Determining how physiotherapists assess and treat executive function in people with stroke using cardiorespiratory and resistance exercises: an online cross-sectional survey

Background/aims People with stroke often experience impairments in executive function, including working memory and attention, which can affect rehabilitation outcomes. While cardiorespiratory and resistance exercises improve cognitive function in healthy older adults and show moderate benefits after stroke, it remains unclear whether these cognitive effects are considered in physiotherapy practice. This study aimed to determine the extent to which physiotherapists in the UK assess executive function, incorporate targeted strategies during treatment, and use cardiorespiratory and resistance exercises to improve executive function in individuals with stroke in clinical practice settings. Methods Data were collected via an online cross-sectional survey, which was distributed to members of the Association of Chartered Physiotherapists in Neurology who specialise in neurological physiotherapy. The survey aimed to capture insights and experiences relevant to their practice with stroke rehabilitation. Descriptive and thematic analysis methods were used to analyse the quantitative and qualitative data collected respectively. Results A total of 73 physiotherapists responded. Physiotherapists recognised that executive function impairments affected rehabilitation potential and considered this in their interventions. Cardiorespiratory exercises and resistance training were the most frequently used interventions. Three main themes emerged: combined intervention; impact on response to treatment; and physiotherapists' use of occupational therapists' assessment findings related to executive function. Conclusions Physiotherapists recognise that problems with executive function can have an impact on the rehabilitation potential of people with stroke, and can improve over time, and they consider executive function in their treatment plans. However, physiotherapists may not recognise the potential connection between their interventions and possible improvements in executive function, and further research is needed to explore this relationship. Implications for practice Physiotherapists may need to consider executive functions deficits more in intervention programmes as treatment outcomes to maximise the cognitive and physical outcomes. A formal executive functions assessment and re-assessment using more sensitive outcome measures should be conducted to evaluate treatment plans and improvement on executive function deficits. Physiotherapists depend on occupational therapists for their executive functions assessment as they are more specialised in assessment. There should be a collaboration between multidisciplinary team members for a holistic treatment approach.