Using the electronic medical record to study the association of child and environmental characteristics on the type of physical therapy services delivered to individuals with cerebral palsy

Stability of the Gross Motor Function Classification System in children with cerebral palsy in the two to four year age band

PURPOSE

This study aimed to investigate the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) in the two to four year age band, the frequency at which children were reclassified, and trends of reclassification to higher or lower ability.

METHODS

This retrospective study included 164 children with CP between 24 to 48 months old with two or more GMFCS ratings at least 12 months apart between their second and fourth birthdays. GMFCS ratings were captured closest to 24, 36, and 48 months. Stability and reclassification trends were analyzed using inferential statistics. Frequency of reclassification, age at ratings, duration between ratings, and corresponding change rate were analyzed using descriptive statistics.

RESULTS

When comparing ratings closest to second and fourth birthdays, a linear weighted kappa of 0.726 was found. Of the total population, 46.95% changed GMFCS levels at any time between two to four years of age, the majority of which were reclassified to a higher level of ability.

CONCLUSION

Findings suggest the GMFCS is less stable in the two to four year age band compared to older age bands. Due to the importance of providing accurate guidance for caregivers and high rate of reclassification, it is recommended GMFCS levels be reassessed every six months during this period of time.

Describing the Delivery of Evidence-Based Physical Therapy Intervention to Individuals With Cerebral Palsy

PURPOSE

To characterize by evidence grades and examine variation in type of physical therapy intervention delivered in routine clinical care in individuals with cerebral palsy (CP).

METHODS

Retrospective data collection from the electronic record over 1 year at a tertiary care pediatric outpatient therapy division.

RESULTS

Four hundred sixty-five individuals with CP received 28 344 interventions during 4335 treatment visits. Sixty-six percent of interventions were evidence-based interventions (EBIs). Significant variation was demonstrated across Gross Motor Function Classification System levels, with children classified as level V receiving the least and level III the most. The most frequent EBIs delivered were caregiver education, motor control, functional strengthening, ankle-foot orthoses, treadmill training, and fit of adaptive equipment.

CONCLUSIONS

Further work is needed to determine whether amount of EBI is related to better outcomes. Combining this information with other aspects of dose (intensity, time, and frequency) may elucidate the contribution of each with outcomes.

Documenting Physical Therapy Dose for Individuals With Cerebral Palsy: A Quality Improvement Initiative

PURPOSE

To describe the quality improvement (QI) activities used to improve treatment dose documentation for individuals with cerebral palsy (CP) and to discuss insights gained from this project.

METHODS

Global and smart aims were established and interventions were tested from January 2017 through February 2018 using Plan-Do-Study-Act cycles. Performance was tracked overtime using run and control charts.

RESULTS

The QI initiative resulted in a sustainable increase in percentage of dose elements present in the electronic medical record from 78% to 94%. Key drivers of improvement included (1) knowledge and awareness of dose, (2) clinician buy-in, (3) effective engagement of child and parent, (4) therapist knowledge of evidence-based treatments, (5) transparent and reliable documentation system, and (6) audit and clinician feedback.

CONCLUSIONS

QI methods provided the tools to improve workflow and increase dose documentation for individuals with CP.