Positioning for stroke patients. A survey of physiotherapists' aims and practices

Purpose : The survey was undertaken to identify current physiotherapy practice for positioning patients in the first week following stroke. Method : A postal questionnaire comprised of closed questions, was sent to 674 physiotherapists identified as working with patients in the first week following stroke, who were employed in 155 randomly selected NHS Trusts throughout England. Results : Response rate was 73%. Specific positions were recommended during the first week following stroke by 98% of respondents. The most common aims of positioning were modulation of muscle tone (93%), preventing damage to affected limbs (92%) and supporting and stabilizing body segments (91%). The positions sitting in an armchair, side lying on the non-hemiplegic side and side lying on the hemiplegic side were recommended by 98%, 96% and 92% of respondents respectively. The components of the positions considered as 'most important' varied between positions, proximal components were usually preferred to distal components. Conclusion : Positioning is still an important part of physiotherapy practice and therefore requires evaluation. The positions used and the aims of positioning identified by clinicians accord with those in the literature. However, there is a lack of consensus regarding key components of the positions. The positions identified in this study should now be systematically evaluated for their ability to achieve different aims.