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Published on: January 11, 2016
Issues of concern before single event multilevel surgery in patients with cerebral palsy
Moon Seok Park1, Chin Youb Chung, Kyoung Min Lee
1Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Sungnam, Kyungki, Korea.
Insights
Parents of children with cerebral palsy undergoing surgery are most concerned about rehabilitation, pain, anesthesia, and cost. Younger patients and mothers tend to express higher concerns. Understanding these issues improves preoperative communication.
Area of Science:
- Orthopedics
- Pediatric Surgery
- Rehabilitation Medicine
Background:
- Cerebral palsy (CP) significantly impacts patients and families, necessitating surgical interventions like single event multilevel surgery (SEMS).
- Understanding parental concerns is crucial for effective patient care and shared decision-making prior to CP surgery.
Purpose of the Study:
- To identify and analyze the primary concerns of parents whose children with cerebral palsy are scheduled for SEMS.
- To provide insights that can improve preoperative communication and patient management.
Main Methods:
- A questionnaire assessing 59 specific items on a 5-point Likert scale was administered to 64 parents of CP patients preoperatively.
- Data were analyzed to determine the most significant parental concerns, considering factors like patient age, involvement type, and procedure type.
Main Results:
- Top parental concerns included postoperative rehabilitation, its duration, immediate pain, general anesthesia, and medical costs.
- Concerns varied with patient characteristics: unilateral involvement had lower overall concern, younger patients showed higher concern, and mothers reported higher concern than fathers.
- Patient age and the responding parent (mother vs. father) were significant factors influencing overall parental concern.
Conclusions:
- Identifying parental concerns facilitates better physician-parent communication, leading to more informed preoperative discussions.
- Addressing key issues like rehabilitation, pain, and cost can improve the family's surgical experience and adherence to treatment plans.
Background:
This study was performed to identify the issues of concern of parents of patients with cerebral palsy before single event multilevel surgery (SEMS).
Methods:
The parental concerns of 64 patients [34 males, 30 females, mean age 15 y and 5 mo (SD 8 y and 10 mo)] with cerebral palsy were obtained using a questionnaire preoperatively. The issues of parental concern were evaluated using 59 items specifically designed for this study. The individual items were scored using a 5-point Likert scale (1 to 5).
Results:
The top 5 issues of concern were as follows: postoperative rehabilitation, duration of rehabilitation, immediate postoperative pain, general anesthesia, and medical cost. Sporting activities and poor compliance to wearing orthosis were included in the top 5 issues of parental concern in patients with unilateral involvement. The overall parental concern in patients with unilateral involvement was lower than that in bilateral involvement (P=0.054). Parents of younger patients showed significantly higher concern score than those of older patients (P=0.020). There was no significant difference in the overall concern score between the parents of patients scheduled for bony procedures and those of patients scheduled for soft tissue procedures (P=0.298). Multiple regression analysis revealed the patient's age (P=0.018) and responding parent (father vs. mother, P=0.025) to be the factors that significantly affected the overall concern score (adjusted R(2)=0.281).
Conclusions:
An understanding of the issues of concern will enhance communication between physicians and parents, which would assist in preoperative discussion.
Level Of Evidence:
Diagnostic level II.
