Extent of goal setting and selection of evidence-based interventions by paediatric physiotherapists working with children with cerebral palsy in Australia

Abstract

Background: Best practice for children with cerebral palsy incorporates regular assessment using robust measures and scales, collaborative goal setting, and selection of effective interventions. The extent to which these practices are currently embedded in standard care is however unknown. Purpose(s): To establish current physiotherapeutic practice with regard to use of classification tools, goal setting, and selection of evidence-based interventions for children aged 3-18 years with cerebral palsy in Australia. Method(s): All physiotherapists working with children and young people with cerebral palsy aged 3-18 years, in five disability service providers in Australia were invited to participate in a longitudinal knowledge translation intervention study. Participants anonymously self-completed a paper-based questionnaire documenting how frequently they completed a number of evidence-based practices in their current daily practice. The questionnaire used a 5 point Likert-scale and was administered on four occasions over two years. Evidence-based practices included: use of functional classification systems, goal setting practices and selection of interventions with high levels of supporting research evidence. Descriptive statistics were used to summarise baseline outcomes. The knowledge translation study is ongoing. Result(s): Of 105 eligible physiotherapists, 82 (78.1%) completed the questionnaire at baseline. Participants mean time from graduation was 14.0 years (range 0-49 years), and clinical experience in the disability field ranged from 0-41 years (mean 10.6 years). Participants had, on average, been with their current employer 5.6 years (range 0-25 years). Seventy-seven percent of respondents reported using functional classification systems more than half of the time in their current practice. Two-thirds (67.1%), of physiotherapists reported both developing and documenting measurable goals with families, and using outcome measures to communicate results of interventions to families more than half of the time, even if goals had not been achieved (65.9%). The majority of respondents (89.0%) reported that they identified if a goal was realistic based on assessment information and prognostic evidence on more than 50% of occasions. However, only 37.8% of respondents reported checking what interventions have higher levels of supporting evidence for 50-100% of the time in their current practice, and a similar proportion reported selecting interventions with the highest level of evidence (35.4%); for 50-100% of the time in their current practice. Conclusion(s): Robust functional classification systems appear to be in common use among physiotherapists who work with young people with cerebral palsy. A discrepancy between goal setting competencies that involve families (development and feedback) versus those that are more likely the locus of the therapist (identification of realistic goals) is evident. Therapists do not typically seek research evidence when selecting interventions; this speaks to the 'research to practice gap' that has been reported in health literature. Implications: Efficient and effective practice could be enhanced by knowledge translation strategies that address family centred goal setting, clear communication around realistic goals for individual clients, and therapist engagement with research literature to support evidence-based therapeutic intervention choices.