Physiotherapy Theory and Practice, 29(4):301–308, 2013

Copyright © Informa Healthcare USA, Inc.

ISSN: 0959-3985 print/1532-5040 online
DOI: 10.3109/09593985.2012.732196

DESCRIPTIVE REPORT

Guillain–Barré syndrome patient’s satisfaction with

physiotherapy: A two-part observational study
Diane Dennis1 and Rachel Mullins2
1
Physiotherapist, Bachelor Applied Science (Physiotherapy), Senior ICU Physiotherapist, Sir Charles Gairdner Hospital,
Perth, Australia
2
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Physiotherapist, Bachelor Physiotherapy, Senior ICU Physiotherapist, Sir Charles Gairdner Hospital, Perth, Australia

ABSTRACT
The purpose of this observational study was to assess Guillain–Barré syndrome (GBS) patients’ satisfaction with
physiotherapy in the acute and sub-acute setting, and provide an overview of inpatient case management, includ-
ing the number of complications. Twenty-seven patients admitted to Sir Charles Gairdner Hospital (SCGH) with
GBS between 1 May 2005 and 30 April 2010 were considered for inclusion. Nineteen patients consented and a
waiver of consent was granted for four other patients. Data were collected from case-note audit (n = 23) and tele-
phone survey (n = 19) during June and July 2011. Participants receiving physiotherapy (n = 16) reported they
were satisfied with management (87%), treatment frequency (88%), duration (94%), and timetabling (81%) of
For personal use only.

treatment and the professionalism and rapport (100%) of physiotherapists. Median length of hospital stay was
20 days (range 5–198) for 23 participants. Physiotherapists documented patient assessment within 2 days
from admission (range 1–5). First functional improvements were documented on day 6 (median, range 2–34).
Physiotherapists were most commonly first to mobilize patients to sit, stand, transfer, and walk (83%, 82%,
81%, and 90%, respectively). Twenty patients (87%) developed complications during their hospital stay, the
most common being low back pain (61%). This study has demonstrated that GBS patients were satisfied with
care provided by physiotherapy.

INTRODUCTION 2005). The weakness of all muscles including those

First reported in the early 1800s, Guillain–Barré
Syndrome (GBS) remains the largest single cause of
acute neuromuscular paralysis (Rees, Thompson,
and Hughes, 1998) in previously healthy people,
with a worldwide annual incidence of one to two per
100,000 persons (Hughes and Rees, 1997). The man-
agement of the patient with severe and protracted
GBS provides a major challenge, as although progno-
sis may be excellent (Bersano et al, 2006; Rees,
Thompson, and Hughes, 1998), complications are
common (Bernsen, de Jager, van der Meché, and
Suurmeijer, 2005) and there may be residual deficits
in up to 20% of patients (Hughes and Cornblath,
Accepted for publication 12 September 2012
Address correspondence to Diane Dennis, Physiotherapist, Bachelor
Applied Science (Physiotherapy), Senior ICU physiotherapist, Sir
Charles Gairdner Hospital, Perth, Australia. E-mail: diane.dennis@
health.wa.gov.au
of respiration may progress to complete paralysis,
and there may be altered sensation throughout the
body, including pain (Hughes and Cornblath, 2005;
Ropper, 1992). There are also secondary effects of
prolonged bed-rest with paralysis, including ortho-
static intolerance, loss of muscle mass, joint range of
movement, balance, and proprioception (Winkleman,
2009).
The amount of time physiotherapists spend with
these inpatients is considerable and there are many
components of care in the acute and sub-acute
setting (Davidson, Wilson, Walton, and Brissenden,
2009). Respiratory physiotherapy may be indicated
in the spontaneously breathing patient in order to
optimize and, in some facilities, monitor lung func-
tion. More frequent examination and treatment may
then be required with the progression to mechanical
ventilation. Physiotherapists maintain joint range and
optimize patient positioning through stretches, trans-
fers, and where necessary, splinting (Davidson,
Wilson, Walton, and Brissenden, 2009). Tilt tables

301
 302 Dennis and Mullins
are used to stand patients gradually in order to
maintain muscle length, approximate joints to main-
tain bone density, and normalize the body’s blood
pressure response in the erect position (Chang,
Boots, Hodges, and Paratz, 2004). Physiotherapists
at also regularly document muscle strength and
sensation changes during recovery.
There is significant scientific literature detailing
residual disability (Bernsen, de Jager, van der
Meché, and Suurmeijer, 2005; Bussmann, Garssen,
van Doorn, and Stam, 2007; Fletcher, Lawn,
Wolter, and Wijdicks, 2000; Forsberg et al, 2005;
Garssen et al, 2004; Kuitwaard, Bos-Eyssen,
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Blomkwist-Markens, and van Doorn, 2009;
Rekand, Gramstad, and Vedeler, 2009; Rudolph,
Larsen, and Farbu, 2008) and health-related quality
of life (Bersano et al, 2006; Forsberg et al, 2005;
Garssen et al, 2004; Merkies et al, 2002) in GBS
survivors. There are also papers that describe the
extent of physiotherapy intervention (Davidson,
Wilson, Walton, and Brissenden, 2009) but little re-
garding specific GBS physiotherapy protocols in the
acute setting. Research describing the patients’
experiences is also limited (Bernsen, de Jager, van
For personal use only.
der Meché, and Suurmeijer, 2005; Forsberg, Ahl-
ström, and Holmqvist, 2008) and to our knowledge,
there is no published data on GBS patients’ satisfac-
tion with the acute inpatient care received, including
physiotherapy services. A recent Cochrane review
concluded that due to the paucity of rigorous
studies examining rehabilitation in GBS, “clinical
practice trials” should be encouraged, whereby pro-
spective and retrospective data are collected without
disrupting the natural milieu of treatment (Khan
et al, 2010). These studies would provide details
about services provided, outcomes, implications for
clinical practice, and models of care. It was also
concluded that there are considerable gaps in the
evidence with a failure to incorporate the GBS
patient’s point of view (Khan et al, 2010).
The purpose of this study was to assess the GBS
patients’ satisfaction with physiotherapy in the acute
and sub-acute setting, and provide an overview of
inpatient case management including physiotherapy
and the complications of the disease.
METHOD
Design
This was a retrospective non-interventional observa-
tional study with data collection from medical case-
notes, and patient telephone survey.
Participants
The Sir Charles Gairdner Hospital (SCGH) Ethics
Committee approved this study (study number
2010-078). All participants gave written informed
consent before data collection began. All acute GBS
cases attending the SCGH, a 600-bed tertiary hospital
in Perth, Australia, between 1 May 2005 and 30 April
2010 were considered. A 5-year period was chosen in
order to generate a reasonable number of subjects who
were able to recall their acute hospital stay with some
clarity.
Prospective participants and their contact details
were identified from the SCGH Allied Health Statisti-
cal (AHS) database during June and July 2011. An
information sheet regarding the nature of the study
together with a consent form was posted to them.
Subjects were then contacted via telephone by a phy-
siotherapist Rachel Mullins to answer any concerns
and if agreeable, arrange a time for telephone inter-
view. It was made clear to participants at this time
that the interviewer Rachel Mullins had had no prior
professional contact with them during their acute in-
patient stay. On receipt of a signed consent form,
they were telephoned in order to undertake the
survey. In addition, their case-notes were reviewed
and data regarding their hospital stay were collected.
Those who remained inpatients at any hospital
facility at the time of the review were excluded, as
they may have been concerned that their answers com-
promised their current management.
Outcome measures
A case-note audit was undertaken with data collec-
tion relating to demographics and admission charac-
teristics as well as the length and location of hospital
stay, the extent of illness, the nature and timing of
medical and physiotherapy interventions, and the
number and nature of complications. The achieve-
ment of rehabilitation milestones and discharge plan-
ning documentation was recorded and AHS data
were reviewed and the occasions of service and dur-
ation of treatments during inpatient stay data were
extracted.
A standardized form was developed to facilitate
data extraction. One investigator Rachel Mullins
extracted all data, and discrepancies in the timing
of interventions were resolved by cross-referencing
medical and allied health documentation. Discrepan-
cies in delivery of medications were resolved by cross-
referencing medical and pharmacy documentation.
An “initial assessment” was defined as the documen-
tation of subjective and objective examination without
Copyright © Informa Healthcare USA, Inc.

treatment, whereas a “treatment” constituted docu-
mentation of examination as well as a specific
hands-on intervention. For patients who had more
than one volume of medical records, all volumes were
recalled and reviewed. The time taken to fully review
and extract all data relevant to the current study
varied between subjects, but was approximately
60 minutes.
A patient survey was also undertaken via telephone
interview Rachel Mullins. This comprised 45 ques-
tions and was able to be completed in less than
20 minutes. It provided data on patients’ recall of
their inpatient stay in terms of the professions that pro-
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vided care, as well as the specific physiotherapy under-
taken. Patients rated their satisfaction on a scale of 1–5
(where 1 was highly dissatisfied and 5 was highly satis-
fied) with specific elements of physiotherapy such as
the frequency and length of treatments, timetabling,
and communication.
For personal use only.
FIGURE 1 Flow of participants through study.
Physiotherapy Theory and Practice
Physiotherapy Theory and Practice 303
Data analysis
This study was conducted over a period of 2 months
and used a convenience sample. Analysis was descrip-
tive using medians, ranges, proportions, and flow-
charts to illustrate findings.
RESULTS
Patient flow and demographics
Flow of participants is shown in Figure 1. Twenty-
seven patients were admitted to SCGH with
confirmed GBS during the study period. Of these,
one remained an inpatient and was excluded from
data collection and two died; one as an inpatient as
a result of GBS and one as an outpatient with cause
unknown. Nineteen patients consented to participate
 304 Dennis and Mullins
TABLE 1 Number (%) or median (range) for admission
characteristics and medically documented symptoms of
respondents, n = 23.
Age (years) median (range) 49 (19–80)
Male, n (%) 14 (61)
Living in metropolitan area, n (%) 10 (43)
Independent at home with partner, n (%) 22 (96)
Length of symptoms prior to acute hospital 3 (1–13)
admission (days) median (range)
Sudden onset weakness, n (%) 21 (91)
Sudden onset sensory disturbance, n (%) 22 (96)
Flu symptoms, n (%) 19 (83)
Other respiratory symptoms, n (%) 6 (26)
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ICU requirement in view of respiratory 7 (30)
compromise, n (%)
Mechanical ventilation required, n (%) 6 (86)
Myalgia symptoms, n (%) 12 (52)
in the study. A waiver of consent was granted to review
and extract inpatient data from the medical notes of
those patients who had died (n = 2) or who were
unable to be contacted for consent (n = 2). The
For personal use only.
result was a total of 23 patients included in this
study. The majority of patients were male (61%)
non-smokers (74%) who were fulltime students or
employed (74%). There were slightly more patients
from country areas (57%) compared with metropoli-
tan and the most common presenting characteristics
were sensory disturbance (96%) and weakness
(91%). Baseline demographic and admission charac-
teristics of the cohort are shown in Table 1.
Characteristics of hospital stay
In terms of the provision of drugs, Intragram was
administered to the majority of patients (96%) com-
mencing day 1 (median, range 1–9 days) for 5 days
(median, range 4–10 days). Both gabapentin (39%)
and steroids (30%) were administered to less than
half of the cohort.
All 23 patients exhibited some degree of motor
weakness during the decline phase. The majority
had significant sensory loss (83%), respiratory
muscle involvement (74%), and cranial nerve involve-
ment (65%). Only five patients (22%) demonstrated
significant hypersensitivity. Spirometry was under-
taken in 19 patients (83%), with 15 (79%) of these
undergoing subsequent spirometry every 6 hours or
more frequently.
Intensive care unit transfer was required for seven
patients (30%). The duration of ICU stay was 9.2
days (median, range 0.75–22.6) and mechanical
TABLE 2 Number (%) or median (range) for complications of
respondents, n = 23.
Patients, n (%) 20 (87)
Number per patient, median (range) 1 (0–5)
Low back pain, n (%) 14 (61)
Pulmonary embolus/DVT, n (%) 2 (9)
Pneumonia, n (%) 5 (22)
Fall, n (%) 5 (22)
Pressure area, n (%) 1 (4)
Contracture, n (%) 1 (4)
ventilation was required in six cases (86%). The dur-
ation of full mechanical ventilation was 37 hours
(median, range 10–201), with an additional 83 hours
weaning (median, range 32–222) using pressure
support ventilation. A tracheostomy was required in
six of the ICU patients (86%) for 31 days (median,
range 13–167). Only five (83%) of these patients
were subsequently decannulated, one (20%) in ICU
and four (80%) on the ward. Five patients (22%)
required splinting of upper or lower extremities.
Twenty patients (87%) developed complications
during their hospital stay (Table 2), with the most
common being low back pain (61%). No data were
collected relating to the severity of low back pain, or
the extent to which it persevered or interfered with
subsequent rehabilitation. Only one patient (4%)
developed contracture, and one other (4%) developed
a pressure area.
All 23 patients had an initial assessment documen-
ted by physiotherapists. Physiotherapy is summarized
in Table 3. The majority of patients had a respiratory
initial assessment (70%) by day 2 (median, range 1–8)
and range of movement exercises (87%) by day 3
(median, range 1–8). A mean number of five different
physiotherapists attended each patient in ICU (SD
4.2) and on the ward (SD 6.2), with 15 (median,
range 1–81) occasions of service in ICU and 10
(median, range 1–307) on the ward. The total dur-
ation of all physiotherapy in ICU was 7.2 hours
(median, range 0.75–29.7) and 9.9 hours (median,
range 0.5–220) on the ward. In terms of mobilization,
only 18 patient records (78%) had clear documen-
tation as to when patients were first sat out of bed,
the median being day 4 (range 1–11). Physiotherapists
were most commonly first to mobilize patients to sit on
the edge of the bed, stand, transfer, and walk (83%,
82%, 81%, and 90%, respectively).
Separation data are shown in Table 4. Overall hos-
pital length of stay was 20 days (median, range 5–198)
and 13 patients (56%) required transfer for extended
rehabilitation. One patient died secondary to GBS in
the inpatient setting.
Copyright © Informa Healthcare USA, Inc.

TABLE 3 Number (%) or median (range) for physiotherapy
management of respondents, n = 23.
General examination documented, n (%)
Initial assessment (days) median (range)
Subsequent frequency of examination
Twice daily, n (%)
Daily, n (%)
Less frequently, n (%)
Respiratory examination documented, n (%)
Initial assessment (days) median (range)
Subsequent frequency of examination/
treatment
Twice daily, n (%)
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Daily, n (%)
Once, n (%)
Functional examination documented
Initial assessment, n (%)
Requirement for aids, n (%)
ROM, n (%)
Provision of ROM exercises, n (%)
Implementation (day) median (range)
Frequency (daily), n (%)
Nature of ROM exercises
Passive, n (%)
Active or active assisted, n (%)
Both active and passive, n (%)
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Subsequent changes in functional level
described, n (%)
Nil contractures noted subsequently, n (%)
Improvement phase
First improvement documented anywhere
(days) median (range)
Lung and strength treatment combined,
n (%)
Respiratory function limiting functional
rehabilitation, n (%)
Service delivery
Occasions of service (n) median (range)
Total length of all treatments (hours)
median (range)
Note: ROM, range of movement.
a
n = 21 as two patients fully ventilated and sedated.
b
n = 17 requiring aids.
c
n = 18 documented.
TABLE 4 Number (%) or median (range) for separation data of
respondents, n = 23.
Duration of hospital stay (days) median (range)
Discharge plan documented (days) median
(range)
Direct discharge home, n (%)
Requiring transfer to rehabilitation facility, n (%)
LOS rehabilitation facility (days) median (range)a
Death due to GBS during inpatient stay, n (%)
a
Data only available for 11 patients.
Physiotherapy Theory and Practice
Physiotherapy Theory and Practice 305
Patient telephone survey
The majority of patients surveyed remembered their
23 (100)
ward stay and physiotherapy staff (84%). Their recall
2 (1–5)
of the personnel involved in their care is summarized
6 (26) in Table 5. The majority could differentiate between
14 (61) health professionals (79%) and remembered specific
3 (13) nursing (79%), medical (79%), and physiotherapy
16 (70) (85%) personnel.
2 (1–8) Physiotherapy was received by 16 surveyed
patients and their satisfaction with components of
2 (12)
physiotherapy is summarized in Table 5. Nearly all
were satisfied with overall physiotherapy care (87%),
10 (63)
4 (25) the frequency (88%), and length (94%) of treatment,
23 (100) and the overall timetabling and reliability of treat-
17 (81)a ment (81%). Most patients were satisfied with the
10 (59)b effectiveness of physiotherapy (75%), and they were
10 (43)
unanimously satisfied with physiotherapists’ profes-
20 (87)
3 (1–8)
sionalism, and their ability to gain rapport and trust
17 (85) (100%). The majority were satisfied with the infor-
mation provided by the physiotherapist regarding
2 (10) outcome (87%), the team approach adopted (81%),
14 (70) and the level of involvement of family in management
4 (20)
(63%).
18 (86)a
Three patients, all men from country areas were
17 (74)
unsatisfied with the effectiveness of physiotherapy.
Two had significant past medical histories (including
6 (2–34) depression and alcoholism) and underwent prolonged
hospital stays (188 and 37 days), one including inten-
12 (67)c sive care and mechanical ventilation. Both patients
also sustained a considerable number of compli-
8 (35)
cations including pulmonary embolus, pneumothor-
ax, pneumonia, low back pain, and a fall, and both
12 (1–341) remained functionally dependent on transfer to a sec-
10 (0.5–241) ondary hospital for further rehabilitation following
acute hospital stay. They received a combined
255 hours over 371 occasions of physiotherapy
during their acute stay. The other patient was up mo-
bilizing by day 2 with the nursing staff, had only one
40-minute session of physiotherapy, and was dis-
charged home after 3 days.
Another three patients, two men and one woman,
were unsatisfied with the involvement of their family by
physiotherapy. Their history and clinical course was
each quite different, although none required intensive
care admission. Two were from the country and one
20 (5–198) was from the metropolitan area. There was variable
9 (5–163) length of hospital stay (6, 18, and 21 days), and frequency
(5, 8, and 21 treatment occasions) and amount of phy-
9 (39) siotherapy (120, 355, and 950 minutes). All patients
13 (56) were able to undertake active or active-assisted range of
21 (6–218)
motion exercises within 2 days of admission. Two were
1 (4)
discharged home and one was discharged to a rehabilita-
tion facility.
 306 Dennis and Mullins

TABLE 5 Number (%) for respondent recollection of personnel (n = 19) and satisfaction with physiotherapy (n = 16).

Strongly disagree Disagree Unsure Agree Strongly agree

I remember…
• my stay on the ward 0 0 3 (16) 2 (10) 14 (74)
• my stay in ICU, n = 4 0 0 0 1 (25) 3 (75)
• differentiating health professionals 0 1 (5) 3 (16) 4 (20) 11 (59)
• nursing staff 0 0 4 (21) 7 (37) 8 (42)
• medical staff 0 0 4 (21) 8 (42) 7 (37)
• physiotherapy staff 1 (5) 0 2 (10) 6 (32) 10 (53)
I was happy with physiotherapy…
• overall care 0 0 2 (12)a 2 (12)a 12 (75)
• treatment
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• frequency 0 2 (12)a 0 6 (38) 8 (50)

• length 0 0 1 (6) 4 (25) 11 (69)
• timetabling 0 1 (6) 2 (12)a 1 (6) 12 (75)
• reliability of timetabling 0 1 (6) 2 (12)a 1 (6) 12 (75)
• effectiveness 2 (12)a 1 (6) 1 (6) 3 (19) 9 (56)
• professionalism 0 0 0 3 (19) 13 (81)
• level of rapport and trust 0 0 0 2 (12)a 14 (88)
• treatment information 0 0 2 (12)a 5 (31) 9 (56)
• outcome information 0 2 (12)a 1 (6) 5 (31) 8 (50)
• team approach 0 1 (6) 2 (12)a 2 (12)a 11 (69)
• involvement of family 0 3 (19) 3 (19) 3 (19) 7 (44)a

Note: Only 16 of the 19 patients surveyed actually received physiotherapy treatment.

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a
Percentages of patients rounded down.

DISCUSSION the illness relating to their physiotherapy care. Results

This observational study provides an overview of inpa-
tient case management including physiotherapy for
GBS patients at a single site. It further provides data
relating to the GBS patients’ satisfaction with attending
physiotherapists. The findings are that in this cohort:
1 GBS patients receiving physiotherapy were most
often satisfied across all domains with the phy-
siotherapy service provided.
2 Physiotherapists were involved in all patients’ care,
and were most commonly the first to mobilize
patients out of bed.
3 Low back pain occurred as a common complication
in more than half of the cohort.
Significant gaps in the evidence base in rehabilita-
tion practice for persons with GBS have been identified
(Khan et al, 2010), including a failure to incorporate
the perspective of the person with GBS. Although
studies have explored the GBS patient’s personal
experiences of falling ill (Forsberg, Ahlström, and
Holmqvist, 2008) and their overall satisfaction
(Forsberg, de Pedro-Cuesta, and Widén Holmqvist,
2006), to our knowledge, this is the first quantitative
study to explore and report on the satisfaction of
patients who have undergone acute management of
demonstrate that satisfaction was high across all facets
of physiotherapy management and that physiothera-
pists were well recognized and remembered during hos-
pitalization. This concurs with a recent Norwegian
study (Normann, Moe, Salvesen, and Sørgaard,
2012) where patients with multiple sclerosis reported
a high level of satisfaction with physiotherapists regard-
ing interpersonal and clinical skills, information, and
instruction. Although the often insidious onset of mul-
tiple sclerosis differs markedly from the sudden
deterioration seen in GBS, the acute and sub-acute
neurological deficits may be comparable.
Of interest was the group of patients who were not
satisfied (18%) with the effectiveness of physiotherapy.
It is possible that in two of these cases, past medical
history and slow functional recovery may have
impacted on their ability to rate the effectiveness of
physiotherapy highly. In the other case, where there
was early mobilization by staff other than physiother-
apy, relatively quick recovery, and discharge home,
it may be that the relevance and importance of
physiotherapy to this individual was overshadowed
by the natural recovery process.
Also of interest is the group of patients who were not
satisfied (18%) with the involvement of their family by
physiotherapy. The explanation of why this was so is
more difficult to discern, as they followed quite differ-
ent individual clinical courses and had variable

Copyright © Informa Healthcare USA, Inc.


physiotherapy input and functional outcome. It may be
that there was a mismatch between what was reasonably
expected and what could reasonably be delivered.
Researching the complex intervention of “rehabili-
tation” in the GBS patient population is problematic,
because although the basic characteristics of clinical
presentation (muscle weakness, sensory disturbances,
and respiratory compromise) are consistent, there may
be a wide range of disability levels requiring an indivi-
dualized approach according to the resources available
across different programs and populations (Khan et al,
2010). In this study, all patients were reviewed by
physiotherapy, whatever the level of disability. This
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finding in itself may be considered atypical as there
is literature to suggest that not all patients receive phy-
siotherapy (Carroll, McDonnell, and Barnes, 2003;
Davidson, Wilson, Walton, and Brissenden, 2009).
Despite the fact that patients were mobilized out of
bed relatively early, there remained a high rate of at
least one significant complication among the cohort,
which may be explained, at least in part, by prolonged
bed rest. An inability to independently reposition
has been shown to alter cutaneous pain perception
(Angel, Bril, Shannon, and Herridge, 2007; Lowthian
For personal use only.
and Parish, 2007) and cause neurophysiological dys-
function in critically ill patients (Fletcher et al, 2003),
with contributing factors including compressive nerve
injury and muscular morphological changes. While
these and other effects of bed-rest are outlined else-
where (Needham 2008; Winkelman 2009), it may be
that disorders such as GBS that are associated with
inflammatory neuropathy, neuropathic pain, muscle
weakness, immobility, hypersensitivity, and loss of
independent function increase complication risk.
Of particular interest was the number of GBS
patients who developed LBP during their acute admis-
sion. Current literature (Heneweer, Vanhees, and
Picavet, 2009; Schiltenwolf and Schneider, 2009)
describes a U-shaped correlation between physical
activity and self-reported low back pain whereby both
physical activity and inactivity can represent a back
pain risk factor. Although this fits with the character-
istics of this inactive cohort, it may be only part of the
problem. Studies (Belavý et al, 2011; Ferreira, Ferreira,
and Hodges, 2004; Hodges and Richardson, 1996;
Hodges and Richardson, 1998) have indicated that in-
effective muscular stabilization of the lumbar spine is
highly correlated with the incidence of low back pain.
As GBS is characterized by moderate to severe
muscle weakness or paralysis, this correlation may
also explain the incidence of LBP in this cohort.
Importantly, the other perhaps more predictable
musculoskeletal complications including muscle
shortening/joint contracture and pressure areas were
less evident in this cohort.
Physiotherapy Theory and Practice
Physiotherapy Theory and Practice 307
Limitations
One limitation of this study is the small number of
patients in a single-site cohort. Although this limits
the extent to which results may be generalized, there
were positive trends, particularly relating to patient
satisfaction.
There are also those limitations inherent with a
retrospective chart review including missing data, par-
ticularly relating to muscle charting in this population.
Non-uniform data collection procedures were mini-
mized by having a standardized data collection form
and survey, and the same individual review case
notes and conduct interviews. This may have in itself
introduced another limitation, in that respondents
knew they were talking to a physiotherapist during
interview, and this may have created a positive bias.
It was however made clear to them that the interviewer
had had no prior contact with them during their acute
inpatient stay.
CONCLUSION
This study provides insight into the extent of phy-
siotherapy in the acute GBS setting, and the patient’s
satisfaction with services provided. More controlled
multi-centred trials are required to add to the body
of knowledge supporting the use of physiotherapy
and associated modalities in the treatment of GBS,
where there is thought to be considerable natural
recovery.
Acknowledgments
The authors gratefully acknowledge Charley Budgeon
(Statistician, University of Western Australia) for her
statistical analysis and Tracy Beckwith and Leanne
Cormack (Senior Physiotherapists, Physiotherapy
Department, Sir Charles Gairdner Hospital) for
their general collaboration and review of the manu-
script. This study was funded by the SCGH Research
Advisory Committee and supported by the SCGH
Research Foundation.
Declaration of interest: The authors report no
conflict of interest.
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