Organisational Themes Best Practice for 24-hour postural management 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 Jenny Tinkler, Principal Investigator; Dr Josette Bettany-Saltikov; Dr Marie Gressman 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 profile Table 1.      Background 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 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 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] Person Partnership/ Collaboration Service Delivery Knowledge & Skills Training Education Results Figure 1 illustrates the thematic network from which the themes for best practice are identified. Figure 1 Characteristic n (%) Gender   Female 28 (98.3%) Male 2 (6.7%) Age (years) 20 – 29 3 (10) 30 – 39 9 (30) 40 – 49 50 – 59 7 (23.3) >60 2 (6.6)  Length of time working in ld* <than 5 years 6 - 10 years 5 (16.7) 11 - 15 years 16 - 20 years >than 20 years 4 (13.3) Areas of previous clinical experience Neurology 21 (14.9) Medical 11 (7.8) Musculoskeletal 15 (10.6) Outpatients 12 (8.5) Paediatrics Palliative care 5 (3.5) Elderly care 6 (11.3) General community Rehabilitation Respiratory Other – Mental Health; wheelchair services; private practice; Amputees 9 (6.4) Organisational Themes Global Theme Best Practice for 24-hour postural management Resources Service Delivery 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 Basic Themes 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 Aims and Objectives 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. Table 2 Summarises the rating by the panel of the themes identified best practice themes. Table 2 Theme Mean % agreement Median value Mode value P>0.05 Training and Education 94.4% 1 .276 Knowledge and Skills .679 Clinical Practice .458 Resources .516 Service Delivery 92.6% .236 Partnership References Method [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 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. Participants A purposive non probability sample of physiotherapists s used to recruit members from the Association of Chartered Physiotherapists for People with a Learning Disability (ACPPLD). Ethics Ethical approval was obtained from Teesside University Contact details Jenny Tinkler, Clinical Specialist, Tees Esk and Wear Valleys NHS Foundation Trust. Email: jennytinkler@nhs.net