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Discussion Mean velocity and cadence increased as thefrequency of the cues increased; and decreased as the frequencyof the cues decreased; except for 92.5% of preferred pace.Mean stride length remained stable regardless of the frequencyof the cues. Therefore auditory cues appear to affect temporal

parameters of gait and have little effect on spatial parameters.Auditory cues using a frequency at 85% of preferred paceappear to have a therapeutic effect by decreasing cadence andthus velocity of gait in subjects with Parkinson’s disease.

Satisfaction with a NewCommunity Stroke RehabilitationSchemeF JonesUniversity of Brighton, EastbourneIntroduction A recent survey of stroke services in the UKhighlighted disorganisation in provision and also recommendedthat patient and carer views should form an integral part of anyservice development and evaluation. Following introduction ofa new community stroke rehabilitation service in Eastbourne,service users were interviewed to explore their needs followingdischarge and satisfaction with the new service.

Method Twenty-eight subjects were recruited consecutively onfulfilment of inclusion criteria. Interviews were structuredincorporating a satisfaction questionnaire, first introduced byPound (1994). The scale was modified for a community basedservice, internal consistency was comparable to the original(Cronbach’s alpha = 0.6885). Data regarding quality of life

(QOL) using the Stroke Adapted Sickness Impact Profile(SASIP30), were used to investigate any relationship with level of satisfaction. Direct quotes from subjects were alsoincorporated to further enrich the study.

Results All subjects reported high levels of satisfaction with thenew service, ranging from 48% to 100% satisfaction in somecases. Lowest levels of satisfaction related to informationprovision and awareness of plans for discharge. No associationwas found with any aspects of perceived QOL. Domainsdescribing physical aspects of QOL demonstrated lowest scores,particularly with regard to managing personal and domestictasks within the home.

Conclusion The need to consider timely and appropriateinformation giving for stroke patients is supported by this study.In addition subjects expressed concern about what happensafter discharge.

Reference

Pound, P, Gompertz, P and Ebrahim, S (1994). ‘Patients’satisfaction with stroke services’, Clinical Rehabilitation, 8, 7-17.

‘It’s Not up to Me, It’s up to You,Teacher’Patients and therapists discussing progressand plans in stroke physiotherapy

R H ParryUniversity of NottinghamIntroduction Feedback between therapists and patients aboutpatients’ achievements and progress is central to physiotherapycommunication. However, disagreement over assessments ofachievement and progress can present problems for thealignment and co-operation on which ongoing participation intreatment depends. This analysis of video-recorded treatmentsattempts systematically to consider communication practiceswhich do the work of achieving or maintaining alignment andagreement in physiotherapy, and the difficulties of doing so.

Method The data comprise 77 video-recorded treatmentsinvolving 21 patients undergoing rehabilitation for stroke, and ten senior physiotherapists. An ethnomethodological/conversation analytic approach is employed. Although widelyapplied in research on doctor/patient interactions, this

methodology may be unfamiliar to physiotherapists. This paperis partly intended as an introduction to this sophisticatedmethod for analysing verbal and bodily conduct. Analysis of two representative extracts where patients and therapistscommunicate about treatment progress and plans is presented.

Findings In each extract, both parties resist a request from theother to give an assessment. Complex sequences follow whereinsome alignment between patient and therapist is achieved. Inboth extracts, a critical/problem assessment is eventually givenby the therapist, who goes on to propose an aim or remedyrelated to this criticism. In one extract, the patient’s agreementwith the problem and plan is full and explicit, while in the otherthe patient verbally resists the plan.

Discussion Through discussion of these extracts and com-parison with research on doctors’ communication practices,some particular difficulties that physiotherapists face in workingtowards agreements on treatment problems and plans areexplored. Analysis also considers communication practices thattherapists may use to reduce disparity between their views andthose of their patients.