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Perspectives on Postural Control Dysfunction to Inform Future Research: A Delphi Study for Children With Cerebral Palsy

Published:August 25, 2016DOI:https://doi.org/10.1016/j.apmr.2016.07.021

      Highlights

      • Perspectives on postural control in cerebral palsy (CP) were identified from clinicians and researchers.
      • Consensus was achieved on definitions for postural control in the context of CP.
      • Gaps in knowledge and practice were identified for frameworks, assessments, and interventions.
      • Future research priorities in postural control were identified for children with CP.

      Abstract

      Objective

      To identify whether consensus can be achieved in how clinicians and researchers define, describe, assess, and treat postural control dysfunction in children with cerebral palsy (CP).

      Design

      Delphi study with 3 iterative rounds.

      Setting

      Electronic survey.

      Participants

      Researchers and/or clinicians (N=43) from 7 countries with a mean ± SD of 20±11 years of experience working with children with CP participated. Participants included authors of published works on postural control in CP (identified from a recent systematic review), members of the Australasian Academy of CP and Developmental Medicine, and 2 major Australian rehabilitation providers.

      Interventions

      Not applicable.

      Main Outcome Measures

      The Delphi study consisted of 3 iterative rounds of surveys. In Round 1, respondents answered open-ended questions regarding their views on (1) definition items for postural control, (2) theoretical frameworks, (3) methods for assessment, and (4) interventions for postural control dysfunction in children with CP. Rounds 2 and 3 were made up of items generated by participants in Round 1 and combined with items identified from the literature. Participants indicated their level of agreement for each item on a 7-point Likert scale. Threshold for consensus was ≥85% agreement.

      Results

      Of 306 items generated, 174 reached consensus by Round 3. Most postural control definition items (90%) achieved consensus. Two theoretical frameworks (14%) reached consensus. Less than half (42%) of assessment items reached consensus. More individual assessment items (89%) reached consensus than multi-item tools (4%). Just over half (61%) of the items generated for interventions reached consensus.

      Conclusion

      Consensus was achieved for a postural control definition. However, substantial research is needed to establish a comprehensive, postural control–specific framework and suite of assessments. These would provide a foundation to improve intervention selection and dosage.

      Keywords

      List of abbreviations:

      AusACPDM (Australasian Academy of Cerebral Palsy and Developmental Medicine), CP (cerebral palsy), CPL (Cerebral Palsy League), ICF (International Classification of Functioning, Disability and Health), NHMRC (National Health and Medical Research Council)
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