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Published on: January 11, 2016
Bridging the Gap in Early Cerebral Palsy Detection: Primary Care Providers' and Specialists' Perspectives on
Annette Majnemer1,2, Darcy Fehlings3,4, Martina Alkot2
1Faculty of Medicine and Health Sciences, School of Physical and Occupational Therapy, McGill University, Montreal, Quebec, Canada.
Insights
Early detection of cerebral palsy (CP) is crucial. The PROMPTs for referral tool aids primary care providers in identifying CP sooner, reducing delays and improving access to early interventions for children.
Area of Science:
- Pediatric Neurology
- Public Health
- Healthcare Implementation Science
Background:
- Cerebral palsy (CP) is the most common childhood physical disability, yet diagnosis is often delayed, hindering early intervention.
- Delayed diagnosis of CP increases caregiver stress and limits access to timely support services.
- The Early Detection and Intervention Toolkit for CP (EDIT-CP) and its PROMPTs for referral tool were developed to address these diagnostic delays in primary care.
Purpose of the Study:
- To optimize and implement PROMPTs for referral within Canadian healthcare settings.
- To explore primary care providers' views on the feasibility, usability, and integration of PROMPTs into routine care.
- To understand pediatric specialists' perspectives on referral patterns, diagnostic age, barriers, and system-level dissemination of early CP detection tools.
Main Methods:
- A qualitative study design was employed, involving review of the EDIT-CP and PROMPTs for referral tool.
- Semi-structured interviews were conducted with 11 primary care providers.
- A focus group (7 participants) and interviews with 2 pediatric specialists were conducted, followed by hybrid inductive-deductive data analysis.
Main Results:
- Primary care providers found PROMPTs useful but emphasized the need for clearer referral thresholds and pathways.
- Pediatric specialists noted progress in early CP diagnosis for high-risk infants but acknowledged hesitancy to diagnose before age two and access inequities.
- Both provider groups supported integrating PROMPTs into existing workflows, stressing the need for training, dissemination, and family communication.
Conclusions:
- There is strong agreement among healthcare providers on the necessity for structured, practical, and scalable early detection pathways for CP.
- PROMPTs for referral can facilitate early detection in primary care, serving as a strategy to minimize diagnostic delays.
- Implementing PROMPTs can promote more equitable access to early intervention services for children with cerebral palsy.
Background:
Cerebral palsy (CP) is the most common childhood-onset physical disability. Although diagnosis can be made within the first year of life, many children, particularly those with milder presentations, are diagnosed well after their second birthday. Delayed recognition limits access to early interventions and increases caregiver stress. The Early Detection and Intervention Toolkit for CP (EDIT-CP) was developed to bridge this gap, including PROMPTs for referral (Primary-care Referral of Motor-impaired children: Physician Tools) to guide early identification in primary care.
Objectives:
This study aimed to explore how PROMPTs can be optimized and implemented across Canadian healthcare contexts. Specifically, we explored (1) primary care providers' perspectives on PROMPTs' feasibility, usability and integration into well-baby visits and surveillance tools; and (2) paediatric specialists' perspectives on referral patterns, age of diagnosis, barriers to early detection and system-level dissemination strategies.
Methods:
In a qualitative study design, participants were first provided access to EDIT-CP and PROMPTs for referral for review prior to data collection. Semi-structured interviews were then conducted with primary care providers (n = 11), and a focus group (n = 7) and interviews with paediatric specialists (n = 2) to explore their perspectives on feasibility, usability, referral patterns and system-level implementation. Data were analysed using a hybrid inductive-deductive approach.
Results:
Primary care providers highlighted the importance of clearer referral thresholds and pathways, with PROMPTs perceived as a useful facilitator. Specialists highlighted progress in earlier diagnosis for infants with high probability of CP, ongoing hesitancy to diagnose before age two and inequities in access. Both groups valued embedding PROMPTs for referral into existing workflows, emphasized the need for training and dissemination strategies and underscored the importance of communication with families.
Contribution:
Findings show strong alignment among providers on the need for structured, practical and scalable early detection pathways. PROMPTs for referral extend early detection into frontline practice, offering a strategy to reduce diagnostic delays and promote equitable access to early intervention for children with CP.
