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Variations in the orthotic management of cerebral palsy
Christopher Morris1, Helen Newdick, Ann Johnson
1Department of Orthotics, Nuffield Orthopaedic Centre NHS Trust, Oxford, UK. christopher.morris@worc.ox.ac.uk
Insights
Children with cerebral palsy received varied orthoses between UK health districts. Clinical practice for prescribing orthoses was influenced by professional preference rather than evidence.
Area of Science:
- Pediatric Orthopedics
- Rehabilitation Medicine
- Health Services Research
Background:
- Cerebral palsy management often involves orthotic interventions.
- Anecdotal evidence suggested variability in orthoses prescribed for children with cerebral palsy across different UK health districts.
Purpose of the Study:
- To investigate and compare the types of orthoses prescribed for children with cerebral palsy in two adjacent UK health districts.
- To explore the factors influencing orthotic prescription decisions among clinicians.
Main Methods:
- An observational comparative case study design was employed.
- Data were sourced from an epidemiological register of children with cerebral palsy and an orthotic patient database.
- A survey questionnaire gathered clinicians' perceptions on orthotic prescription practices.
Main Results:
- Significant variation in prescribed orthoses, especially ankle-foot orthoses, was observed between the districts.
- Clinicians reported differing responsibilities for initiating and approving orthotic prescriptions.
- Prescribing practices appeared largely driven by professional preference, with noted uncertainty among clinicians.
Conclusions:
- Variability in orthotic provision for pediatric cerebral palsy exists between geographical health service areas.
- Understanding the spectrum of activity limitations is crucial for advancing health services research and intervention trials.
- Further research is needed to standardize evidence-based orthotic prescription for children with cerebral palsy.
Objective:
Anecdotal reports that children with cerebral palsy were provided different orthoses in two adjacent UK health districts were investigated using an observational comparative case study.
Method:
The populations were compared using an epidemiological register of children with cerebral palsy, which confirmed that a comparable health service response could be expected. Merging data from the register with the orthotic patient database facilitated comparison of the orthoses prescribed in each district. A survey questionnaire was used to gather the perceptions of clinicians in both districts to understand how each team decides which orthosis to prescribe.
Results:
There was considerable variation in the types of orthoses prescribed between districts, and particularly of ankle foot orthoses. Survey respondents from the same profession described having the same roles, although clinicians expressed different responsibilities for initiating and sanctioning orthotic prescriptions in their district programmes. The survey also suggested that most clinicians were uncertain when prescribing orthoses, and clinical practice was therefore largely determined by professional preference.
Conclusion:
Defining the spectrum of activity limitation in geographically defined populations would enhance health services research and assist in the development of trials using different interventions to reduce those limitations.