Consensus of physician behaviours to target for early diagnosis of cerebral palsy: A Delphi study
Lynda McNamara1, Karen M Scott1, Roslyn N Boyd2
1The Children's Hospital Westmead Clinical School, The University of Sydney, Sydney, New South Wales, Australia.
Insights
Early diagnosis of cerebral palsy under six months is crucial. Key physician actions include using the General Movements Assessment and Hammersmith Infant Neurological Examination to improve outcomes.
Area of Science:
- Pediatric Neurology
- Developmental Pediatrics
- Implementation Science
Background:
- Delayed diagnosis of cerebral palsy (CP) beyond 12 months hinders early intervention.
- Early intervention is critical for optimizing functional outcomes in children with CP.
- Current diagnostic practices in Australia often lead to late identification of CP.
Purpose of the Study:
- To identify and prioritize physician diagnostic behaviors for early cerebral palsy diagnosis.
- To inform the development of targeted implementation interventions.
- To increase the rate of cerebral palsy diagnosis in Australia before 6 months of age.
Main Methods:
- A two-round online Delphi study was conducted with multi-professional experts in cerebral palsy.
- A reference group proposed six modifiable diagnostic behaviors for early CP diagnosis.
- Participants rated item importance and ranked priorities for intervention.
Main Results:
- Consensus was reached on all six proposed diagnostic behaviors (100% inclusion).
- The top three prioritized behaviors for physician implementation interventions were identified.
- These priorities include: General Movements Assessment, Hammersmith Infant Neurological Examination, and clear communication of diagnosis.
Conclusions:
- The Delphi method effectively identified priority behaviors for intervention development.
- Consensus was achieved on key physician actions to lower the diagnostic age for cerebral palsy.
- Targeted interventions focusing on these behaviors can improve early detection of cerebral palsy in Australia.
Aims:
Historically, the diagnosis of cerebral palsy has been made after 12 months of age, delaying access to crucial early intervention that optimises functional outcomes. This study aimed to identify and specify priority physician diagnostic behaviours to target in implementation interventions to increase the rate of diagnosis of cerebral palsy under 6 months of age in Australia.
Methods:
We conducted a two-round online Delphi study with a multi-professional expert panel of cerebral palsy researchers and clinicians. A reference group identified a six-item list of potential diagnostic behaviours, which were modifiable at the individual level, that could lead to an early cerebral palsy diagnosis. In the first survey, participants rated the importance of each item on a 10-point Likert scale and supplied their reasoning for this, and were able to suggest new behaviours. In the second survey, participants ranked items in order of priority.
Results:
All six items reached consensus for inclusion (100%). No new items were added to the list. Ranking identified the top three priorities for online physician implementation interventions: (i) refer for or conduct the General Movements Assessment; (ii) refer for or conduct the Hammersmith Infant Neurological Examination; and (iii) communication of the diagnosis.
Conclusion:
An online Delphi method can effectively inform tailored implementation intervention development. A consensus was achieved on the priority physician diagnostic behaviours to target in interventions to lower the age of cerebral palsy diagnosis in Australia.
