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172 APPENDICES Physiotherapy KCE reports vol.40 Table 12 Gait disorders in elderly people: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Tai Chi Quan 01 ± 1% Type of evidence Evidence for (weak to moderate) Evidence available in the literature on physiotherapy of gait rehabilitation in the elderly There is weak to moderate evidence that Tai Chi Quan preserves a high-automated level of motor control necessary for the gait regularity.
KCE reports vol.40 APPENDICES Physiotherapy 173 The treatment modalities and the proportion of physiotherapists in our survey treating at least one elderly patient with gait disorders are confronted in Table 4.12 with the results of the literature review on evidencebased therapeutic modalities. Only a small number of evidence was available in the literature relative to the physiotherapeutic modalities used to treat gait disorders in elderly people. Indeed, gait disorders in the elderly are generally studied in the context of specific conditions rather than in a more general context. Weak to moderate evidence was demonstrated for muscle strengthening and balance rehabilitation, the two most common treatment modalities applied by Belgian ambulatory physiotherapists to treat gait disorders in elderly people. The literature review has found that exercise programs in general seem efficacious in improving walking performance and more specifically gait speed, walking independence and step height. Exercise programs usually include muscle strengthening, balance exercises, mobilizations, stretching, coordination exercises, transfer exercises, etc. Thus, these types of exercises could be effective in improving gait in elderly people. Studies are however required to identify which of these exercises are actually effective in the treatment of gait disorders in the elderly. Weak to moderate evidence was also found for aerobic exercises and Tai Chi Quan. This latter is almost not used in ambulatory physiotherapy as it is not really a physiotherapeutic modality treatment. Thus, Tai Chi Quan is probably not a technique within physiotherapists province. Bronchiolitis in infants and children The most frequent treatment modalities applied by Belgian ambulatory physiotherapists to treat infants and children with bronchiolitis were, from the most prevalent to the least: chest percussion, education of the parents, assisting coughing, aerosol, forced exhalation techniques, postural drainage, and chest vibration. The following treatment modalities were also common but to a lesser extent: acceleration of expiratory flow, nasopharyngeal decongestion, and slow prolonged expiration. The treatment modalities rarely applied by ambulatory physiotherapists include slow increase of expiratory flow and use of specific devices. The treatment modalities and the proportion of physiotherapists in our survey treating at least one infant/child with bronchiolitis are confronted in Table 4.13 with the results of the literature review on evidence-based therapeutic modalities. A paucity of evidence was available in the literature relative to the physiotherapeutic modalities used to treat bronchiolitis in infants and children.
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