How do clinicians and researchers define, describe, assess and treat postural control dysfunction in cerebral palsy: A Delphi survey

Abstract

Background and Objective(s): Despite impairment of posture being central to the universally accepted definition of cerebral palsy (CP), there is scant information on the classification, assessment and treatment of postural control dysfunction in this population. A major factor contributing to this is a lack of common understanding of how postural control is defined, described, assessed and treated. To improve the direction of postural control research and clinical practice in cerebral palsy, this paper aims to identify perspectives from current clinicians and/or research leaders in the field regarding postural control definitions, frameworks, assessments and interventions for children with cerebral palsy (CP). Study Design: 3-round Delphi survey. Study Participants & Setting: Potential participants (n = 711) were emailed and included health professionals with expertise in research and/or clinical assessment and treatment of children with cerebral palsy. They included authors of published works on postural control in CP (identified from recent systematic reviews), members of the Australasian CP and Developmental Medicine Academy and two major Australian rehabilitation providers. Respondents were 43 researchers and/or clinicians from 7 countries with a mean(SD) of 20(11) years experience working with children with CP. Materials/Methods: In Round-I, respondents answered openended questions regarding their views on: (i) definition elements for postural control, (ii) theoretical frameworks, (iii) methods for assessment, and (iv) interventions for postural control dysfunction in children with CP. Round-I responses were subject to content analysis to create a list of items for Round-II. Round-II items were a combination of items identified in Round-I as well as items identified in recent systematic reviews. During Round-II and Round-III respondents ranked items on a 7-point Likert scale ranging from 1 = Strongly Disagree to 7 = Strongly Agree. Items reaching ≥85% agreement reached consensus. Results: In the Definitions category, 21 items were proposed and 19 reached consensus - enough to create an overarching definition of postural control. In the Frameworks category, 12 frameworks or clinical approaches were proposed, however only two items reached consensus. In the Assessment category, 47 test batteries and 31 individual test items were proposed, but less than half reached consensus. Most consensus items were individual test items (26 items) rather than test batteries (2 items). In the Interventions category, 29 clinical interventions were proposed with over half reaching consensus (16 items). An extensive range of qualitative comments were received across all categories, which indicated a high level of certainty about postural control definitions, but a high level of uncertainty about postural control frameworks and how best to assess or treat postural control dysfunction. Conclusions/Significance: Consensus exists for definitions but research is needed to develop a comprehensive, widely accepted framework, specifically for postural control. This would provide a foundation to investigate assessments and improve intervention selection and dosage.L6143269102017-02-10 <br />