Urinary incontinence (UI) post-stroke is a common symptom affecting 9 to 15% of the patients one year after the stroke.(1) Stroke survivors who present with UI have poorer rehabilitation outcomes, and the family caregivers tend to experience adverse social, psychological, and financial consequences.(2) Stroke guidelines recommend a “structured assessment” for those with incontinence; however, the role of physiotherapists (PTs) in assessing or managing incontinence is not described. Urinary incontinence assessment and management have primarily been viewed as nursing roles. However, considering the clinical features of UI and its impact on activity and participation, a whole-team approach is recommended, including physiotherapy. Research exploring current physiotherapy practice for UI post-stroke is scarce. A Canadian study showed that less than 15% of physiotherapists use best practice assessments such as UI identification, and only 3% conduct best practice interventions post-stroke.(3) The primary aim of this study was to explore how New Zealand physiotherapists perceive their current role in UI assessment and management post-stroke. The secondary aim was to identify what limits and facilitates their role.

We undertook a qualitative exploratory study using one-to-one interviews with physiotherapists who worked with patients following stroke. Interviews were conducted via Zoom, and the zoom application transcribed the interview audio files. Transcribed interviews were analysed using an inductive content analysis approach. Firstly, data were organised into categories relating to the research question (i.e. the interview questions providing an initial coding framework). Then, an inductive examination of ideas within and across each category was conducted to develop codes capturing the main ideas. The researchers conducted Independent parallel coding for four interviews, and any inconsistencies were settled by discussion. The researchers, all women, brought physiotherapy knowledge to the analysis process – the researcher who interviewed participants was a fourth-year physiotherapy Honours student, and the others are academics with physiotherapy and doctorate degrees and qualitative research experience, including incontinence research with stroke survivors.

PTs involved in continence care post-stroke varied across hospital (less involvement) and community settings (more). Four main themes were derived (Figure 1).: 1) "Physiotherapists view of their scope of practice": Physiotherapy practice focused on activity limitations and participation restrictions to achieve patient goals. Therefore, physiotherapy management indirectly addressed functional UI. 2) "Resources for stroke physiotherapists": Physiotherapists considered that a lack of time and formal training, as well as uncertainty about who holds the responsibility for managing UI, limited their involvement with UI assessment and management. 3) "Lack of collaboration between professions": Physiotherapists viewed nurses as the lead professionals for UI following stroke. They believed that more collaboration within the healthcare team would improve UI care. 4) “Physiotherapists view of UI assessment and management experienced by patients”: PTs believed that UI management post-stroke is often focused on containment rather than recovery and defaulting to product reduced patient opportunities for choice and retaining dignity. Ten subthemes were identified for the main themes

Physiotherapists felt they did not have primary responsibility for UI assessment and management and lacked the confidence to contribute – except indirectly – to continence care. Physiotherapists thought more collaborative discussions around continence decision-making and goals would improve patient care.

UI management post-stroke is complex and requires skilled healthcare professionals and excellent interprofessional collaboration. Further education and training for UI management following stroke are needed to improve Physiotherapists' confidence to include this within their scope of practice.

Patel, M., Coshall, C., Rudd, A. G., & Wolfe, C. D. (2001). Natural history and effects on 2-year outcomes of urinary incontinence after stroke. Stroke, 32(1), 122–127. https://doi.org/10.1161/01.str.32.1.122
Arkan, G., Beser, A., & Ozturk, V. (2018). Experiences related to urinary incontinence of stroke patients: A qualitative descriptive study. Journalof Neuroscience Nursing, 50(1), 42–47. https://doi.org/10.1097/jnn.0000000000000336
Dumoulin, C., Korner-Bitensky, N., & Tannenbaum, C. (2007). Urinary incontinence after stroke: Identification, assessment, and intervention by rehabilitation professionals in Canada. Stroke, 38(10), 2745–2751. https:// doi.org/10.1161/strokeaha.107.486035.