24-hour postural management - PowerPoint Presentation

Slide1

24-hour postural management programmes (PMP) to protect body shape are commonly used for adults with PIMD, to prevent musculoskeletal deformity [1]. A robust evidence base to support this practice is not currently available.24-postural management is used to maintain current level of function, mobility and reduce the risk of further musculoskeletal deformity by ensuring they are appropriately supported when lying, sitting, standing and walking [2]. In today’s health care climate, where resources are finite, clinicians have a responsibility to ensure that clinical interventions are evidence-informed and targeted to those who will benefit the most. Common secondary conditions include scoliosis, hip subluxation or dislocation, tissue adaptation and fixed contractures, pain, and respiratory compromise, constipation, incontinence (bowel and bladder) and cardiovascular problems [3]

Background

Aims and Objectives

Data analysis.Consensus was set a priori at 75% agreement.For the qualitative data a thematic analysis.For the quantitative data descriptive statistics were used to calculate modes and medians.Thirty-seven participants consented to take part in this study. The response rate for each round was 81%, 90% and 90% respectively for rounds one, two and three.Table 1 shows the participant profileTable 1.         

Method

Results

Conclusion

Findings from Delphi studies have to be considered in the context from which they were taken. In the absence of strong evidence to support the uptake of 24-hour PMP’s this study found that physiotherapists would welcome, and support nationally agreed guidelines for best practice for 24-hour postural management for adults with a PIMD.A consensus statement presents a set of minimum standards for physiotherapy practice in this specialist area.There is an urgent need for further research in this area

References

[1] Gough.M.(2009) Continuous postural management and the prevention of deformity in children with cerebral palsy: an appraisal. Developmental Medicine and Child Neurology.Vol:51,p.105[2] Pope.P.(2007) Severe and Complex Neurological Disability. Management of the Physical Condition. Elsevier Ltd.UK.[3] Gajdoski.G.C.; Cicirello.N.(2001) Secondary Conditions of the Musculoskeletal System in Adolescents and Adults with Cerebral Palsy. Physical and Occupational Therapy in Pediatrics. Vol:21(4),p.49

Research Aim:24-hour postural management for adults with PIMD: A Delphi consensus study exploring physiotherapists’ perceptions of practice.Research Objectives:Identify through consensus the minimum requirements for physiotherapy practice in 24-hour postural management of adults who have PIMD.Identify a framework for the development of minimum practice recommendations for practice in 24-hour postural management of adults who have PIMD.

Jenny Tinkler, Principal Investigator; Dr Josette Bettany-Saltikov; Dr Marie Gressman

The 24 hour Management and Protection of Body Shape for Adults with a Profound Intellectual and Multiple Disability (PIMD) and body shape distortion: A Delphi consensus study exploring physiotherapists’ perceptions of practice

A

three round classical e-Delphi survey, was used to elicit opinions and gain consensus in relation to physiotherapists practice in 24-hour postural management for adults with PIMD. ParticipantsA purposive non probability sample of physiotherapists s used to recruit members from the Association of Chartered Physiotherapists for People with a Learning Disability (ACPPLD).EthicsEthical approval was obtained from Teesside University

ThemeMean % agreementMedian valueMode valueP>0.05Training and Education94.4%11.276Knowledge and Skills94.4%11.679Clinical Practice94.4%11.458Resources94.4%11.516Service Delivery92.6%11.236Partnership92.6%11.458

Characteristicn (%)Gender  Female28 (98.3%) Male2 (6.7%)Age (years)  20 – 293 (10) 30 – 399 (30) 40 – 499 (30) 50 – 59 7 (23.3) >60 2 (6.6) Length of time working in ld*  <than 5 years 7 (23.3) 6 - 10 years 5 (16.7) 11 - 15 years 9 (30) 16 - 20 years 5 (16.7) >than 20 years 4 (13.3)Areas of previous clinical experience  Neurology21 (14.9) Medical 11 (7.8) Musculoskeletal 15 (10.6) Outpatients 12 (8.5) Paediatrics 11 (7.8) Palliative care 5 (3.5) Elderly care 6 (11.3) General community 15 (10.6) Rehabilitation 15 (10.6) Respiratory 11 (7.8) Other – Mental Health; wheelchair services; private practice; Amputees 9 (6.4)

Proposed national framework for the development of best practice guidance for physiotherapists’ in 24-hour postural management for adults with a PIMD is illustrated in figure 2.Figure 2

Figure 1 illustrates the thematic network from which the themes for best practice are identified.

The participants reached a 100% consensus on a definition for 24-hour postural management: “Postural management is concerned with ensuring the body is appropriately supported over a 24-hour period so as to promote and maintain function, prevent and reduce body shape distortion and prevent and reduce the impact of secondary complications”Best Practice

Table 2 Summarises the rating by the panel of the themes identified best practice themes.Table 2

Figure 1

Basic Themes

Organisational Themes

Global Theme

Best Practice for 24-hour postural management

Resources

ServiceDelivery

Partnerships

Training & Education

Clinical Practice

Knowledge & Skills

Equipment for assessment

Clinical working space

Staffing

Training materials

Procurement of equipment

Resources centres

Postural Management Pathway

Access to experts

Care Pathways

External partners

Multidisciplinary partners

Interagency partners

Internal partners

Standardised carer education

Undergraduate training for physiotherapy assistants

Postgraduate training

Outcome Measures

Review & monitoring

Standardised Assessment

Measuring

Continuing Professional Development

Competencies

Research

Evidence

Supervision

Contact details

Jenny Tinkler, Clinical Specialist, Tees

Esk

and Wear Valleys NHS Foundation Trust. Email: jennytinkler@nhs.net