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Osborne LJ, Gowran RJ, Casey J. Evidence for 24-hour posture management: A scoping review. Br J Occup Ther 2023. [DOI: 10.1177/03080226221148414] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Introduction: People with complex physical disabilities unable to change their position independently are at risk of developing postural deformities and secondary complications. 24-hour posture management is needed to protect body structure. With inconsistencies in current service provision, this research aimed to scope the evidence for a 24-hour posture management approach. Method: A scoping review was conducted using four health and social science databases. Inclusion and exclusion criteria were applied; further papers were included through citation chaining. Results: The evidence for 24-hour posture management was often low quality due to the complications of completing robust research studies in this complex specialty. However, many professionals in the field agree that a 24-hour approach to postural care is essential. Conclusion: There is a need for clear national policy and guidance relating to postural care and scope for development of dedicated posture management services. Current NHS service provision is variable and inconsistent. Lack of postural care is a safeguarding and human rights issue. Specialist training and research in postural care within the Occupational Therapy profession is required to raise awareness of the role Occupational Therapists can play in preventing postural deformities and other secondary complications through providing good postural care.
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Affiliation(s)
| | - Rosemary Joan Gowran
- Discipline Occupational Therapy, Faculty of Education and Health Sciences, School of Allied Health, Health Research Institute, Health Implementation Science and Technology, University of Limerick, Limerick, Ireland
- School of Health and Sports Science, University of the Sunshine Coast, Queensland, Australia
- Assisting Living and Learning (ALL) Institute Maynooth University, Maynooth, Co. Kildare, Ireland
| | - Jackie Casey
- Advanced Practitioner Occupational Therapist-Specialised Seating, Regional Rehabilitation Engineering Centre, Belfast Health & Social Care Trust, Belfast, Northern Ireland
- Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK
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McGuire FE, Hutson J, Oldenburg H. Educating rehabilitation professionals on clinical skills for postural care services: A scoping review. J Rehabil Assist Technol Eng 2022; 9:20556683221114786. [PMID: 35966342 PMCID: PMC9373169 DOI: 10.1177/20556683221114786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Revised: 07/01/2022] [Accepted: 06/05/2022] [Indexed: 11/17/2022] Open
Abstract
Background: This scoping review aims to identify evidence-based
practices for educating rehabilitation professionals who provide assistive
technology interventions, specifically night-time postural care, to children
with cerebral palsy. Methods: A review of both peer-reviewed and grey literature
published between 2000 and 2021 was undertaken in June 2021. The articles were
analyzed using a process outlined by Arksey and O’Malley in 2005: scanning
abstracts, completing initial and critical reviews, collating and summarizing
data into themes. Results: The search resulted in 15 articles, predominantly from the
United Kingdom and the United States: 10 primary research, two reviews, two
conceptual/theoretical, and one gray-literature source. Four themes emerged (1)
Successful service delivery required competence, (2) Benefits of incorporating
practice, collaboration, and feedback, (3) Effective online education through
multifactorial approaches, (4) Considering different learning requirements among
team members. Conclusions: There’s beginning evidence that rehabilitation
professionals’ competence with night-time postural care might be achieved via
active, interactive, multi-factorial online training.
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Affiliation(s)
- Faye E McGuire
- Occupational Therapy, St Catherine University, St. Paul, MN, USA
| | - Jennifer Hutson
- Occupational Therapy, St Catherine University, St. Paul, MN, USA
| | - Hannah Oldenburg
- Occupational Therapy, St Catherine University, St. Paul, MN, USA
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Hutson JA, Hodges JS, Snow L. Educating caregivers of persons with cerebral palsy in night-time postural care: A randomized trial comparing two online training programs. Clin Rehabil 2021; 35:1317-1328. [PMID: 33858230 DOI: 10.1177/02692155211009484] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Compare effectiveness of two differently formatted training programs in educating night-time postural care implementers. DESIGN Mixed-methods parallel-group double-blind design with random assignment. SETTING United States academic institution. PARTICIPANTS Thirty-eight adult caregivers/providers of children with cerebral palsy. INTERVENTIONS Both 2-hour online programs included content on night-time postural care evidence, risk-factor monitoring, sleep-system types, positioning methods, and assessments. Group A used interactive videos, Group B summary information with web-links. MAIN MEASURES We measured self-perceived competence via questionnaires (baseline, post-training, post-simulation) containing 4-point rating-scales of knowledge, ability, and confidence and measured positioning ability via a simulation observation instrument comprising 16 positioning-task ratings with space for describing performance. We recorded participant actions/statements using fieldnotes. RESULTS Thirty-eight completed training (19 per group). Group A (vs B) showed significantly greater self-perceived competence changes post-training (0.46 points (SE 0.17), P = 0.008). Thirty-seven positioned a standardized "client," with groups not differing significantly on total tasks completed correctly (F(1, 92.32) = 1.91, P = 0.17) averaging 11.85 (SE 0.83) and 12.60 (SE 0.84) of 16 tasks correct. Group A's post-positioning/simulation self-ratings were significantly associated with actual ability (r = 0.53, P = 0.019). In both groups ⩾47% of caregivers incorrectly completed the tasks of placing head and neck in neutral and snugging up all [positioning] parts. CONCLUSION The sleep care positioning training program (interactive video-based format) is effective in building caregivers' self-perceived competence for night-time postural care. While the lesson was well-received by caregivers and considered a "match [to their] learning style," the lesson did not lead to greater improvement in actual ability to position the "client" compared to control training.
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Affiliation(s)
- Jennifer Ann Hutson
- Occupational Therapy, St. Catherine University, St. Paul, MN, USA.,Gillette Children's Specialty Healthcare, St. Paul, MN, USA
| | - James S Hodges
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis, MN, USA
| | - LeAnn Snow
- Division of Rehabilitation Science, Department of Rehabilitation Medicine, University of Minnesota, Minneapolis, MN, USA
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Stinson M, Crawford S, Madden E. Current clinical practice in 24-hour postural management and the impact on carers and service users with severe neurodisability. Br J Occup Ther 2020. [DOI: 10.1177/0308022620944739] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Introduction The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. The aim of this research was to investigate the use of 24-hour postural management by occupational therapists and to explore its impact on service users with neurodisability and their carers. Methods Quantitative and qualitative methods were employed in two phases: (a) online survey with 96 occupational therapists across one UK region, with data analysed by descriptive statistics and correlations; (b) focus groups with service users and/or carers ( n = 9), with data analysed by thematic analysis. Results Findings showed moderate positive correlation between frequency of use and (a) all key intervention skills and (b) knowledge of night-time positioning ( p < 0.001). Moderate positive correlations were found between level of training and (a) assessment skills and (b) knowledge of night-time positioning ( p < 0.001). The overarching theme from focus groups was ‘reliance on individualised equipment’, with overwhelming frustration from lack of support, loss of identity, equipment cost, insufficient focus on preventative strategies and accessibility issues. Conclusion A clinical practice guideline, including training, is crucial to direct practice. Providers must engage with service users and carers to address their frustrations.
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Affiliation(s)
- May Stinson
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, UK
| | - Shelley Crawford
- Occupational Therapy Department, Wheelchair Resource Team, Western Health and Social Services Trust, Londonderry, UK
| | - Emma Madden
- Institute of Nursing and Health Research, School of Health Sciences, Ulster University, Newtownabbey, UK
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Humphreys G, King T, Jex J, Rogers M, Blake S, Thompson-Coon J, Morris C. Sleep positioning systems for children and adults with a neurodisability: A systematic review. Br J Occup Ther 2018. [DOI: 10.1177/0308022618778254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction Sleep positioning systems are often prescribed as part of a 24-hour postural management programme for children and adults with neurodisabilities. In a search for evidence of effectiveness for children with cerebral palsy a recent Cochrane review found two randomised controlled trials. This review aims to appraise a broader set of studies including any neurological diagnosis and users of all ages to inform therapists about the quality of the evidence underlying practice. Method A comprehensive search for all peer-reviewed studies that evaluated the use of sleep positioning systems was conducted in MEDLINE, EMBASE, CINAHL, Cochrane Library databases, BNI, HMIC, PEDro, OTSeeker and clinical trials registries. Disability organisations, manufacturers and colleagues worldwide were also contacted. Titles were screened for relevance by two reviewers. Data were extracted into bespoke quantitative or qualitative forms by one reviewer and checked by a second. Findings were analysed into simple themes. Results A total of 14 studies were eligible for inclusion; all were small and most were of low quality. Inferences of benefits cannot be made from the literature but also no harm was found. Conclusions The body of evidence supporting practice remains small and mostly of low quality. Therapists should remain cautious when presenting the benefits to families.
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Affiliation(s)
| | - Tanya King
- Director of Client Services, Dame Hannah Rogers Trust, Ivybridge, UK
| | - Jo Jex
- Physiotherapist, Active Design Ltd., Birmingham, UK
| | - Morwenna Rogers
- Information Specialist, National Institute for Health Research (NIHR) CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Sharon Blake
- Associate Research Fellow in Child Health, Peninsula Cerebra Research Unit for Childhood Disability (PenCRU), University of Exeter Medical School, Exeter, UK
| | - Jo Thompson-Coon
- Associate Professor in Evidence Synthesis, NIHR CLAHRC South West Peninsula (PenCLAHRC), University of Exeter Medical School, Exeter, UK
| | - Christopher Morris
- Senior Research Fellow in Child Health, Peninsula Cerebra Research Unit for Childhood Disability (PenCRU), University of Exeter Medical School, Exeter, UK
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Blake SF, Logan S, Humphreys G, Matthews J, Rogers M, Thompson‐Coon J, Wyatt K, Morris C. Sleep positioning systems for children with cerebral palsy. Cochrane Database Syst Rev 2015; 2015:CD009257. [PMID: 26524348 PMCID: PMC8761500 DOI: 10.1002/14651858.cd009257.pub2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Sleep positioning systems can be prescribed for children with cerebral palsy to help reduce or prevent hip migration, provide comfort to ease pain and/or improve sleep. As sleep disturbance is common in children with developmental disabilities, with impact on their carers' sleep, and as sleep positioning systems can be expensive, guidance is needed to support decisions as to their use. OBJECTIVES To determine whether commercially-available sleep positioning systems, compared with usual care, reduce or prevent hip migration in children with cerebral palsy. Any negative effect of sleep positioning systems on hip migration will be considered within this objective.Secondary objectives were to determine the effect of sleep positioning systems on: (1) number or frequency of hip problems; (2) sleep patterns and quality; (3) quality of life of the child and family; (4) pain; and (5) physical functioning. We also sought to identify any adverse effects from using sleep positioning systems. SEARCH METHODS In December 2014, we searched CENTRAL, Ovid MEDLINE, Embase, and 13 other databases. We also searched two trials registers. We applied no restrictions on date of publication, language, publication status or study design. We checked references and contacted manufacturers and authors for potentially relevant literature, and searched the internet using Google. SELECTION CRITERIA We included all randomised controlled trials (RCTs) evaluating whole body sleep positioning systems for children and adolescents (up to 18 years of age) with cerebral palsy. DATA COLLECTION AND ANALYSIS Two review authors independently screened reports retrieved from the search against pre-determined inclusion criteria and assessed the quality of eligible studies.Members of the public (parent carers of children with neurodisability) contributed to this review by suggesting the topic, refining the research objectives, interpreting the findings, and reviewing the plain language summary. MAIN RESULTS We did not identify any randomised controlled trials that evaluated the effectiveness of sleep positioning systems on hip migration.We did find two randomised cross-over trials that met the inclusion criteria in respect of secondary objectives relating to sleep quality and pain. Neither study reported any important difference between sleeping in sleep positioning systems and not for sleep patterns or sleep quality (two studies, 21 children, very low quality evidence) and pain (one study, 11 children, very low quality evidence). These were small studies with established users of sleep positioning systems and were judged to have high risk of bias.We found no eligible trials that explored the other secondary objectives (number or frequency of hip problems, quality of life of the child and family, physical functioning, and adverse effects). AUTHORS' CONCLUSIONS We found no randomised trials that evaluated the effectiveness of sleep positioning systems to reduce or prevent hip migration in children with cerebral palsy. Nor did we find any randomised trials that evaluated the effect of sleep positioning systems on the number or frequency of hip problems, quality of life of the child and family or on physical functioning.Limited data from two randomised trials, which evaluated the effectiveness of sleep positioning systems on sleep quality and pain for children with cerebral palsy, showed no significant differences in these aspects of health when children were using and not using a sleep positioning system.In order to inform clinical decision-making and the prescription of sleep positioning systems, more rigorous research is needed to determine effectiveness, cost-effectiveness, and the likelihood of adverse effects.
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Affiliation(s)
- Sharon F Blake
- University of Exeter Medical SchoolPeninsula Cerebra Research Unit (PenCRU)Room 008, Veysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
| | - Stuart Logan
- University of Exeter Medical SchoolPeninsula Cerebra Research Unit (PenCRU)Room 008, Veysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
| | - Ginny Humphreys
- Vranch House Clinical ServicesPinhoe RoadExeterEX4 8APUKDevon
| | - Justin Matthews
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
| | - Morwenna Rogers
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
| | - Joanna Thompson‐Coon
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
| | - Katrina Wyatt
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
| | - Christopher Morris
- University of Exeter Medical SchoolPeninsula Cerebra Research Unit (PenCRU)Room 008, Veysey BuildingSalmon Pool LaneExeterDevonUKEX2 4SG
- University of Exeter Medical SchoolNIHR PenCLAHRC, Institute of Health ResearchExeterUK
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Castle D, Stubbs B, Clayton S, Soundy A. A 24-hour postural care service: Views, understanding and training needs of referring multidisciplinary staff. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2014. [DOI: 10.12968/ijtr.2014.21.3.132] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Darren Castle
- Senior Physiotherapist at Birmingham Community Healthcare NHS Trust, and a MRes in Health Student at the University of Birmingham, UK
| | | | - Sarah Clayton
- Biologist specialising biomechanics at Postural Care CIC, Tamworth, UK
| | - Andrew Soundy
- Lecturer in Physiotherapy at the University of Birmingham, UK
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Novak I, McIntyre S, Morgan C, Campbell L, Dark L, Morton N, Stumbles E, Wilson SA, Goldsmith S. A systematic review of interventions for children with cerebral palsy: state of the evidence. Dev Med Child Neurol 2013; 55:885-910. [PMID: 23962350 DOI: 10.1111/dmcn.12246] [Citation(s) in RCA: 787] [Impact Index Per Article: 71.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/05/2013] [Indexed: 02/07/2023]
Abstract
AIM The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). METHOD This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. RESULTS Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded 'do it' (green go); 58% (76 out of 131) 'probably do it' (yellow measure); 20% (26 out of 131) 'probably do not do it' (yellow measure); and 6% (8 out of 131) 'do not do it' (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). INTERPRETATION Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.
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Affiliation(s)
- Iona Novak
- Cerebral Palsy Alliance, Sydney, Australia; University of Notre Dame Australia, Sydney, Australia
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Dawson NC, Padoa KA, Bucks RS, Allen P, Evans H, McCaughey E, Hill CM. Ventilatory function in children with severe motor disorders using night-time postural equipment. Dev Med Child Neurol 2013; 55:751-7. [PMID: 23582011 DOI: 10.1111/dmcn.12149] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/02/2013] [Indexed: 11/28/2022]
Abstract
AIM Night-time postural equipment (NTPE) can prevent hip subluxation in children with severe motor disorders (SMDs). However, it is unclear how it affects ventilatory function. The aims of the study were to determine how NTPE use affects ventilatory function and to compare night-to-night variability of ventilatory function in children with SMDs and typically developing healthy children. METHOD Fifteen NTPE users (six males, nine females), aged 1 to 19 years (mean age 8y 7mo) alternated sleep condition between NTPE and sleeping unsupported for 14 nights. In all but two participants, gross motor function was classified as Gross Motor Function Classification System (GMFCS) level V; in the other two it was level IV. Oxyhaemoglobin saturation (SpO2 ) was monitored each night and transcutaneous CO2 (PtcCO2 ) for one night in each sleep condition. In 17 healthy children of similar age, home SpO2 only was monitored for seven nights. RESULTS In 13 of 15 NTPE users and 12 of the 17 typically developing children, SpO2 monitoring was satisfactorily completed. Of the children with SMDs, two had mean SpO2 levels below the treatment threshold for supplemental oxygen, which was uniquely associated with use of NTPE in only one participant, and three had nocturnal hypoventilation, which was uniquely associated with NTPE use in only one case. Night-to-night SpO2 variability was higher in children with SMDs than in typically developing children. INTERPRETATION NTPE may impair or enhance ventilatory function in a minority of children. Owing to night-to-night variability in SpO2 , at least three nights of monitoring are recommended to determine optimal positioning for effective ventilation before and after NTPE introduction.
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Affiliation(s)
- Nicola C Dawson
- Division of Clinical Experimental Sciences, Faculty of Medicine, University of Southampton, Southampton, UK
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Abstracts. Br J Occup Ther 2013. [DOI: 10.1177/03080226130767s101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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