Willoughby Kate L, Toovey Rachel, Hodgson Jan M, Graham H Kerr, Reddihough Dinah S
Centre of Research Excellence in Cerebral Palsy, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.
Orthopaedic Department, Royal Children's Hospital, Melbourne, Victoria, Australia.
J Paediatr Child Health. 2019 Jan;55(1):32-41. doi: 10.1111/jpc.14108. Epub 2018 Jul 5.
This study aimed to explore health professionals' experiences of implementing hip surveillance for young people with cerebral palsy (CP) and to identify any barriers they encounter.
A cross-sectional web-based survey of health professionals supporting children with CP was conducted. Responses were analysed through mixed methods. Responses to items presented as ordinal scales were analysed using descriptive statistics, and open-ended responses through a qualitative approach to identify themes.
A total of 32 paediatricians, 2 rehabilitation specialists and 50 physiotherapists completed the survey, with respondents working within both hospital- and community-based settings. Barriers most frequently reported were inconsistency in radiology practice and reporting (35%), parent engagement (32%), limited communication between clinicians (31%), lack of clarity in lines of responsibility (27%) and forgetting to undertake surveillance (26%). Four major themes were identified through qualitative analysis: (i) recognition of the importance of clinical guidelines to hip surveillance; (ii) the value of each role in the team around a child; (iii) the challenge of sharing responsibility; and (iv) the importance of communication in facilitating collaboration.
Barriers can be encountered at each phase of the hip surveillance process, but there are also factors that act as facilitators. Locally, the results will inform the development of an enhanced state-wide approach to hip surveillance for all children with CP. The identified barriers do not appear unique to the local context, and the findings may be transferable to other settings. Awareness of the potential barriers and facilitators would be valuable to those implementing hip surveillance in other areas.
本研究旨在探讨医疗专业人员对脑瘫（CP）青少年实施髋关节监测的经验，并确定他们遇到的任何障碍。
对支持脑瘫儿童的医疗专业人员进行了一项基于网络的横断面调查。通过混合方法对回复进行分析。对以有序量表形式呈现的项目回复使用描述性统计进行分析，对开放式回复采用定性方法来确定主题。
共有32名儿科医生、2名康复专家和50名物理治疗师完成了调查，受访者在医院和社区环境中工作。最常报告的障碍是放射学实践和报告不一致（35%）、家长参与度（32%）、临床医生之间沟通有限（31%）、职责分工不明确（27%）以及忘记进行监测（26%）。通过定性分析确定了四个主要主题：（i）认识到临床指南对髋关节监测的重要性；（ii）儿童周围团队中每个角色的价值；（iii）分担责任的挑战；（iv）沟通在促进协作方面的重要性。
在髋关节监测过程的每个阶段都可能遇到障碍，但也有一些促进因素。在当地，这些结果将为制定针对所有脑瘫儿童的全州范围内强化髋关节监测方法提供信息。所确定的障碍似乎并非当地所特有，研究结果可能适用于其他环境。对潜在障碍和促进因素的认识对在其他地区实施髋关节监测的人员将很有价值。
