Brown Laurey, Hoffman Katie, Corbo-Galli Chiara, Kelley Carolyn, Carry Terri, Civitello Matt, Coratti Giorgia, DeSanctis Roberto, Duong Tina, Driscoll Brigid, Flickinger Jean, Glanzman Allan M, Jones Jennifer, Maczek Elizabeth, Moat Dionne, Montes Jacqueline, Muni-Lofra Robert, Nelson Leslie, Pasternak Amy, Valle Melanie, Krosschell Kristin J
Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, IL, United States.
Weinberg College of Arts and Sciences, Northwestern University, Evanston, IL, United States.
Front Neurol. 2025 Apr 16;16:1502495. doi: 10.3389/fneur.2025.1502495. eCollection 2025.
Individuals with Spinal Muscular Atrophy (SMA) often present with muscle contractures. Serial casting has been used in a variety of other peripheral nerve, muscle, and central nervous system disorders to improve knee and ankle range of motion limitations and functional performance in both ambulatory and non-ambulatory individuals.
The goal of this study was to reach a consensus about the parameters, considerations and general guidelines that should inform practice when serial casting to improve flexibility in individuals with SMA.
This international effort was conducted between August 2020 and May 2023. An expert panel of physical therapists was assembled with multiple panel meetings and a 2-round Delphi survey performed covering topics relevant to serial casting which included three domains: clinical appropriateness, program-based considerations and program adherence/feasibility. Consensus was reached for all items in the three topic areas using a validity index of >75%. Following completion of the Delphi survey, community insights from patients and caregivers were collected via semi-structured interview.
This study included the synthesis of meetings from the initial expert panel which produced a comprehensive survey for the different considerations when performing serial casting for an individual with SMA. The study also included the completion of a Delphi survey by 18 therapists in round 1 and 15 therapists in round 2 for a consensus on 296 items. Strong consensus was obtained in all three domains with 96.6% agreement for clinical appropriateness, 95.0% agreement for program-based considerations, and 96.9% for program adherence/feasibility. A guideline document was developed enumerating the specific items detailed in the survey. Community perspectives were utilized to support the results of the Delphi survey and to add insight into real-world experience.
The serial casting guidelines developed upon collaborative discussions from the expert panel and from the Delphi survey consensus and semi-structured interviews, should be utilized when applying serial casts to patients with spinal muscular atrophy. Future endeavors should look to apply the guideline recommendations to determine casting efficacy for improving joint contracture and impact on function for those with SMA.
脊髓性肌萎缩症（SMA）患者常出现肌肉挛缩。连续石膏固定已被用于多种其他周围神经、肌肉和中枢神经系统疾病，以改善步行和非步行个体的膝关节和踝关节活动范围受限及功能表现。
本研究的目的是就连续石膏固定以改善SMA患者灵活性时应指导实践的参数、注意事项和一般指南达成共识。
这项国际合作于2020年8月至2023年5月进行。组建了一个物理治疗师专家小组，召开了多次小组会议，并进行了两轮德尔菲调查，涵盖与连续石膏固定相关的主题，包括三个领域：临床适宜性、基于方案的考虑因素以及方案依从性/可行性。使用有效性指数>75%就三个主题领域的所有项目达成了共识。在德尔菲调查完成后，通过半结构化访谈收集了患者和护理人员的社区见解。
本研究包括对最初专家小组会议的综合，该会议产生了一份关于为SMA患者进行连续石膏固定时不同考虑因素的全面调查问卷。该研究还包括18名治疗师在第一轮和15名治疗师在第二轮完成的德尔菲调查，以就296个项目达成共识。在所有三个领域都获得了强烈共识，临床适宜性的同意率为96.6%，基于方案的考虑因素的同意率为95.0%，方案依从性/可行性的同意率为96.9%。制定了一份指南文件，列举了调查中详细的具体项目。利用社区观点来支持德尔菲调查的结果，并深入了解实际经验。
在对脊髓性肌萎缩症患者应用连续石膏固定时，应采用基于专家小组合作讨论、德尔菲调查共识和半结构化访谈制定的连续石膏固定指南。未来的努力应着眼于应用指南建议来确定石膏固定对改善关节挛缩的疗效以及对SMA患者功能的影响。
