Addressing the theory-practice gap: a qualitative study of Bobath and non-Bobath physiotherapists using the rehabilitation treatment specification system (RTSS)

To explore the similarities and differences in clinical practice and intervention choices of Bobath- and non-Bobath-educated physiotherapists during a single post-stroke clinical session. A qualitative interpretive description approach was used, incorporating stimulated recall with video-recorded treatment sessions and in-depth interviews. Thirty-two neurological physiotherapists from diverse clinical settings participated, including 16 Bobath educated (BG) and 16 non-Bobath educated (NBG) therapists. Video recordings provided primary data for intervention interpretation and were cross-referenced with interview data describing clinical reasoning. The Rehabilitation Treatment Specification System (RTSS), including treatment targets, ingredients, and mechanisms of action, was applied to clarify intervention selection and theoretical underpinnings. A total of 2507 interventions were analysed and categorised. The BG emphasised sensory stimulation, manual facilitation, and environmental organisation to influence body configuration, postural control, and sensorimotor integration, reflecting implicit neurophysiological mechanisms. The NBG prioritised task repetition, strength training, and verbal cueing, aligning practice with explicit motor learning principles. The BG used therapeutic touch more frequently (65.4%) and structured session around part-task progression, whereas the NBG employed more hands-off strategies (44.3%) and favoured task repetition. The RTSS framework effectively illustrated differences in intervention structure, intent, clinical reasoning, and mechanisms of action between Bobath- and non-Bobath-educated physiotherapists. Clinical reasoning in neurological physiotherapy is complex and often implicit; structured tools are required to explicate both the interventions and their related theoretical framework.Bobath and non-Bobath therapists differ in treatment focus and interaction style, which may affect patient engagement and therapeutic outcomes.Theoretical frameworks used by therapists to understand neurological movement-related problems, shapes the clinical reasoning and thus the interventions used to seek to resolve the movement dysfunction.The Rehabilitation Treatment Specification System (RTSS) framework enables structured specification of stroke rehabilitation interventions, by aligning interventions with relevant theory and expected outcomes, thereby potentiating transparency in clinical practice and research. Clinical reasoning in neurological physiotherapy is complex and often implicit; structured tools are required to explicate both the interventions and their related theoretical framework. Bobath and non-Bobath therapists differ in treatment focus and interaction style, which may affect patient engagement and therapeutic outcomes. Theoretical frameworks used by therapists to understand neurological movement-related problems, shapes the clinical reasoning and thus the interventions used to seek to resolve the movement dysfunction. The Rehabilitation Treatment Specification System (RTSS) framework enables structured specification of stroke rehabilitation interventions, by aligning interventions with relevant theory and expected outcomes, thereby potentiating transparency in clinical practice and research.