Development of treatment schedules for research: a structured review to identify methodologies used and a worked example of ‘mobilisation and tactile stimulation’ for stroke patients
To identify methodologies used to describe the content of current physical therapy and to formulate a treatment schedule for ‘mobilisation and tactile stimulation’ (MTS) for the paretic upper limb after stroke as a precursor to evaluative research. This study was conducted in two major parts. Part 1 was a systematic review of studies developing descriptions of current physical therapies. Studies were identified by an electronic search of MEDLINE, EMBASE and CINHAL and by searching the reference lists of studies fulfilling the review's inclusion criteria. Three reviewers extracted data independently on methodologies used. In Part 2, seven experienced neurophysiotherapists completed individual semi-structured interviews. Verbatim transcripts were condensed independently by two researchers into draft lists of interventions, which were subsequently compared for agreement. Disagreement was resolved through discussion. A preliminary list of interventions was produced, then discussed and refined at a focus group meeting to produce a final list. This was transformed into a draft treatment schedule, piloted in clinical practice and refined further to produce the final treatment schedule. Part 1. Several methodologies to describe therapy were identified from the 15 studies reviewed. These commonly involve five stages: (1) generation of treatment lists using expert opinion, clinical experiences and/or the literature; (2) refinement of the list into a treatment schedule by consulting expert clinicians (discussion groups, focus groups, workshops); (3) piloting the treatment schedule in clinical practice; (4) establishment of external validity (generalisability); and (5) testing reliability of the schedule. Part 2. Detailed descriptions of treatment were listed under subheadings including: passive and accessory movements; massage; sensory input; selective movement; and functional patterns. Identified treatment aims included reduction of hypersensitivity, increased sensory awareness and improved alignment of structures. Appropriate methods for describing current therapy have been identified and an MTS treatment schedule has been produced that can now be evaluated in pilot studies.