Received: 6 March 2023 | Revised: 4 July 2023 | Accepted: 11 July 2023

DOI: 10.1111/jep.13909

REVIEW ARTICLE

Physiotherapy assessment in people with neurological

conditions—Evidence for the most frequently included
domains: A mixed‐methods systematic review

Jill Garner M Clin rehab1 | Maayken van den Berg PhD2 | Belinda Lange PhD3 |
Sally Vuu BPT2 | Sheila Lennon PhD4

1
Department of Physiotherapy, Caring
Futures Institute, College of Nursing and
Health Sciences, Flinders University and
Southern Adelaide Local Health Network,
Adelaide, South Australia, Australia
2
Department of Clinical Rehabilitation, Caring
Futures Institute, College of Nursing and
Health Sciences, Flinders University, Adelaide,
South Australia, Australia
3
Department of Physiotherapy, Caring
Futures Institute, College of Nursing and
Health Sciences, Flinders University, Adelaide,
South Australia, Australia
4
Department of Physiotherapy, College of
Nursing and Health Sciences, Flinders
University, Adelaide, South Australia, Australia
Correspondence
Jill Garner, Department of Physiotherapy,
College of Nursing and Health Sciences,
Flinders University, Bedford Park, Adelaide,
SA 5042, Australia.
Email: jill.garner@flinders.edu.au
Abstract
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.

This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any
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© 2023 The Authors. Journal of Evaluation in Clinical Practice published by John Wiley & Sons Ltd.

J Eval Clin Pract. 2023;1–23. wileyonlinelibrary.com/journal/jep | 1


2 |
KEYWORDS
nervous system diseases, physical therapy modalities
1 | INTRODUCTION
Approximately one billion people are affected by a neurological
condition worldwide.1 Physiotherapy commonly plays an important
role in the overall care and management of people with neurological
conditions, and this assessment is a cornerstone of clinical practice.
The World Health Organisation (WHO) has described assessment as
a process that includes examination, history taking, screening and the
use of specific tests and measures through analysis and synthesis
2
within a process of clinical reasoning”. More specifically within
the physiotherapy context, World Physiotherapy (WPT) highlights
the clinical reasoning element of the assessment, by defining a
physiotherapy assessment as an approach using clinical reasoning,
incorporating current evidence and the patient and care giver's
perspectives, and ensures that the physiotherapist develops and
evaluates an appropriate plan of care for each patient.3
In preparation for clinical practice, physiotherapy students
are taught many assessment domains such as pain; posture;
range of movement; strength/weakness; sensation; balance; and
co‐ordination. Some of these domains, such as communication and
mood, can also be assessed by other health professionals. Physio-
therapy students often identify complexity in the assessment process
and difficulties in developing an optimal treatment plan for people
with neurological conditions.4 The theoretical basis for assessment in
expert textbooks recommends the inclusion of approximately 28
5,6
domains. The detailed assessment students are taught at university
for people with neurological conditions is often not reflected in
expectations while on placement, suggesting that other factors may
influence assessment such as experience or healthcare setting.4 In
addition to health care settings, geographical settings may also need
to be considered. A large study investigating the scope of musculo-
skeletal practice tendencies between countries worldwide has
demonstrated a large variability, discussing this in the context of
educational requirements and models as well as differences in
5
healthcare systems.
Current clinical practice in the assessment of people with a
neurological condition is based on a diversity of resources, including
textbooks,7 recommendations by professional associations, govern-
ment bodies and disability frameworks such as the International
Classification of Functioning, Disability and Health (ICF) framework,2
or condition‐specific guidelines such as stroke.8 However, to date,
there is a lack of formal consensus on the domains that physiothera-
pists should include in their assessment.
Different strategies have been described for clinical reasoning
from novices to experienced physiotherapists,9 suggesting
differences in assessment practices. Evidence has demonstrated
differences in clinical reasoning processes between expert and
novice clinicians in musculoskeletal and cardiorespiratory physio-
therapy practice, including information gathering and synthesis,
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GARNER ET AL.
communication, and assessment time have been.10–12 Little infor-
mation is available on the factors that influence assessment
practices in neurological physiotherapy training and practice.
Moreover, the focus has been mainly on the assessment of a single
domain, such as gait, and the use of standardised measurement
tools in relation to specific conditions.13,14
In summary, there is limited evidence in the literature related to
the domains to be included in the physiotherapy assessment of a
person with a neurological condition in varying clinical contexts.
Although there is some evidence suggesting that certain factors, such
as therapist experience, clinical and geographical setting, and clinical
condition may play a role, little is known about factors influencing
neurological physiotherapy assessment practice.15–18
This mixed‐methods systematic review aimed to determine (1)
what domains physiotherapists routinely assess in clinical practice in
people with neurological conditions, and (2) whether the factors of
clinical and geographical setting, therapist experience and neurologi-
cal condition play a role in the choice of these assessment domains.
2 | METHOD
A mixed‐methods systematic review of the scientific and grey
literature was conducted. The Joanna Briggs Institute (JBI) Conver-
gent Integrated Approach to mixed‐methods systematic reviews was
used. The results were reported following the Preferred Reporting
Items for Systematic Reviews and Meta‐Analyses (PRISMA).19
2.1 | Search strategy
Searches were conducted in MEDLINE, PubMed, CINAHL, Scopus,
Web of Science, and the Cochrane Library. The searches were limited
to English publications published from 1946 to January 2023.
Additionally, relevant grey literature was searched, such as websites
of physiotherapy associations and councils, and targeted hand
searching of reference lists supplemented the search strategy. The
full search strategy for scientific and grey literature searches is
presented in Appendix 1.
2.2 | Eligibility and screening
For the purpose of this review, the term ‘physiotherapy assessment’
describes any process that includes history‐taking, screening and
evaluation of the results of the examination through analysis and
synthesis within a process of clinical reasoning.3
Studies of any research design reporting on domains of
physiotherapy assessment in clinical practice with people with

GARNER ET AL.
neurological conditions were included. Studies were included for any
setting; if participants were physiotherapists who assessed adults
with neurological conditions; and the study provided data about
assessment domains. Studies were excluded if they were systematic
or scoping reviews, textbooks, or commentaries; reviewed the
reliability and validity of a standardised measurement tool; directed
therapists to use a specific standardised measure; or focused on a
theoretical discussion of best practice guidelines with no data on
neurological physiotherapy assessment in clinical practice. Studies
describing the assessment related to headache, dementia, and
vestibular dysfunction were excluded, as their assessment domains
were different from those of other neurological assessments.20–22
The title and abstract, as well as full‐text articles, were screened
independently by two authors (JG, SV). Disagreements regarding
eligibility for study inclusion were discussed and resolved and
involved two further members of the research team (MB, BL), which
were deemed necessary.
2.3 | Methodological quality
The methodological quality of the included studies was assessed using
qualitative or quantitative McMaster University critical appraisal
tools23,24 The research team identified four McMaster criteria that
were deemed critical based on answering the questions for this review
(see Appendices 2–3 for full details). These four criteria are critical: a
detailed description of the intervention, a detailed description of the
sample, appropriate analysis methods, and appropriate conclusions.
2.4 | Data extraction and analysis
Data were extracted by one researcher (JG) and checked for accuracy
by the research team (MB, BL, SL) using a purposefully developed pro
forma, based on the JBI Mixed Methods Data Extraction Form
25
following a Convergent Integrated Approach. Data related to study
characteristics, participant characteristics, and assessment, were
extracted from all quantitative and qualitative studies. The study
characteristics included author, year, country, study design, study
aim, clinical setting, study population and sample size. Data related to
participant characteristics included age, sex, level of education, years
of qualification, and neurological physiotherapy experience. Finally,
collated information related to the assessment domains assessed,
neurological condition assessed, assessment timing, and frequency of
assessment. Classification of domains was decided on using a
consensus approach, which was guided by the literature and
discussed between the researchers until an agreement was reached.
As part of this discussion, in the context of gait patterns, it was
decided that individual impairments, such as strength and, somato-
sensation, were considered separately from gait‐related parameters,
such as distance and speed described as gait. Quantitative data were
presented descriptively, tabulated, and synthesised using a narrative
synthesis approach.
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| 3
In parallel, further to the data extracted as described above,
any additional qualitative data pertaining to assessment were also
extracted and managed using NVivo 12 software.26 An inductive
thematic analysis approach was used to analyse and synthesise this
data.27 Codes were developed based on the identified content in these
qualitative studies, then refined and grouped into sub‐themes and
themes. This was reviewed, and discussed with the research team (MV,
BL, SL) until a consensus was reached. The qualitative and quantitative
data were then integrated to verify domains routinely assessed by
physiotherapists in clinical settings in people with neurological
conditions and to explore factors influencing the assessment.
3 | RESULTS
Figure 1 shows the PRISMA flow diagram. Following the removal of
duplicates, 1742 studies were independently screened for eligibility.
One hundred and seventy‐seven full texts were assessed as
potentially eligible. Most studies were excluded from assessment
data that were theoretical in nature (n = 31) or described non‐
physiotherapy assessment (n = 30). In total, 23 studies were judged
eligible for inclusion in this review (16 quantitative studies and 7
qualitative studies). The review findings are presented separately for
the quantitative and qualitative studies.
4 | Q U A NT I TAT I V E S TU D I E S
4.1 | Study characteristics
The characteristics of the 16 quantitative studies included are presented
in Table 1. Studies have been conducted in the United Kingdom,18,28–30
Canada,31–33 Canada and India,34 Australia,35 and the United States of
America.36 One study included participants worldwide.37 Thirteen
studies used a cross‐sectional design using surveys,18,28,30,32–35,37–42
two used a case study design,29,36 and one used a retrospective chart
audit.31 With regard to study aims, seven studies explored the influences
of assessment on treatment choice and decision‐making,18,29,30,33–36
and six studies explored the use of standardised measures.14,29,31,32,39,43
Three studies aimed to develop an expert consensus related to beliefs
underpinning physiotherapy assessment practice.18,28,42
The number of physiotherapists included in the studies ranged
from 144 to 1022.18 Two studies reported the age of participants,
with 89% of participants aged between 30 and 5933 and mean age
32.65 (SD 9.19).31 Sex, reported in four studies only, was mainly
female.33,34,37,39 Years of clinical experience were reported in nine
studies18,28,29,38 ranged from 7 to 16 years.43 The clinical work
settings were mixed in eleven studies.38 One study included mostly
rehabilitation settings,35 and three studies were conducted in a single
setting, that is inpatients,31 outpatients29 and stroke units.18
Clinical populations included stroke (n = 9),14,18,28–30,36–38,43
neurological conditions in general (n = 4),31,32,34,45 Parkinson's
disease (n = 1)14,33 and acquired brain injuries (n = 2).33
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4 | GARNER ET AL.

FIGURE 1 Prisma Flowchart (Moher et al., 2015).19

4.2 | Study quality balance (n = 7),18,31–36 range of movement (n = 6),14,18,31,32,34,36 postural

alignment and symmetry (n = 6),18,29,31,33,35,36 gait (n = 6),29–33,35 and
Appendix 2 provides the quality assessment results. Seven somatosensation (n = 6).14,29,30,32,36,40
14,18,28,29,38–40
studies were judged medium quality, and nine Domains that were reported only once included spasticity,38
30–37
studies were judged high quality. The main limitations tremor,14 psychological and higher brain function,35 mood,35 deep
are related to the lack of analysis and limited description of the tendon reflexes,38 pain,33 and quantified motor practice.35
methods.

4.4 | Factors influencing selection of assessment

4.3 | Assessment domains domains

The assessment domains identified in the quantitative studies are There are not enough data to support the influence of country,
summarised in Table 2. Most frequently described domains included clinical setting, therapist experience or neurological condition on the
function (n = 9)14,18,28,30,31,33,34,38 strength (n = 8),14,18,30–32,34,35,38 included assessment domains.
 TABLE 1 Study characteristics and quality of included quantitative studies (n = 16).
GARNER

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
ET AL.

study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

1. Bailey To enhance research Survey Stroke Physiotherapists n = 167 BIT, copy picture or draw No data 15% of physiotherapy Medium
et al., into assessment Outpatients: 18% Years since qualifications: figure, simultaneous respondents reported
1998 and treatment of Private practice: 2% at least 6 years, extinction tests testing for neglect.
United hemineglect, and to Elderly care and 84% >17 years 98% identified neglect as
Kingdom increase knowledge general medical part of routine
about current wards: 32% assessment, 40% by
practice in stroke Specialist units: 25% observation and 60%
Community: 23% by observation and
specific tests

2. Blanchette Increase knowledge Survey General neurological Physiotherapists n = 204 clonus, Motor Assessment 83.3% of Occupational 83% performed spasticity High
et al., about current Outpatients: 15.7% Gender: Scale, deep tendon therapists and assessment on
2017 trends in spasticity General wards: 10.3% Female n = 88 reflexes functional Physiotherapists admission with lower
Canada management and Acute wards: 17.2% Male n = 16 scales, Original Ashworth believed spasticity reassessment
treatment Extended care: 2.5% Level of education: Scale, Modified should be assessed percentage
Rehabilitation: 53.4% Diploma n = 6 Ashworth Scale, rapid on admission to
Community: 10.3% Bachelor degree n = 146 passive movements rehabilitation, with
Home care: 11.3%. Masters degree n = 49 reassessment at an
PhD n = 3 interim time,
Neurological experience: discharge, and
<1 year n = 5 (2.5%) follow up
1–3 years n = 26 (12.7%)
4–10 years n = 52 (25.5%)
>10 years n = 121 (59.3%)

3. Carr Investigate factors Survey Stroke Physiotherapists n = 208 Abnormal postural reactions, No data Respondents had High
et al., what influences Rehabilitation: 89% Level of education: Action Research Arm difficulty explaining
1994 treatment choice, Acute wards: 77% Additional education Test, Functional the underlying
Australia theoretical basis for Nursing homes: 36% post‐qualifying: 71% Independence Measure, theoretical basis for
treatment choices Other: 28% Neurological experience: quantified motor their treatment
8 ± 6.0 years performance, motor choices
control, Motor
Assessment Scale, tone

4. Cavanaugh Describe the decision‐ Case report Stroke Physiotherapists n = 1 Activity tolerance, bed Admission and The case illustrated how a High
& making process of a Inpatient No other data mobility, behaviour, Berg discharge physiotherapist uses
Schenkm- physiotherapist rehabilitation: Balance Scale, cognition, models and
an, 1996 working with a 100% falls risk, Fugel Meyer, frameworks to
United States stroke patient sensorimotor evaluation, organise information
of divided attention, and the value of
America extinction, gait, goal analysing assessment
identification, item findings that explore
|

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 6

TABLE 1 (Continued)
|

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

cancellation, line functional limitations,

bisection, Mini Mental assisting in setting
State Exam, mood, multi‐ goals and prioritise
tasking, pain, postural treatment
control, range of
movement, rolling,
reaching, sitting balance,
standing, transfers,
Timed Up and Go Test,
timed sitting and
standing, trunk
weakness, visual
attention, 6‐min
walk test

5. Checketts To determine which Survey Stroke Physiotherapists n = 55 Assessment of neglect No data For the assessment of High
et al., neglect tests are Inpatients: 74.5% Years since qualifications: neglect, cognitive
2020 used, by which Outpatient: 23.6% 3 months to 34 years tests were used for
Worldwide stroke clinicians, in Community: 16.3%. 82% of respondents,
which countries, 80% used functional
and whether choice tests, and 20% used
is by professional neuroimaging or
autonomy or neuromodulation
institutional policy Respondents agreed a
combined approach is
needed for screening
and further training

6. Demers Identify and compare Survey General neurological Physiotherapists n = 317 No data No data 10.8% of Canadians High
et al., the use of Outpatients: 32% Gender: reported never using
2018 standardised General hospital: 20% Female n = 259 standardised outcome
Canada and outcome measures Acute ward: 20% Male n = 58 measures, compared
India and factors that Extended care: 6% Level of education: with 3.3% of Indians
influence this Rehabilitation: 52% Bachelor n = 183
Community: 11% Masters degree n = 123
Home care: 20% PhD n = 11
Other: 8% Neurological experience:
<3 years n = 93
4–10 years n = 80
>10 years n = 144
GARNER
ET AL.

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 TABLE 1 (Continued)
GARNER

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
ET AL.

study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

7. Gervais Identify physiotherapy Retrospective Stroke and other No data Activity tolerance, active No data There is variation in the High
et al., assessment tools in chart (complex range of movement, assessment of balance
2014 the assessment of review musculoskeletal, balance, orientation in
Canada balance in inpatient amputee, space, individual sensory
population deconditioning input, static stability
after acute illness, control of dynamics,
cardiac surgery) anticipatory movement
Inpatients 100% strategies, reactive
movement strategies,
cognitive processing, Berg
Balance Scale, Chedoke‐
McMaster Stroke
Assessment Scale, co‐
ordination, gait, distance
walked, internal
perturbations, external
perturbations, pain and
temperature, postural
alignment, proprioception,
passive range of
movement, light touch,
stairs, strength, swelling,
transfers, Timed Up and
Go Test, vision, 2‐min
walk test, 6‐min walk test

8. Lennon, Provide expert Survey Stroke Physiotherapists n = 8 Bartel Index, outcome No data Bobath therapists Medium
Baxter & consensus related Stroke Years since measures, self‐devised believed normal tone
Ashburn, to theoretical units: 10%–15% qualifications: 7–13 outcome measures was essential and use
2001 beliefs More than one years normal movement
United underpinning setting: 15%–17% Neurological experience: patterns to perform
Kingdom current bobath 5–15 years (mean = 9.4 functional tasks
practice years) If tasks affected tone
adversely some tasks
were delayed
There was use of walking
aids and orthotics

9. Lennon, To describe the use of Case Stroke Physiotherapists n = 2 Communication ability, correct No data Suggests recovery of Medium
2001 outcome measures description Outpatients: 100% Years since qualifications: alignment, and block more normal
to document >10 years atypical movements, movement patterns
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 8

TABLE 1 (Continued)
|

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

United recovery of Neurological experience: collaborative functional and functional ability

Kingdom movement within >6 years goals, current functional and gives insight into
the gait cycle and level, gait, pre‐morbid bobath therapists
walking ability an functional level, goals, practice
describe treatment hearing, information
process used by the gathering re: history, light
physiotherapists to touch, medical history,
educate gait mental status, muscle
tone, neglect, outcome
measures, passive or
active assisted movement,
postural tone, problem list,
proprioception in the
limbs, social, history, vision

10. Provide expert Survey Stroke Physiotherapists n = 1022 Alignment of key points and 31% would review at Four theoretical themes Medium
Lennon, consensus of the Inpatient: 14% Years since the interaction between 6 weeks, 2% were in use in
2003 theoretical beliefs Mixed setting: 17% qualifications: >10 base of support with reviewed at practice: the
United underlying years—58% gravity in different 6 months promotion of normal
Kingdom physiotherapy postural sets, balance, movement, the
practice in stroke Bartel Index, function, control of tone, the
rehabilitation Functional Independence promotion of function,
Measure, muscle strength, and recovery of
range of movement, movement with
Rivermead Motor optimisation of
Assessment, selective compensation
movement, sensation,
self‐devised tools, tone

11. Lyon Explore current Survey Acquired brain injury Physiotherapists n = 373 18 outcome measures No data 93% used outcome High
et al., practices in use of Inpatient: 29.5% Age: 23–67 (mean = 32.65, most frequently used: Berg measures in people
2022 balance outcome Outpatient: 51.5% SD = 9.19) Balance Scale, Dynamic with acquired brain
United States measures and the Home: 5.1% Gait Index, Timed Up injury
of America role of outcome Mixed: 3.5% and Go comfort, equipment
measures in clinical Other: 2.4% availability, and
decision making psychometric
properties were the
most frequent reasons
for choosing the
outcome measure
GARNER
ET AL.

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 TABLE 1 (Continued)
GARNER

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
ET AL.

study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

Clinical decision making

was impacted by
outcome measure

12. Proud Explore the upper limb Survey Parkinson's disease Physiotherapists and Active movement, No data 54% of respondents Medium
et al., assessment Inpatient: 46% Occupational bradykinesia, Coin regularly assessed the
2013 practices of Outpatient: 51% therapists Rotation Task, Canadian upper limb
Australia Australian Residential: 11% Physiotherapists n = 122 Occupational There was widespread
physiotherapists and Community: 7% Years since Performance measure, use of non‐
occupational qualifications: 10 years Disability Rating Scale, standardised methods
therapists, including —58% dyskinesia, Goal to assess Parkinson's
frequency, Level of education: no Attainment Scale, Motor Disease‐specific
impairments and data, neurological Assessment Scale, muscle impairments
activity limitations, experience: no data length, nine‐hole peg test, Standardised measures
and methods and passive range of were more frequently
outcome movement, Parkinson's used to evaluate
measures used Disease questionnaire, activity limitations
Purdue Pegboard Test,
sensation, strength, timed
functional activities, tone
and rigidity, tremor,
Unified Parkinson's
Disease Rating Scale, JHF

13. Sackley & Explore current Survey Stroke Physiotherapists n = 91 Chartered Society of No data Physiotherapists found it High
Lincoln, approaches to Large variety in work Gender: Physiotherapy published difficult to describe a
1996 treatment and settings. Most Female n = 68 tools and local ones, theoretical basis for
United choice of frequent Male n = 23 Chedoke‐ McMaster their treatment
Kingdom assessment community and Stroke Assessment Scale, Limited use of
methods hospital: 39.5% Lindmark, Motor standardised
assessment Scale, Motor assessments
Club Asessment,
Motricity index,
Rivermead Motor
Assessment, Rivermead
Motricity Index, Sheffield
Motor Assessment, Teler
Standardised
Assessment, timed,
balance scores, walking
distance
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 10

TABLE 1 (Continued)
|

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

14. Wilson Describe the current Survey Moderate to severe Physiotherapists n = 59 Dynamic balance, functional Admission and Domains of assessment High
et al., practice patterns acquired brain Age: 30–59 years independence of gait, discharge most frequently
2018 of Canadian injury (not (89.8%) Gender: gait efficiency, gait included “often or
Canada physiotherapists including stroke) Female n = 36 endurance, gait very often” at initial
regarding the Inpatient: 52% Male n = 23 kinematics, gait speed, and discharge‐visual
assessment and Outpatients: 67% Years since qualifications: goal setting observation (≥88.2%
treatment Community: 14% 0.5–5 years n = 9 (15%) for adults with mild‐
of gait dysfunction Residential: 5% 6–10 years n = 15 (25%) moderate and severe
Other: 3% 11–15 years n = 7 (12%) ABI) and the Berg
16–20 years n = 6 (10%) Balance Scale (≥76.3%
21–25 years n = 11 (19%) for adults with mild‐
26–30 years n = 7 (12%) moderate ABI)
31–35 years n = 4 (7.5%) Higher level gait training
Level of education: exercises were used
Diploma n = 1 (2%), more often for adults
Bachelor degree with mild‐moderate
n = 27 (46%) than severe ABI
Masters degree
n = 29 (49%)
PhD n = 2 (3%)

15. Winward Identify perceived Survey Stroke Physiotherapists n = 95 Light touch, pain, 93% assess 82 physiotherapists (84%) Medium
et al., clinical relevance No data on setting Gender: proprioception, pin prick, somatosensation indicated that they
1999 of somatosensory Female 85% pressure, stereognosis, on admission, 7% routinely performed
United testing for health Male 15% temperature, vibration, assess weekly, somatosensory
Kingdom professionals Years since qualifications: two‐point discrimination, 12% assess assessment
(doctors, occupational 7–16 years extinction monthly, 24% The two most commonly
therapists, and assess pre‐ included domains
physiotherapists) discharge were proprioception
and light touch
88 physiotherapists (90%)
believed that
somatosensory
assessment is
important in
determining prognosis
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ET AL.

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 TABLE 1 (Continued)
GARNER

Author/year/
country/ Design and Clinical population Therapist population Key assessment Quality
ET AL.

study number Aims/scope methodology and setting demographics domains (list) Timing of assessment Key findings rating

16. Yoward To explore the current Survey General neurological, Physiotherapists n = 269 Balance, Elderly Mobility No data 91% of respondents (245/ Medium
et al., use of outcome stroke, multiple Years since qualifications: Scale, range of 269) reported using
2008 measures of sclerosis, brain 2–38 years (mean = 12.6 movement, co‐ordination, standardised measure
United balance, walking, injury, Parkinson's years) sensory system, postural The most commonly used
Kingdom and gait in disease, spinal alignment, Berg Balance outcome measures
physiotherapy cord injury, Scale, were: 10‐metre (or
clinical practice central nervous Timed Up and Go, Functional other distance) walk
system tumours Reach, Motor Assessment test; the Berg Balance
No data on setting Scale, muscle strength, Scale; the Get Up and
POAM, postural sway, Go/Timed Up and Go
Rivermead Mobility Index, Test; and the
Rivermead Mobility Index Functional Reach Test
incorporating, modified
Rivermead Mobility Index,
sitting balance, timed
standing, (incorporating
timed unsupported
standing/TUSS), Tinetti/
modified Tinetti,
6‐min (or other time) walk
test, tone
Turn tests combined
(180◦and 360◦), walking,
10‐metre (or other
distance) walk test
|11

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12 | GARNER
TABLE 2 Assessment domains included in quantitative studies.
5 | QUALITATIV E S TUDIES
5.1 | Study characteristics
Seven qualitative studies were included in this review, and their
characteristics are summarised in detail in Table 3. Studies were
conducted in Canada,44,46 Norway,47 Australia,48 Japan,49 the United
States50 and Saudi Arabia.51 All six studies used interviews to collect
data. One study additionally used an observational approach to
gather information on physiotherapy assessment and treatment,47
another study also used focus groups.48 Most studies investigated
clinical reasoning as part of a physiotherapy assessment of people
44,49
with neurological conditions (n = 6).
The number of physiotherapists included in the studies ranged
from 1047 to 33.48 Age and sex were described in only three studies,
with participants being predominantly female46 and age ranging from
49
20 to 50 years and over, ranging from 20 to 50 years and over. Five
studies reported years of clinical experience, noting a mean of 8
years,49 a mean of 11.4 years,52 a range from 2 to 10 years,47 a range
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ET AL.
from 1 to 21 years46 and a range from 1 to greater than 15 years.46
The clinical work setting of the participants was described in six
studies and included inpatient rehabilitation,49 outpatients,47 and
mixed settings.44,46 Clinical populations included those with
stroke,44,49 Multiple Sclerosis,47 and mixed neurological conditions.46
5.2 | Study quality
Appendix 3 presents the results of the quality assessment. Studies
were mostly rated as high quality (n = 5)46,47 and two study were
considered medium quality.49 Limitations related to theoretical
connections and procedural rigour.
5.3 | Assessment domains
The assessment domains identified from the qualitative studies are
presented in Table 4. The domains described in at least three of the
 TABLE 3 Study characteristics of qualitative studies (n = 7).
GARNER

Author/
country/ Clinical
ET AL.

study Design & population and Timing of Quality

number Study aims methodology setting Therapist population demographics Key assessment domains assessment Key findings rating

1. Alatawi To integrate the Interviews and Stroke Physiotherapists n = 21, age and gender Range of movement, pain, No data Total of 74 Medium
et al., PARIHS consensus Rehabilitation no data, sensation, function recommendations, 63
2022 framework as a approach centre Years since qualification: 1–5 years 9.5%, recommendations
Saudi Arabia way of 6–10 years 42.9%, 11–15 years 33.3%, reached the consensus
categorising >15 years 14.3%, level for PHS practice,
evidence, context, Level of education: secondary prevention of
and facilitation Dip 9.5%, PHS (n = 10),
elements for Bsc 66.7% assessment (n = 14),
effective Msc 19%, PhD 4.8% PHS care management
implementation of (n = 19), and service
evidence based delivery (n = 20)
PHS rehabilitation Each recommended
from a vast dataset guideline was
of rigorous stroke integrated into the
sources of appropriate element of
evidence the PARIHS framework

2. McGlynn Explore clinical Semi‐ Stroke Physiotherapists n = 12 Gait, goal setting No data Preference for informal High
and decision‐making structured Inpatients: Gender: outcome measures information sources to
Cott, process and interviews 66.6% Female n = 11 muscle tone, movement guide decision making‐
2007 sources of Outpatients: Male n = 1 restriction sight, touch,
Canada information or 16.6% Years since qualifications: mean 13.5 years subjective, information discussions with clients,
evidence that are Community: Level of education, neurological experience Timed up and Go Test clinical experience, and
used in daily 1.6% n = 1–21 years (mean 9 years) 2‐min walk test, 6‐min consultation with peers
practice walk test Formal information
including outcome
measures for
professional
development, evidence
review, ongoing
education and to
support decisions

3. Normann Identify what aspects Semi‐ Multiple Physiotherapists n = 10 Alignment, No data Community High
et al., community structured sclerosis Age: no data balance, gait physiotherapists
2014 physiotherapists interviews Outpatients: Gender: no data identified movement
Norway perceived as 100% Years since qualifications, level of education: analysis of a familiar
significant when no data patient as significant
guided by a Neurological experience: 2 to >10 years for professional
development,
|

(Continues)
13

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 14

TABLE 3 (Continued)
|

Author/
country/ Clinical
study Design & population and Timing of Quality
number Study aims methodology setting Therapist population demographics Key assessment domains assessment Key findings rating

neurological especially the analysis

physiotherapist of interaction between
different parts of the
body and analysis of
movement

4. Pattison Describe the methods Semi‐ Stroke Physiotherapists, sample size n = 28 Information from peers, Physiotherapists used High
et al., used to evaluate structured Inpatients: Age: modified standardised observation of
2015 walking and the interviews 67.8% 5–29 years (n = 5) measures, movement and
Canada reasons for Outpatients: 20–29 years, 30–39 years (n = 9) standardised measures, standardised
choosing these 39.3% 40–49 years (n = 10), 50+ (n = 4) Timed up and Go Test, assessment tools
methods Gender: Chedoke‐Mcmaster Factors that influenced
Female n = 25 Stroke Assessment, 2‐ choice of tools were
Male n = 3, min walk test characteristics of tool,
Years since qualifications: >10 years n = 18, the therapists’
≤5 years n = 8, 6–9 years n = 3, level of familiarity with using
education: Bachelor n = 20, <aster n = 7, the tool, the workplace,
certificate n = 1 Neurological experience: and patients.
no data

5. Plummer Identify how Focus groups Stroke Physiotherapists n = 33 Function, attention ‐ No data Physiotherapists use High
et al., physiotherapists and one on No data on Age: no data sustained and in observation of
2006 assess, record and one phone clinical Gender: no data complex functional tasks to
Australia measure Unilateral interviews setting Years since qualifications: no data Level of environments, assess for unilateral
neglect (ULN) and education: no data, neurological grooming, hand neglect and do not
the clinical experience: no data positioning, hygiene, differentiate between
reasoning maintenance of midline, the different types
processes used pen and paper tests, of ULN
posture, ULN is rarely measured
response of the patient to Physiotherapists use
the therapist, response hypothesis testing and
of the patient to verbal pattern recognition to
cueing clinical reason in the
assessment of ULN

6. Seale & Investigate the current Semi‐ Stroke Physiotherapist n = 22, Age: mean age 46 Gait, tone, standardised No data Novice and experienced High
Utsey, trends in PTs structured Inpatients: years measures clinicians take
2020 clinical reasoning interviews 100% Gender: systematic approach to
USA in assessing and and focus Outpatients: Female n = 19 the examination of a
managing gait in groups 4.5% Male n = 3 person with a
Home: 4.5% hemiplegia, they agree
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ET AL.

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 TABLE 3 (Continued)
GARNER

Author/
country/ Clinical
ET AL.

study Design & population and Timing of Quality

number Study aims methodology setting Therapist population demographics Key assessment domains assessment Key findings rating

persons with Gait lab: 4.5% Years since qualifications: mean 7 years on common deficits
hemiplegia Level of education: diploma n = 10 found
masters n = 4,
baccalaureate n = 1
Neurological experience: less than 2 years’
experience: n = 7

7. Takahashi Determine the Semi Stroke Physiotherapists n = 15, age: mean Brunstruum stage, Walking independence was Medium
et al., physiotherapy structured inpatients: 32.5 ± 4.5 year: cognitive ability, decided by observation
2014 focus when interviews 100% Gender: Female n = 5 mental stability, daytime of behaviour during
Japan deciding on level of Male n = 10 drowsiness, walking or treatment.
independence of a Years since qualifications: mean 8.0 ± 3.2 direction changes, falls, Most of the PTs focused on
patient with years, functional analysis, the “patients’ state”
walking aids and Level of education: no data gait, understanding whilst walking, brain
the reasoning Neurological experience: no data and responding to the function, ability to
process environment, light‐ balance
headedness, pain, Additionally, asking other
stability, shortness of involved healthcare
breath, standing, professionals
stepping, walking aids,
walking to a target
|15

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16 | GARNER
TABLE 4 Assessment domains included in qualitative studies.
seven studies included: postural alignment and symmetry,44,46–49
gait,44,46,47,50 and function.36,37,48,49 The domains of muscle tone 44,
non‐specific and self‐devised outcome measures,46 diagnostic
44
specific outcome measures, activity tolerance 48, subjective/social
history and ‘falls and safety’,49 were reported only once.
5.4 | Key themes were identified in relation to
physiotherapy assessment of people with neurological
conditions
Thematic analysis of the qualitative studies identified five key themes
related to physiotherapy assessment of people with neurological
conditions. These included the clinical reasoning process, clinical use of
standardised measures, utilisation of the senses, clinician experience
and information gathering. A thematic schema (see Figure 2) was
developed based on the approach outlined by Farrance et al.45 and
shows how the themes and associated concepts interact.
5.5 | Clinical reasoning process
The clinical reasoning process was considered in all seven qualitative
44,46–51
studies, including the concepts of hypothesis formation, trigger
for pattern recognition, experience guiding prognostication, and
understanding movement behaviour’. The study findings showed that
experienced physiotherapists often used a ‘form of pattern
recognition’ to assess certain deficits such as neglect, rather than a
specific assessment tool.48 They also used an in‐depth understanding
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ET AL.
of movement behaviours to assist prognostication. These concepts,
under the overarching theme of the clinical reasoning process, were
noted as important foundations for the assessment and planning of
treatment.
5.6 | Clinical use of standardised measures
The clinical use of standardised measures was mentioned in five
studies.44,46,47,50 Concepts of familiarity, confidence, suitability for
individual patients/clients, and time to completion are believed to
influence their use.
“The decision to administer a measure with each patient is
influenced first and foremost by patient factors, then caseload, time
and priority, and documentation by others”.46
5.7 | Information gathering
Four studies referred to information gathering as part of both subjective
and objective assessment. It was evident from these studies44,46,48,50
that this process did not happen at one point in time, but was a
continuous process throughout the management of the patient/client
and was used to continually generate and test hypotheses.
“Although some of the participants described a
systematic method for collecting clinical data from
the patient, it was clear that the physiotherapists
interpreted the assessment findings continuously,

GARNER ET AL.
FIGURE 2 Thematic schema, influences on the assessment process.
generating and testing hypotheses and modifying the
assessment accordingly”.46
5.8 | Utilisation of senses in assessment
Clinicians use their senses to guide their assessment and adjust and
tailor their responses and interactions with patients/clients. Utilisa-
tion of the senses was evident in four of the seven studies.46,47
Physiotherapists described the use of more than one sense at a time
such as observation and ‘hands on’ when assessing people with
neurological conditions and expressed the importance of knowing
when and when not to use touch during assessment.
5.9 | Clinician experience
46–48,50
In four out of seven studies physiotherapists talked about
clinical experience within the context of prognostication and the use
of standardised measures. Physiotherapists believed that clinical
experience guided prognostication, and those with 5 or more years’
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| 17
of clinical experience valued this and used it to guide how they
predicted recovery in their patients/clients and, how they made
decisions that guided their practice.46
“Participants with 5 years or more of neurological
physiotherapy work experience mentioned their clini-
cal experience as an important source of information
guiding their practice …”.46
The authors reported that previous experience guided thinking
when making judgements regarding anticipated outcomes.46
5.10 | Integration of quantitative and qualitative
data in context of the research aim
The key findings across all 23 studies were integrated, noting that the
frequently assessed domains in neurological assessment included
gait, balance, muscle strength, postural alignment and symmetry, and
function (see Figure 3). The findings suggest that the type of
information gathered contributes to the clinical reasoning process
and clinician experience and utilisation of the senses may play a role
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18 | GARNER ET AL.

F I G U R E 3 Integration of qualitative and quantitative data. This figure depicts the frequently assessed domains (postural alignment and
symmetry, balance, function, muscle strength and gait), key themes related to assessment as identified in the literature (clinical reasoning
process, information gathering, utilisation of the senses, clinical use of standardised measures, and clinical experience), and how this comes
together in the assessment process. The figure illustrates factors of which their influence on the assessment process remains unclear
(geographical and clinical setting, and clinical condition, clinical experience).

in the choice and interpretation of assessment. However, the role of
factors thought to influence the selection of assessment domains,
including country, clinical experience, healthcare setting, and type of
neurological condition remains unclear. Novice clinicians use stan-
dardised measures to assist with prognostication. All but one of the
studies focusing on stroke referred to the domains of muscle strength
and range of movement, inferring that this was essential when
assessing people with this condition.
6 | DISC US SION
The primary aim of this systematic review was to systematically
identify the domains that physiotherapists assess in individuals with
neurological conditions in a clinical setting. This review identified the
five most frequently included assessment domains in the physio-
therapy assessment of people with neurological conditions in the
clinical setting: function, postural alignment and symmetry, gait,
balance, and muscle strength. Minimal data were provided on factors
thought to influence the inclusion of assessment domains such as
country, clinical experience, healthcare setting, and type of neuro-
logical condition. Clinical experience has been found to influence the
use of standardised measures.
Expert textbooks are used as a reference for physiotherapy
practice and to inform physiotherapy students about assessment.
They recommend a varied set of domains, including cognition, mental
state, motivation, coping, memory, vision awareness, awareness of
self‐ movement, quality of life, attention, orientation, appropriate
interaction communication, understanding blood pressure, and
activities of daily living. This review identified only a limited number
of domains commonly assessed in clinical practice, in contrast to the
multiple domains recommended in expert theoretical textbooks.3,35 A
potential explanation for this may be that some of these domains are
viewed as remits of other health professionals13 or may be specific to

GARNER ET AL.
each patient presentation; therefore the number of domains may
vary depending on the individual case.53 Further work is needed to
identify how appropriate it would be to include these five domains in
clinical practice.
The assessment of people with neurological conditions is the
basis of clinical reasoning.54 The clinical reasoning process is the sum
of thinking and decision‐making processes associated with clinical
practice.9 It has been defined as “a process in which the therapist,
interacting with significant others (e.g., family and other health‐care
team members), structures meaning, goals and health management
strategies based on clinical data, client choices, and professional
judgement and knowledge”.35 The International Professional Body
for Physiotherapy WPT3 recommends that treatment should be
based on a comprehensive assessment involving a clinical reasoning
process of (1) information gathering (subjective, objective); (2)
interpretation (hypothesis formation from a problem list linked to
collaborative goal setting); (3) treatment planning, and (4) evaluation/
review (use of standardised measures; goal achievement). A total
of 19 of the 23 included studies referred to clinical reasoning
processes,14,29–31,33–41,44,46–50 but not all studies reported on
the four key components described by the WPT. Only four
studies18,29,36,38 discussed all four components. Most studies
included information gathering, and only eight studies discussed
this interpretation. References to treatment planning were noted
in more than half of the included studies. Evaluation and review
were described by 12 studies. Evaluation and review were mainly
discussed in relation to the use of standardised outcome measures.
The use of standardised measures has been recommended for
monitoring changes in the patient's health status in guidelines,52,55
more than half of the studies included in this review reported using
them (n = 13). Only two studies looked at goal achievement.36,46
Lexell and Brogardh52 recommend that therapists interpret the
2
results of an assessment based on the ICF rehabilitation framework.
The ICF‐based framework represents a biopsychosocial health model
that enables physiotherapists to understand and manage their patients
holistically. The therapist generates a hypothesis of how impairments
impact movement dysfunction, function (activity), and participation to
come up with a movement diagnosis.52 None of the studies in this
review directly referred to the WHO ICF framework. However, some
domains identified in this systematic review have incorporated ICF
concepts. Examples are ‘impairments activity and participation’ which
can be linked to the frequently included domains of ‘postural alignment
and symmetry’, and activity that can be linked to function, balance, and
gait. No studies in this review discussed the environmental factors that
affect patient progress or recovery as described in the ICF framework.1
This concurs with the review by Allet, Burge and Monnin56 who
concluded that the WHO ICF framework has not been integrated into
physiotherapy clinical practice.
The neurological condition being assessed may influence the
46,50
domains assessed in the clinical setting. The Australian Stroke
Guidelines35 direct the healthcare professional to assess in a specific
way and focus on rehabilitation needs, suggesting that following the
guidelines will influence the included assessment domains. However,
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| 19
in this review, studies that explored assessment in people with stroke
had no common domains that set them apart from other studies. A
single study of people with Parkinson's disease was the only study to
include bradykinesia, tone, and dyskinesia.13 Five studies explored
the clinical assessment in general neurological disorders.23–25,33,37 All
these studies included the domains of muscle strength and range of
movement.
Clinical experience can be defined as the time spent practising
clinically after qualification. Clinical experience has been reported by
14 studies.10,13,21–23,25–30,32,35
There is little evidence to support how clinical practice may
or may not change related to experience, but some evidence
supports changes in practice with increasing expertise.57 Clinical
experience is influenced by the knowledge and requirements of
the organisation.22
Expert clinicians are defined by “their ability to combine knowledge
with experience, to know what is important, and recognise and
appreciate the significance of critical cues”.22 In our thematic schema
(see Figure 2) the theme of ‘clinician experience’ was linked to clinical
reasoning with formation of hypotheses and pattern recognition. As
clinical experience develops, there is an increasing understanding
of movement behaviours.22 Clinician experience was linked to the
use of standardised measures in this review. The use of measures is
dependent on confidence and familiarity with their use.5,23 The most
frequently used standardised measures were timed walking measures
(n = 6),24–27,29,30 and Motor Assessment Scale (n = 5)12,24,26,28,29 Clini-
cian experience was linked to the theme of ‘information gathering’,
suggesting that experienced clinicians were used as a resource for
information gathering by less experienced clinicians.
The methods of assessment were described by 12 stud-
ies.10,13,21–23,26,28,30,32,35 The use of touch, including terms such
as ‘hands on and hands off’, was described in two studies,46,47
suggesting the use of touch as a method of assessment.
Observation was described in all qualitative studies and seven
quantitative studies. Observation skills was needed for movement
analysis which is the ‘systematic study of movement produced
during human action using skilled observational assessment’.58
Movement analysis, as an assessment method is a core component
of physiotherapy clinical practice6,59 with 12 studies in our review
including some of the above domains related to more common
aspects of movement analysis.
These skills are used in neurological assessment to assess walking,
sit to stand, bed mobility, reaching and grasping, posture, and balance.58
With the increased use of telerehabilitation as a method for delivering
care to people in their homes with neurological conditions.60
physiotherapists assessing and treating patients with these conditions,
such as stroke, may need to the enhance observation‐based analysis
necessary for tele‐ therapeutic interactions.
The strength of this review is that it is the first systematic review,
to our knowledge, to identify the domains that are frequently
included in physiotherapy assessment of people with neurological
conditions in the clinical setting, taking an inclusive approach
including all study designs.

20 | GARNER
7 | C ONC LUS I ON
Only limited guidance has emerged from this review regarding
frequently assessed domains that are included in the assessment of
people with neurological conditions in clinical practice. The appropri-
ateness of these five most frequently assessed domains, and the need
to include more domains, requires exploration in future work. This
review demonstrates that the physiotherapy profession has yet to
reach a consensus on the frequently assessed components that
underpin neurological assessment. With literature supporting the use
of the ICF framework to guide assessment and management in the
clinical setting, physiotherapists should look at a more structured
approach to assessment in their clinical practice. Further research is
needed to explore the assessment of people with neurological
conditions in clinical practice.
A U T H O R C O N TR I B U T I O N S
Jill Garner: conceptualisation, methodology, formal analysis, data
curation, software, writing—original draft preparation, visualisa-
tion, project admin. Maayken van den Berg: conceptualisation,
software, software, validation, formal analysis, data curation,
writing—original draft preparation (draft review), supervision,
project admin. Belinda Lange: conceptualisation, software, valida-
tion visualisation, Investigation, writing—original draft preparation
(draft review), supervision. Sally Vuu: data curation. Sheila Lennon:
conceptualisation, software, validation, formal analysis, resources,
writing—original draft preparation (draft review), writing review,
visualisation, supervision.
A C KN O W L E D G E ME N T S
We would like to acknowledge the continued support of librarians
from Flinders University and the Southern Adelaide Local Health
Network, Adelaide. Open access publishing facilitated by Flinders
University, as part of the Wiley ‐ Flinders University agreement via
the Council of Australian University Librarians.
CO NFL I CT OF INTERES T S T ATEME NT
The authors declare no conflicts of interest.
D A TA A V A I L A B I L I T Y S T A T E M E N T
Data sharing is not applicable to this article as no new data were
created or analyzed in this study.
ORCID
Jill Garner http://orcid.org/0000-0002-9552-0804
Sally Vuu http://orcid.org/0000-0003-0455-8389
Sheila Lennon http://orcid.org/0000-0001-5434-0893
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How to cite this article: Garner J, Berg Mvd, Lange B, Vuu S,
Lennon S. Physiotherapy assessment in people with
neurological conditions—Evidence for the most frequently
included domains: a mixed‐methods systematic review. J Eval
Clin Pract. 2023;1‐23. doi:10.1111/jep.13909
 13652753, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jep.13909 by National Health And Medical Research Council, Wiley Online Library on [22/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
22 | GARNER ET AL.

A P P E N D IX 1 : S E A R C H S T R A T E GY # Searches
Databases: Ovid MEDLINE, CINAHL, Scopus, web of science and
19 professional practice gaps/
Cochrane Library, Pubmed
20 Translational Medical Research/
Database(s): Ovid MEDLINE(R) and Epub Ahead of Print, In‐Process
& Other Non‐Indexed Citations and Daily 1946 to January 2023 21 decision making/or choice behaviour/
Search Strategy: 22 Clinical Decision‐Making/

23 Practice Patterns, Physicians'/

# Searches 24 (knowledge translation or knowledge transfer* or knowledge
1 neurological examination/ uptake or knowledge implementation or implementation
science).ti,ab,kf.
2 (neurol* adj3 (Assess* or measur* or test* or examin* or
evaluat*)).ti,ab,kf. 25 decision making.ti,ab,kf.

3 or/1–2 26 choice behav*.ti,ab,kf.

exp Nervous System Diseases/ 27 ((practice or clinical) adj2 gap*).ti,ab,kf.

5 exp brain injuries/ 28 ((current or usual or pattern* or standard)

adj2 practice*).ti,ab,kf.
6 ((nervous system or somatosens* or sensor*) adj2 (condition* or
disease*)).ti,ab,kf. 29 or/19–28

7 (stroke or poststroke or multiple sclerosis or parkinson* or guillain 30 and/13,18,29

barre or polio* or dystonia or brain cancer* or brain neoplasm*
or brain tumo* or Glioblastoma or Amyotrophic Lateral
Sclerosis or Motor neurone disease or ALS or MND or Spinal
cord injur* or brain inj*).ti,ab,kf.

8 or/4–7
A PP EN DI X 2 : Q U A LI T Y AS SES S MEN T OF
9 “Outcome Assessment (Health Care)”/or “Outcome and Process
Assessment (Health Care)”/or Treatment outcome/or Q U A NT I T A T I V E S T U D I E S
Disability evaluation/ Studies which met the four McMaster criteria deemed critical by
10 (Assess* or measur* or test* or examin* or evaluat* or the research team were based on answering the research
domain*).ti,ab,kf. questions for this systematic review. They were detailed descrip-

11 or/9–10 tion of the intervention, detailed description of the sample,

appropriate analysis methods, appropriate conclusion. If the study
12 and/8,11
met all four criteria and scored 80% or more on the Mc Master
13 or/3,12 critical appraisal tool for quantitative studies, these were judged
14 exp Physiotherapy Modalities/ as high quality. Studies which met three of the critical criteria
15 Physical Therapists/ and/or obtained an overall score of between 50% and 79% were
judged medium quality. Studies which met two or less of
16 Physiotherapy Specialty/
the critical criteria and/or obtained an overall score of ≤49%
17 (physiotherap* or physical therap*).ti,ab,kf.
were judged low quality. These studies were marked with green
18 or/14–17 triangle for yes, red triangle for no.

GARNER ET AL.
A P P E N D IX 3 : Q U A L I TY AS S E S S M E N T OF
Q U A L IT A T I V E S TU D I E S
Studies which met the four McMaster criteria deemed critical
by the research team were based on answering the research
questions for this systematic review. They were procedural rigour,
analytical rigour, auditability and theoretical connections. If the
study met all four criteria and scored 80% or more on the Mc
13652753, 0, Downloaded from https://onlinelibrary.wiley.com/doi/10.1111/jep.13909 by National Health And Medical Research Council, Wiley Online Library on [22/08/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
| 23
Master critical appraisal tool for qualitative studies, these were
judged as high quality. Studies which met three of the critical
criteria and/or obtained an overall score of between 50% and 79%
were judged medium quality. Studies which met two or less of
the critical criteria and/or obtained an overall score of ≤49% were
judged low quality. These studies were marked with green triangle
for yes, red triangle for no.