Consensus recommendations for botulinum toxin injections in the spasticity management of children with cerebral palsy during COVID-19 outbreak

The patients with intrathecal baclofen pump in the age of COVID-19: a single center study

PURPOSE

Intrathecal baclofen pump treatment is employed in the treatment of various diseases. Despite the benefits of intrathecal baclofen pump, patients may occasionally encounter severe complications. These complications may necessitate urgent assessment or intervention for patients with intrathecal baclofen pumps. This study aimed to evaluate the intrathecal baclofen pump-related problems, the utilization of health services, physical-psychosocial status, and the quality of life of patients with intrathecal baclofen pumps during the coronavirus disease 2019 pandemic.

MATERIALS AND METHODS

We conducted a cross-sectional, phone-based survey study between 1 June 2021 and 15 July 2021 with a sample of 23 patients with intrathecal baclofen pumps. The patients' quality of life before the implantation of the pump, after one year of implantation, and during the pandemic was evaluated with the 3-level version of EQ-5D.

RESULTS

Catheter migration developed in one of the patients, after which the pump was changed. While the dose of baclofen was altered in eight (38.1%) patients during the pandemic period, the filling period was modified in three (14.3%) patients. While 61.9% of the patients reported that their general health, mobility, spasticity and joint mobility were worse than before the pandemic, 90.5% of the patients stated that their communication and mood were worse than before the pandemic. The 3-level version of EQ-5D and EQ-Visual Analogue Scale scores of the patients were significantly decreased during pandemic (p < .05).

CONCLUSIONS

Due to the complications of the intrathecal baclofen pump, its management should continue uninterruptedly during the pandemic period.

The Rehabilitation Interventions and Adaptive Technologies Used for Treating Patients With Cerebral Palsy

Cerebral palsy (CP) is one of the most common disorders in pediatric patients. The prevalence of CP is 2-3 in 1,000 live births, but various changes in some trends are seen in different groups. This article is a systematic review of multiple sources available for interventions and new adaptive techniques used for treating patients for their better lifestyles. With recent advancements, it is possible to diagnose a child who is below six months to two years. For achieving goals, proper interventions and techniques are necessary in the early stages of the disease. This article summarizes the rehabilitation and interventions available for treating these children with the best procedures.

The impact of the COVID-19 pandemic on children with disabilities and their parents or caregivers

Objectives

The study aimed to determine the impact of the pandemic on parents/caregivers and children with neurologic disabilities.

Patients and methods

This multi-center cross-sectional study was conducted with 309 parents/caregivers (57 males, 252 females) and their 309 children (198 males, 111 females) with disabilities between July 5, 2020, and August 30, 2020. The parents/caregivers were able to answer the questions and had internet access. The survey included questions on the utilization of educational and health care services (whether they could obtain medicine, orthosis, botulinum toxin injection, or rehabilitation) during the pandemic. A Likert scale was used to evaluate the effect of the specific health domains, including mobility, spasticity, contractures, speech, communication, eating, academic, and emotional status. The Fear of COVID-19 Scale was used to assess fear of COVID-19.

Results

Among the children, 247 needed to visit their physician during the pandemic; however, 94% (n=233) of them could not attend their physician appointment or therapy sessions. The restricted life during the first wave of the pandemic in Türkiye had negatively affected 75% of the children with disabilities and 62% of their parents. From the perspective of the parents/caregivers, mobility, spasticity, and joint range of motion of the children were affected. Forty-four children required repeated injections of botulinum toxin; however, 91% could not be administered. The Fear of COVID-19 Scale scores were significantly higher in the parents who could not bring their children to the routine physician visit (p=0.041).

Conclusion

During the pandemic, access to physical therapy sessions was disrupted in children with neurological disabilities, and this may have harmful consequences on the functional status of children.

Delphi methodology in healthcare research: How to decide its appropriateness

The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.

Delphi methodology in healthcare research: How to decide its appropriateness

The Delphi technique is a systematic process of forecasting using the collective opinion of panel members. The structured method of developing consensus among panel members using Delphi methodology has gained acceptance in diverse fields of medicine. The Delphi methods assumed a pivotal role in the last few decades to develop best practice guidance using collective intelligence where research is limited, ethically/logistically difficult or evidence is conflicting. However, the attempts to assess the quality standard of Delphi studies have reported significant variance, and details of the process followed are usually unclear. We recommend systematic quality tools for evaluation of Delphi methodology; identification of problem area of research, selection of panel, anonymity of panelists, controlled feedback, iterative Delphi rounds, consensus criteria, analysis of consensus, closing criteria, and stability of the results. Based on these nine qualitative evaluation points, we assessed the quality of Delphi studies in the medical field related to coronavirus disease 2019. There was inconsistency in reporting vital elements of Delphi methods such as identification of panel members, defining consensus, closing criteria for rounds, and presenting the results. We propose our evaluation points for researchers, medical journal editorial boards, and reviewers to evaluate the quality of the Delphi methods in healthcare research.

Evaluation of the effects of the COVID-19 pandemic on children with cerebral palsy, caregivers' quality of life, and caregivers' fear of COVID-19 with telemedicine

Background

The sudden and unexpected pandemic changed the daily routine of the children with cerebral palsy (CP) and their caregivers.

Aims

This study aimed to investigate the impact of the novel coronavirus (COVID-19) pandemic on the utilization of health and rehabilitation services and the general health and physical status of children with CP. In addition, the second aim of the study was to examine the effects of the COVID-19 pandemic on caregivers’ quality of life (QOL) and their fear of COVID-19.

Methods

The utilization of children health and rehabilitation services during the pandemic, the general health and physical status of the children during the pandemic, and the children and caregivers’ history of COVID-19 infections were questioned. Furthermore, the caregivers’ level of fear of COVID-19 and their QOL were examined.

Results

One hundred twenty caregivers were contacted by phone, and 94 (78.33%) caregivers agreed to participate in the study. Sixty-three of 94 children (67.1%) did not attend their routine control check-up during the pandemic. Twelve children (12.8%) discontinued their physical therapy sessions during the pandemic. Caregivers physical and mental QOL significantly decreased during the pandemic (p < 0.05). The median of caregivers’ Fear of COVID-19 scale (FCV-19S) was 17.5 (7–35).

Conclusion

We think that more attention should be given to telerehabilitation and telemedicine services of the clinicians who deal with the children with CP, and their caregivers in order to prevent the negative effects of future pandemic periods.