Barriers to Using Balance and Gait Assessment Tools by Physical Therapists in Patients with Neurological Impairments: A Systematic Review

Introduction: The balance disability and pathological gait caused by neurological impairments deter activities of everyday living and social participation, deteriorate the quality of life, and increase the risk of falling. Physical therapeutic intervention plays a critical role in improving the balance disability and pathological gait. For effective physical therapy, accurate assessment of a patient is a priority. Objective: This study aimed to identify the barriers regarding the use of the balance and gait assessment tests in patients with neurological impairments. Method: Two reviewers used Electronic databases (Cochrane Library, MEDLINE, PEDro and RISS) to assess the titles and abstracts from the literature published until Dec. 2016 with the use of keywords, including "balance or posture or postural control or postural stability", "gait or walking or locomotion or ambulation", "test or assessment or measurement or outcome measure or assessment tool or measurement tool", "barriers", and "facilitators", read the full texts of identified articles, selected the publications related to the purpose of our study, and then analyzed materials from the literature. Result: Independent reviewers and one analyst selected six materials from the literature relevant to the purpose of our study, and identified several barriers to using the balance and gait assessment tools by physical therapists, including therapists and patients’ individual factors (lack of knowledge, low priority, and patients’ functional ability), environmental factors (time, cost, space, and low organizational support), and measure-specific factors of the assessment tools (reliability, validity, and assessment tools appropriate for population). Conclusion: Our study revealed the barriers to the use of the balance and gait assessment tool. Overcoming the barriers is essential to make it possible for physical therapists to efficiently use the tool for balance and gait assessment.