title: "Six sessions is a drop in the ocean": an exploratory study of neurological physiotherapy in idiopathic and inherited ataxias.
abstract: OBJECTIVE
  An exploratory study to examine specialist neurological physiotherapy service provision and utilisation for people with progressive ataxia.
  
  
  METHODS
  Qualitative study involving thematic analysis of accounts in semi-structured interviews with physiotherapists and patients.
  
  
  METHODS
  People with ataxia and specialist neuro-rehabilitation physiotherapists in Greater Manchester, UK.
  
  
  METHODS
  38 people with ataxia and 8 neurological-physiotherapists working in academic and hospital and community-based services in NHS and private settings. Recruiting physiotherapists experienced in working with the patient group was a challenge.
  
  
  METHODS
  One hour cross-sectional semi-structured interview at physiotherapists' workplaces or in patients' own homes.
  
  
  RESULTS
  Neurological physiotherapy was experienced by 25 (66%) of the 38 people with ataxia. The overarching themes emerging from the analysis were 'making a difference,' engagement and service provision. A majority of both samples felt that services should be organised so as to provide longer term therapy and support that goes beyond short care packages followed by provision of home exercise programme. Engagement with services was linked to patient expectations, adherence and perception of outcomes. The most predominant codes in the data set were encapsulated by the theme 'making a difference,' which further included concerns about how to measure perceived clinical improvement (as experienced by patients) in the context of progressive decline.
  
  
  CONCLUSIONS
  The findings suggest a model of idealised service provision involving a holistic, open-access service including research efforts to improve the evidence base. Special attention needs to be paid to measuring improvements following therapy.
authors.affiliation: Centre for Primary Care, Institute of Population Health, 5th Floor, Williamson Building, University of Manchester, Oxford Road, Manchester M13 9PL, United Kingdom. Electronic address: gavin.daker-white@manchester.ac.uk.
authors.forename: Gavin
authors.initials: G
authors.lastname: Daker-White
authors.forename: Julie
authors.initials: J
authors.lastname: Greenfield
authors.forename: John
authors.initials: J
authors.lastname: Ealing
mesh_terms: D000328:Adult; D000368:Aged; D001259:Ataxia / Q000534:rehabilitation*; D018450:Disease Progression; D005260:Female; D005621:Friedreich Ataxia / Q000534:rehabilitation*; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D026741:Physical Therapy Modalities / Q000458:organization & administration / Q000706:statistics & numerical data*; D020754:Spinocerebellar Ataxias / Q000534:rehabilitation*; D013222:State Medicine; D006113:United Kingdom
keywords: Cerebellar ataxia; Physiotherapy; Qualitative study