Urinary incontinence assessment and management after stroke: An exploratory qualitative study of physiotherapists’ perceptions of their practice in Aotearoa New Zealand

Abstract

Urinary incontinence post-stroke is associated with poor rehabilitation outcomes. Current stroke guidelines recommend that physiotherapists are involved in addressing urinary incontinence problems post-stroke to improve rehabilitation outcomes; however, physiotherapists’ perceptions of their role are not known. This study explored how New Zealand physiotherapists perceive their current role in urinary incontinence assessment and management post-stroke, along with exploring what limits or facilitates this role. Using an exploratory qualitative methodology, eight physiotherapists from across New Zealand were interviewed. Data were analysed using a qualitative descriptive approach presented in four main themes: (a) physiotherapists’ view of their scope of practice, (b) resources and training of physiotherapists, (c) lack of collaboration between professions, and (d) physiotherapists’ view of urinary incontinence assessment and management experienced by patients. The physiotherapists’ practice focuses primarily on functional mobility, balance, and upper limb function to achieve patient goals. Therefore, the physiotherapists perceived their stroke assessment and management had positive, indirect benefits for those who found it difficult to toilet independently post-stroke. The physiotherapists considered that a lack of time and formal training, and uncertainty about their role in urinary incontinence rehabilitation, limited their involvement in the urinary incontinence rehabilitation area. The physiotherapists viewed nurses as the lead profession for continence. However, they believed better collaborative practice within the healthcare team would improve the delivery of continence services.