Training families to assist with therapy interventions seems sensible. Families are present more regularly than health professionals and are often keen to help. It is not unusual for physiotherapists to ask family members to assist with therapy programs for patients of all ages with stroke or other diagnoses, particularly when access to physiotherapy is limited. Small studies have been conducted in this area1 and in other areas of allied health practice;2 however, there is no clear conclusion as to whether this practice is safe and/or effective.
The study by the ATTEND Collaborative Group is the first large trial to investigate the effectiveness of family-led rehabilitation. It was well-designed, with high methodological quality (PEDro score 8/10). Importantly, the trial found that training families to conduct a rehabilitation program including physical interventions did not increase caregiver burden, and was safe. However, it showed no improvement in patient outcomes. Outcomes ranging from death and disability to quality of life showed no difference between intervention and control groups.
Shall we as physiotherapists therefore stop engaging families in physiotherapy? It is important to understand that the focus of this study was on task shifting, in a setting where usual care interventions were very limited. It highlights that the role of trained physiotherapists in stroke management is not easily replaced.
Involving families in physiotherapy is an emerging area of research. Future research will need to acknowledge the complexities of family engagement and consider whether families are being trained to fulfil a caring role or a therapy role, to replace therapists or augment physiotherapy interventions.