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Powered mobility interventions for very young children with mobility limitations to aid participation and positive
Nathan Bray1,2, Niina Kolehmainen3,4, Jennifer McAnuff3
1School of Health Sciences, Bangor University, Bangor, UK.
Insights
Early powered mobility offers benefits for young children, though evidence is limited. Focus on developmental appropriateness and movement for its own sake, not just age, for optimal outcomes.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Health Technology Assessment
Background:
- One-fifth of disabled children have mobility limitations, with early powered mobility hypothesized to aid development in children under 5.
- The optimal age for introducing powered mobility remains unknown, necessitating evidence synthesis.
Purpose of the Study:
- To synthesize evidence on the effectiveness and cost-effectiveness of powered mobility for very young children (<5 years) compared to later introduction (≥5 years).
Main Methods:
- A mixed-methods evidence synthesis including framework and thematic synthesis was performed.
- Economic modeling was attempted but limited by data; a budget impact analysis was conducted instead.
- Extensive database searches were conducted from 1946 to September 2019, with 89 studies included.
Main Results:
- Low-quality evidence exists; no conclusive findings on effectiveness or cost-effectiveness were found for any age group.
- Powered mobility interventions show strong support for improving children's movement and mobility, with moderate support for participation, play, social interactions, and safety.
- Key factors include the 'fit' between child, equipment, and environment, and outcomes like independence and self-expression. 'Movement for movement's sake' is prioritized over destination-focused mobility.
Conclusions:
- Early powered mobility likely benefits very young children, despite limited robust evidence.
- Developmentally appropriate interventions focusing on 'movement for movement's sake' are more crucial than chronological age.
- Future research should focus on developing, implementing, and evaluating diverse early powered mobility approaches.
Background:
One-fifth of all disabled children have mobility limitations. Early provision of powered mobility for very young children (aged < 5 years) is hypothesised to trigger positive developmental changes. However, the optimum age at which to introduce powered mobility is unknown.
Objective:
The aim of this project was to synthesise existing evidence regarding the effectiveness and cost-effectiveness of powered mobility for very young children, compared with the more common practice of powered mobility provision from the age of 5 years.
Review Methods:
The study was planned as a mixed-methods evidence synthesis and economic modelling study. First, evidence relating to the effectiveness, cost-effectiveness, acceptability, feasibility and anticipated outcomes of paediatric powered mobility interventions was reviewed. A convergent mixed-methods evidence synthesis was undertaken using framework synthesis, and a separate qualitative evidence synthesis was undertaken using thematic synthesis. The two syntheses were subsequently compared and contrasted to develop a logic model for evaluating the outcomes of powered mobility interventions for children. Because there were insufficient published data, it was not possible to develop a robust economic model. Instead, a budget impact analysis was conducted to estimate the cost of increased powered mobility provision for very young children, using cost data from publicly available sources.
Data Sources:
A range of bibliographic databases [Cumulative Index to Nursing and Allied Health Literature (CINHAL), MEDLINE, EMBASE™ (Elsevier, Amsterdam, the Netherlands), Physiotherapy Evidence Database (PEDro), Occupational Therapy Systematic Evaluation of Evidence (OTseeker), Applied Social Sciences Index and Abstracts (ASSIA), PsycINFO, Science Citation Index (SCI; Clarivate Analytics, Philadelphia, PA, USA), Social Sciences Citation Index™ (SSCI; Clarivate Analytics), Conference Proceedings Citation Index - Science (CPCI-S; Clarivate Analytics), Conference Proceedings Citation Index - Social Science & Humanities (CPCI-SSH; Clarivate Analytics), Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects (DARE), NHS Economic Evaluation Database (NHS EED), Health Technology Assessment (HTA) Database and OpenGrey] was systematically searched and the included studies were quality appraised. Searches were carried out in June 2018 and updated in October 2019. The date ranges searched covered from 1946 to September 2019.
Results:
In total, 89 studies were included in the review. Only two randomised controlled trials were identified. The overall quality of the evidence was low. No conclusive evidence was found about the effectiveness or cost-effectiveness of powered mobility in children aged either < 5 or ≥ 5 years. However, strong support was found that powered mobility interventions have a positive impact on children's movement and mobility, and moderate support was found for the impact on children's participation, play and social interactions and on the safety outcome of accidents and pain. 'Fit' between the child, the equipment and the environment was found to be important, as were the outcomes related to a child's independence, freedom and self-expression. The evidence supported two distinct conceptualisations of the primary powered mobility outcome, movement and mobility: the former is 'movement for movement's sake' and the latter destination-focused mobility. Powered mobility should be focused on 'movement for movement's sake' in the first instance. From the budget impact analysis, it was estimated that, annually, the NHS spends £1.89M on the provision of powered mobility for very young children, which is < 2% of total wheelchair service expenditure.
Limitations:
The original research question could not be answered because there was a lack of appropriately powered published research.
Conclusions:
Early powered mobility is likely to have multiple benefits for very young children, despite the lack of robust evidence to demonstrate this. Age is not the key factor; instead, the focus should be on providing developmentally appropriate interventions and focusing on 'movement for movement's sake'.
Future Work:
Future research should focus on developing, implementing, evaluating and comparing different approaches to early powered mobility.
Study Registration:
This study is registered as PROSPERO CRD42018096449.
Funding:
This project was funded by the National Institute for Health Research (NIHR) Health Technology programme and will be published in full in Health Technology Assessment; Vol. 24, No. 50. See the NIHR Journals Library website for further project information.
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