1. 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
years
5 (16.7)
years
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.