (p50.139),
or the type of patients they treated (Table II), except
the ‘eclectic’ physiotherapists’ patients were older.
The physiotherapists had been qualified for a
mean of 5 years (SD 4.8 range 1 – 20). ‘Eclectic’
physiotherapists had been qualified for a mean of
5.2 years (SD 5.3) and ‘strongly Bobath’ physio-
therapists for a mean of 5.3 years (SD 3.25). This

as ‘strongly Bobath’). None perceived their practice difference was not statistically different (p50.824
to be solely based on the Bobath Concept (Bobath 95% CI 73.767, 3.042). There were nine (26%)

Table I. The frequency with which interventions were used.

Intervention Frequency of use (n)

Preparation for treatment 1969 (40.6%)

For personal use only.

Facilitating movements (performing movement patterns with the therapist guiding the movements) and/or
Normalizing tone using mobilization of trunk, shoulder girdle or pelvis or more distal body segments
Practising balance & walking activities 1583 (32.6%)
Activities þ/or components of activities performed under the therapist’s assistance þ/or supervision
but without direct (hands on) facilitation
Practising functional tasks 703 (14.5%)
Activities practised within a therapy session with an aim to improve functional ability. Performed under the
therapist’s guidance/assistance and supervision but without direct (hands on) facilitation
Teaching HCP/carers 280 (5.8%)
Activities to teach/show another person how to help the patient in the therapist’s absence.
Independent practice 195 (4%)
Any activity to enable the patient to practise functional activities or undertake specific exercises outside
therapy sessions and/or therapist supervision
Exercise 113 (2.3%)
Prescribing & supervising exercises to be performed during therapy sessions or for independent practice
Provision of equipment 11 (0.2%)
Providing equipment and/or teaching patient or carer or other HCP how to use it

Table II. Comparing the patients treated by ‘Strongly Bobath’ and ‘eclectic’ physiotherapists.

95% CI

Physio approach Mean (SD) p value Upper Lower

Age (years) Eclectic 70.27 (13.0) 0.039* 0.63 21.05

Strongly Bobath 59.43 (17.3)
Time since stroke (weeks) Eclectic 6.57 (6.7) 0.156 732.89 5.78
Strongly Bobath 20.13 (36.2)
Side of stroke (Left/right) Eclectic 64/46 0.406
Strongly Bobath 8/12
Aim of treatment (sitting/standing/walking Eclectic 27/31/51 0.225
Strongly Bobath 6/8/7

Italics indicate a significant difference at p50.05; NB Mean, standard deviations and confidence intervals are not shown for the side of
stroke or aim of treatment as these are nominal data assessed using the chi-square test.
 398 S. F. Tyson & A. B. Selley

junior physiotherapists; 13 (37%) senior IIs, nine
(26%) senior Is and four (11%) clinical specialist/
superintendent IIIs. Eighteen (51%) worked in
stroke units, three (8%) in general rehabilitation,
four (11%) in acute medical or acute stroke wards,
one in outpatients and nine (26%) in mixed settings
(combinations of general rehabilitation, medical
wards and out-patient settings).
The physiotherapists’ adherence to the Bobath
concept made little difference to the interventions
used. The ‘strongly Bobath’ physiotherapists used
more interventions than ‘eclectic’ physiotherapists
(mean 8.63 (SD 6.37) vs. 6.17 (SD 4.10), p ¼ 0.000,
95% CI 70.12, 0.41) but the same pattern of the
use of interventions was seen in both groups (Table I
and III). This was that ‘preparation for practice’ was
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intervention use was seen in both groups. This was
that physiotherapists most frequently used interven-
tions which emphasized the normalization of muscle
tone and movement patterns by using ‘hands-on’
mobilization and facilitation techniques which were
led by the physiotherapists and in which the patient
was relatively passive. Functional tasks were prac-
tised but this was predominantly in the treatment
session under the physiotherapists’ close supervision.
Interventions to promote practice or activity out-
side the treatment session in every day life such as
teaching carers and other HCPs how to assist the
patient session, organizing independent practice, or
providing or training in the use of equipment were
rarely used. Similarly interventions to address impair-
ments other than muscle tone such as strengthening

by far the frequent intervention type, followed by
‘practising balance and walking activities’. Organiz-
ing independent practice, exercise and the use of
equipment were the least frequently used in both
groups. The only significant difference in the type of
intervention used was that the ‘strongly Bobath’
physiotherapists used ‘preparation for treatment’
more frequently (Table III). There was a significant
difference in perceived adherence to Bobath concept
For personal use only.
exercises to reduce weakness, or the use of splints to
maintain or improve joint range were rarely used.
The only significant difference was that ‘strongly
Bobath’ physiotherapists used ‘preparation for treat-
ment’ (mobilisation and facilitating movement) more
often than eclectic therapists,
Despite the fact that most participants perceived
their practice to be eclectic, their actual practice
closely matched a traditional Bobath model as des-

with experience (p50.023); the novice physiothera-
pists almost exclusively perceived themselves to be
‘eclectic’ (n ¼ 20/22) while only half of the experi-
enced physiotherapists (n ¼ 6/12) held this view.
Discussion
The results of this study show that physiotherapists’
perceived adherence to the Bobath Concept had little
effect on the interventions used to treat postural
control problems after stroke. The same pattern of
cribed and defined by Lennon et al. [6]. They identi-
fied that the main components of the Bobath concept
were to re-educate normal movement by normali-
zing tone, to facilitate normal movement and postural
reactions and to undertake task-specific practice
using specific manual guidance. The rationale for
practising functional tasks was also described [6];
practice of functional tasks was thought important
but needed to be guided and facilitated by the
physiotherapist until/unless the patient could perform
them ‘normally’, and activity outside treatment

Table III. Comparing the frequency with which interventions were used by ‘strongly Bobath’ and ‘eclectic’ physiotherapists.

95% CI

Use of Bobath Mean (SD) p value Lower Upper

Preparation for treatment Eclectic 7.10 (3.15) 0.01 72.88 70.42

Strongly Bobath 5.45 (2.45)
Practising balance and walking activities Eclectic 5.42 (3.19) 0.88 71.25 1.54
Strongly Bobath 5.57 (2.75)
Practising functional tasks Eclectic 1.91 (1.11) 0.618 70.25 0.41
Strongly Bobath 1.83 (1.20)
Teaching other health care professionals Eclectic 1.67 (0.77) 0.131 70.63 0.08
Strongly Bobath 1.94 (0.91)
Organizing independent practice Eclectic 1.46 (0.77) 0.977 70.28 0.27
Strongly Bobath 1.47 (0.69)
Exercise Eclectic 1.04 (0.20) 0.167 70.43 0.08
Strongly Bobath 1.21 (0.43)
Use of equipment Eclectic 1.00 (0.00) *
Strongly Bobath 1.00 (0.00)

*A p value cannot be computed because the standard deviations of both groups are zero. Italics indicate a significant difference at p50.05.
 The effect of Bobath on physiotherapy intervention choice
sessions should be delayed if movement quality was
poor. Function was believed to automatically im-
prove if movement patterns or quality improved.
This rationale clearly matches the interventions used
(or not used) in the participants’ actual practice
(described above). Lennon et al. [6] also described
recent developments of the Bobath concept which
incorporate a systems model of motor control, motor
learning theory and the use of equipment. Unfortu-
nately the way in which these theories are operatio-
nalized within the Bobath concept have not been
described which makes it difficult to assess whether
these developments have been appropriately inter-
preted or adopted into everyday clinical practice, but
the indications from this study are that they are not.
The incorporation of a systems model of motor
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control means that there is an appreciation of the
role of motor impairments other than spasticity/tone
(such as soft tissue compliance and muscle length
or weakness) and that physiotherapists use treatment
techniques to address these. In this study by far the
most common interventions (preparation for treat-
ment) aims to reduce muscle tone. In contrast,
interventions to address other motor impairments
such as weakness or limited joint range were amongst
For personal use only.
the least frequently used interventions. A summary of
the application of motor learning theory to stroke
rehabilitation involves recognition of the importance
of task and context specific practice for activity in
everyday life; the need for the patient to be active and
engaged, and details of how the type and intensity of
task, practice and feedback can facilitate or hinder the
motor skill acquisition. A key implication is that
initial attempts at tasks do not need to be perfect as
errors can assist skill acquisition [16]. These princi-
pals were not incorporated into everyday practice; the
patients’ passive role within the treatment session was
evident. Functional tasks were practised within the
physiotherapy sessions but not in every-day life.
Provision of, or training in the use of equipment
was the least frequently used intervention, which
contradicts the perception that physiotherapists do
now embrace the use of equipment [6,12].
An obvious question rising from these results is
why this mismatch between the physiotherapists
perceived and actual practice occurs. There is no
obvious explanation deriving from the participants’
training, experience or the patients they treated, but
it may revolve around the labels attached to the
‘approaches’ used. Although physiotherapists define
their practice in terms of the treatment approach they
use [4 – 7], there has been little work to define or
describe the approaches. It is therefore difficult to
assess their content and to establish the differences
and similarities between them, and consequently to
assess their relative efficacy. It may be that any
differences between approaches are much less than
399
their similarities and that they are in effect indistin-
guishable. There is some evidence beyond the results
of the present study to support this view. Three
previous studies have compared different approaches
(the Bobath concept, an eclectic approach and the
Motor Relearning, or Movement Science approach)
by comparing the theoretical beliefs of physiothe-
rapists using a Bobath or eclectic approach [6],
comparing the literature regarding the scientific
theories underlying the Bobath concept and Motor
Relearning approach [17] and comparing the treat-
ment behaviours used by physiotherapists using the
Bobath or Movement Science-based (or Motor
Relearning) approach [17]. All found that although
there were important differences there were many
more similarities between the approaches used.
Recent developments in the Bobath concept iden-
tified by Lennon et al. [6] incorporate many of the
principles of the Motor Relearning programme
[19,20] (a systems model of motor control and the
principles of motor learning) which may make the
different approaches indistinguishable (assuming
that they are operationalized in the same way), and
several reviews have failed to find evidence that any
one treatment approach is more effective than ano-
ther [1,3,7].
An alternative explanation revolves around the
complexities of changing clinical practice. A new
intervention is most easily incorporated into clinical
practice if it fits into the existing model of service
delivery and the physiotherapists’ theoretical beliefs
which form the basis of their clinical reasoning – the
way in which treatment is delivered and the physio-
therapists’ explanation of the patients’ problems and
what to do about them. In the UK, the Bobath
concept is predominant [4 – 6] and in the Bobath
concept the patient’s problems are thought to be
primarily due to abnormal movement patterns and
muscle tone so, as the results of this study show,
most interventions aim to address this problem.
Consequently, clinical services are configured to
provide these interventions. As the results of this
study show, there is an emphasis on hands-on
contact in a one-to-one treatment session with a
qualified physiotherapist. It would be relatively easy
to adapt clinical practice to incorporate a new
intervention if it fitted in with this model of clinical
reasoning and service delivery. If, however, a new
intervention did not fit with this mode of reasoning
and practice then much more complex and challen-
ging decisions and changes would need to be
addressed before it were incorporated in to clinical
practice. It would be difficult to rationalize and
justify the use of interventions that did not address
the problems that physiotherapists felt were impor-
tant and limiting the patients’ abilities. This may
explain why interventions that address impairments
 400 S. F. Tyson & A. B. Selley
other than muscle tone were rarely used. Physio-
therapists would need to develop a new clinical
reasoning process, involving different theoretical
beliefs if they were to develop a rationale to justify
the use of interventions which have been traditionally
viewed as ‘undesirable’, such as using equipment,
exercise and encouraging independent practice. In
addition, the clinical service may need to be re-
configured to accommodate a new intervention if it
does not match the current way in which physiother-
apy is delivered. For example, the introduction of
treadmill training would require a treadmill to be
funded and housed, staff to be trained to use it,
(possibly) the skill mix of the staff to be altered so a
physiotherapy assistant could supervise its use, and
decisions made about whether treadmill training is
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used in addition to, or instead of, the current service,
and if it is an alternative treatment which aspects of
current treatment are withdrawn. Faced with these
challenges, it is perhaps not surprising that the
physiotherapists used the interventions that fitted
into the model of practice with which they were
comfortable and familiar and which they had the
resources to deliver; the traditional Bobath model.
Although they felt open to the idea of ‘other
For personal use only.
methods’, the clinical rationale (or theoretical frame-
work) for why, when and how they should be used,
and information about the optimal model of service
delivery with which to operationalize them is not
currently available. The challenge for stroke phy-
siotherapy research is to obtain this information. As
well as information about the effectiveness of
individual interventions, we need to understand the
content of the approaches and assess the validity (or
otherwise) of their underlying theoretical constructs.
We need to identify their unique aspects and their
similarities, where differences exist we need to
establish which is most effective, and where there
are gaps we need to develop new theories and
models. It is only with this knowledge that informed
choices can be made about how to progress clinical
practice. It is insufficient to merely know whether
individual interventions are effective (or not). For
an intervention to be successfully used in clinical
practice there also needs to be a theoretical frame-
work to give a rationale for their use and a successful
model of service delivery in to which they can be
incorporated.
In a recent Cochrane review it was concluded that
stroke physiotherapy treatment approaches were so
complex that the methodological barriers to research
into them were insurmountable and that further
physiotherapy research should focus on testing the
effectiveness of specific interventions instead. How-
ever many of these methodological barriers [7]
are being broken down; the Bobath concept has
been defined and described [6,11 – 13], and a
methodology and system to report the interventions
used has been developed [14]. A remaining gap in
knowledge is whether specific interventions can be
identified as ‘belonging’ to a treatment approach.
Can physiotherapists identify which interventions
form part of the Bobath concept and which do not,
for example? This knowledge is needed to clearly
distinguish the content of different approaches,
and ultimately test the effectiveness of the interven-
tions associated with them. A study is under way to
address this issue.
This study has some limitations that need to be
borne in mind when considering the results of
this study. Firstly there is no generally accepted
definition of purist or eclectic approaches to treat-
ment. Consequently the definitions used in this study
are fairly arbitrary and based on the authors’ under-
standing and clinical experience, which is that a purist
is a physiotherapist who uses one treatment approach
to the virtual exclusion to others, where as an eclectic
physiotherapist is someone who uses interventions
from a variety of approaches. The Likert scale to
assess adherence to the Bobath concept was piloted
with colleagues and clinical physiotherapists so we
are confident that it is meaningful and reflective of
physiotherapists’ thinking but different wording or
different definitions of ‘purist’ and ‘eclectic’ could
give different results. An indication of this comes
from other studies which have asked stroke phy-
siotherapists about their perceived practice. Three
postal questionnaire surveys (two national [5,6] and
one regional [4]) have asked physiotherapists which
approach they use most often [4], which approach
they primarily used [5] and which was their preferred
approach [6]. They found that the Bobath concept
was predominant with 80%, 88% and 67% (respec-
tively) of respondents choosing the Bobath concept.
In contrast we asked participants how closely they
adhered to the Bobath concept, rather than which
they used primarily which would account for the
differences.
The other issue is the generalisability of the results.
The study covered Greater Manchester, a population
of three million people and so the study participants
were a reasonable representation of stroke patients
and physiotherapists, however geographical variation
in the way stroke physiotherapy is practised has
been noted previously [5] so generalization should be
treated with caution. A national level survey is now
under way to assess this issue. It should also be noted
that the data from the ‘strongly Bobath’ physiothera-
pists came from only seven individuals. Finally, the
SPIRIT merely attempts to record the content of
physiotherapy. It does not address the physiothera-
pists’ clinical reasoning – why interventions were
used – which could provide a deeper insight into
the complex processes involved, and may enable the
 The effect of Bobath on physiotherapy intervention choice
theoretical basis of current physiotherapy as it is
practised to be better understood.
Conclusion
A cross sectional survey of stroke physiotherapy in
one geographical area within the UK has found that
although most physiotherapists perceive their prac-
tice to be eclectic, their actual practice followed a
traditional Bobath model. Recent developments of
the Bobath concept to include a systems model of
motor control, principles of motor learning and the
use of equipment have not been incorporated into
clinical practice. A possible reason for this apparent
mismatch are that differences between approaches
are less than the similarities so that physiotherapists’
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purporting to use different approaches are, in effect,
doing the same thing. An alternative explanation is
that although physiotherapists feel that they should use
‘other methods’ the barriers to implementing them
into existing models of service delivery are too great
so in practice they maintain the models of service
delivery with which they are familiar and comfortable.
Acknowledgements
For personal use only.
The authors acknowledge and thank the stroke
physiotherapists in Salford Royal NHS Trust, Royal
Bolton NHS Trust, Pennine Acute NHS Trust,
Stockport NHS Trust, Tameside NHS Trust, Cen-
tral Manchester NHS Trust, South Manchester NHS
Trust, and Trafford NHS Trust who participated in
the study, and The Stroke Association, and Hum-
phrey Booth Charities and Physiotherapy Dept of
North Manchester Hospital who funded the study.
Dr Monica Busse of Cardiff University, Ms Gill Baer
of Queen Margaret’s University College Edinburgh
and Dr Sheila Lennon, of University of Ulster for
discussion and comments in the preparation of the
manuscript.
References
1. Ashburn A, Partridge C, De Souza L. Physiotherapy in the
rehabilitation of stroke: A review. Clin Rehabil 1993;7:
337 – 345.
2. Langhorne P, Wagenaar R, Partridge C. Physiotherapy after
stroke: More is better? Physiothe Res Int 1996;1:75 – 88.
401
3. Kwakkel G, Kollen BJ, Wagenaar RC. Therapy impact on
functional recovery in stroke rehabilitation: A critical review of
the literature. Physiotherapy 1999;85(7):377 – 391.
4. Sackley C, Lincoln N. Physiotherapy treatment for stroke:
A survey of current practice. Physiother Theory Practice 1996;
12:87 – 96.
5. Davidson I, Waters K. Physiotherapists working with stroke
patients: A national survey. Physiotherapy 2000;86:2;69 – 80.
6. Lennon S, Baxter D, Ashburn A. Physiotherapy based on the
Bobath concept in stroke rehabilitation: A survey within the
UK. Disabil Rehabil 2001;23:254 – 262.
7. Pollack A, Baer G, Pomeroy V, Langhorne P. Physiotherapy
treatment approaches for the recovery of postural control and
lower limb function following stroke. The Cochrane Library
2005 Issue 3. Chichester, UK: John Wiley & Co; 2005.
8. Wade D. Barriers to rehabilitation research, and overcoming
them. Clin Rehabil 2003;17:1 – 4.
9. Effective Health Care Bulletin No. 2. (1992) Stroke Rehabi-
litation. Leeds University Printing Services.
10. Partridge C. Evaluation of physiotherapy for people with
stroke. London: Kings Fund; 1994.
11. Lennon S. The Bobath concept: A critical review of the
theoretical assumptions that guide physiotherapy practice in
stroke rehabilitation. Phys Ther Rev 1996;1:35 – 45.
12. Lennon S, Ashburn A. The Bobath concept in stroke reha-
bilitation: A focus group study of the experienced physiothera-
pists’ perspective. Disabil Rehabil 2000;22(15):665 – 674.
13. Lennon S. Gait re-education based on the Bobath concept in
two patients with hemiplegia following stroke. Phys Ther
2001;81(3):924 – 935.
14. Tyson S, Selley A. Development of the Stroke Physiotherapy
Intervention Record Tool. Disabil Rehabil 2004;26(20):
1184 – 1188.
15. Tyson S, Selley A. A content analysis of physiotherapy for
postural control in people with stroke: An observational study.
Disabil Rehabil (in press).
16. Schmidt RA. Motor learning principles for physical therapy.
In: Proc II STEP conference on contemporary management
of motor control problems. Alexandria: Foundations of
Physical Therapy 1991;49 – 63.
17. Lettinga A, Siemonsma P, Van Veen M. Entwinement of
theory and practice in physiotherapy: A comparative analysis
of two approaches to hemiplegia in physiotherapy. Physiother-
apy 1999;85(9):476 – 490.
18. Van Vliet P, Lincoln N, Robinson E. Comparison of the
content of two physiotherapy approaches to stroke. Clin
Rehabil 2001;15:398 – 414.
19. Carr J, Shepherd R. A motor re-learning programme for
stroke. Heinemann Medical, London; 1982.
20. Carr J, Shepherd R. Movement science: Foundations for
physical therapy in rehabilitation. 2nd ed. Maryland USA:
Aspen Publishers; 2000.