Interventions to Improve or Maintain Lower-Limb Function Among Ambulatory Adolescents with Cerebral Palsy: A Cross-Sectional Survey of Current Practice in the UK

Figures & data

Table 1. Description of participants in the nominal group technique.

Participant	Experience as a pediatric physiotherapist (yr)	Settings participant worked in as pediatric physiotherapist	Setting participant currently works in as pediatric physiotherapist	Proportion of clients on current caseload who are adolescents with cerebral palsy (%)
1	5 to 8	Inpatient, acuteInpatient, rehabilitationCommunity, rehabilitationOutpatient, rehabilitation	Community, rehabilitation	0
2	> 8	Inpatient, acuteCommunity, rehabilitation	Community, rehabilitation	0
3	0 to 2	Community, rehabilitationOutpatient, rehabilitation	Community, rehabilitation	1 to 25
4	> 8	Inpatient, rehabilitationCommunity, rehabilitation	Community, rehabilitation	26 to 50
5	> 8	Community, rehabilitation	Community, rehabilitation	1 to 25
6	0 to 2	Community, rehabilitationInpatient, acute	Community, rehabilitation	1 to 25
		Outpatient, rehabilitation	Special needs school
7	0 to 2	Community, rehabilitationSpecial needs school	Community, rehabilitation	1 to 25
			Special needs school
8	5 to 8	Community, rehabilitationOutpatient, rehabilitationSpecial needs school	Outpatient, rehabilitation	0
9	> 8	Community, rehabilitationInpatient, acute	Community, rehabilitation	1 to 25
			Special needs school
10	0 to 2	Community, rehabilitation	Inpatient, acute	1 to 25
		Outpatient, rehabilitationInpatient, acute	Outpatient, rehabilitation

Table 2. Description of interventions identified by focus group.

Intervention	Description	To access further information
Rebound Therapy	Therapeutic use of the trampoline	Rebound Therapy Association of Chartered Physiotherapists (2007) “Safe Practice in Rebound Therapy.” Retrieved from http://www.csp.org.uk/sites/files/csp/secure/safe_practice_in_rebound_therapy_01_10_16_0.pdf (Accessed 19 April 2017).
		Smith, S. and Cook, D. (1990) A Study in the Use of Rebound Therapy for Adults with Special Needs. Physiotherapy, 76 (11), pp. 734–735.
MOVE programme	An activity-based programme combining therapy with an instructional process designed to help the individual acquire motor skills	MOVE International. What is MOVE? Retrieved from http://www.move-international.org/what-is-move/
Postural management	A planned approach to support good posture, usually throughout a 24-hour period, that is tailored specifically to the individual and may include specialist equipment (e.g., special seating, standing frames, orthotics) exercise and therapy.	Enable Ireland. Guide to postural management. Retrieved from http://www.enableireland.ie/sites/default/files/publication/Guide%20to%20Postural%20Management.pdf (Accessed 19 April 2017).NICE (2016) Clinical guideline 145; Spasticity in under 19s: management. Available at: nice.org.uk/guidance/cg145 (Accessed 19 April 2017).
Lycra	Lycra splints or suits consist of sections of lycra stitched together using specific tensions and directions of pull.	Healthcare Improvement Scotland (2005) Dynamic lycra splinting for children with cerebral palsy: evidence note 11. Retrieved from http://www.healthcareimprovementscotland.org/our_work/technologies_and_medicines/earlier_evidence_notes/evidence_note_11.aspx (Accessed 19 April 2017).

Table 3. Demographic and professional characteristics of participants (n = 135).

Characteristic		n (%)
Age (yr)	20 to 30	15 (11)
	31 to 40	47 (35)
	41 to 50	32 (24)
	51 to 60	33 (24)
	≥ 61	8 (6)
Settings (previously worked in)	Inpatient, acute	88 (65)
	Inpatient, rehabilitation	68 (50)
	Community, rehabilitation	127 (94)
	Outpatient, rehabilitation	69 (51)
	Special needs school	117 (87)
	Other	23 (17)
Sector (currently working in)	Private	19 (14)
	NHS	96 (71)
	Both private and NHS	11 (8)
	Other	9 (7)
Settings (currently working in)	Inpatient, rehabilitation	88 (65)
	Community, rehabilitation	108 (80)
	Outpatient, rehabilitation	34 (25)
	Special needs school	69 (51)
	Other	15 (11)
Region of the UK (currently working in)	East Anglia	16 (12)
	Kent	6 (4)
	London	21 (16)
	Manchester	2 (2)
	Merseyside	3 (2)
	Northern Ireland	2 (2)
	North Trent	1 (1)
	Oxford	1 (1)
	Scotland	16 (12)
	South West	17 (13)
	Surrey and border	3 (2)
	Sussex	2 (2)
	Wales	2 (2)
	West Midlands	11 (8)
	Yorkshire	12 (9)
	Other	18 (13)

Table 4. Percentage of participants reporting that they used the following interventions frequently, sometimes, rarely, never, and at least once in the past year (for interventions where more than 50% of participants reported using each intervention frequently).

Intervention	n	Frequently	Sometimes	Rarely	Never	At least once^1
Provision of explanations to child	134	90%	7%	2%	1%	99%
Liaison with families	135	90%	8%	2%	1%	99%
Liaison with health professionals	134	86%	9%	4%	1%	99%
Advice to school	134	79%	16%	4%	1%	99%
Flexibility exercises/stretching	130	76%	16%	6%	2%	98%
Core stability exercises	134	75%	15%	8%	2%	98%
Muscle strengthening exercises	133	74%	20%	4%	2%	98%
Provision of orthotics or splints	133	72%	22%	5%	1%	99%
Functional activities	134	72%	19%	7%	2%	98%
Self-management strategies	132	67%	21%	9%	3%	97%
Postural management	133	62%	19%	16%	4%	96%
Equipment advice and provision	134	62%	22%	13%	3%	97%
Encourage to use community resources and access sporting activities	134	60%	25%	13%	2%	98%

¹ Calculated as the sum of percentages in frequently, sometimes, and rarely for each intervention.

Table 5. Percentage of participants reporting that they used the following interventions frequently, sometimes, rarely, never, and at least once in the past year (for interventions where less than 50% of participants reported using each intervention frequently).

Intervention	n	Frequently	Sometimes	Rarely	Never	At least once^1
Gait training	133	47%	31%	17%	5%	95%
School assessments	130	43%	31%	20%	6%	94%
Provision of mobility aids	132	42%	30%	23%	5%	95%
Night time positioning	131	39%	24%	23%	14%	86%
Neurodevelopmental therapy	131	39%	21%	21%	19%	81%
Specialist seating	131	36%	26%	21%	17%	83%
Resistance training with body weight	128	31%	31%	17%	22%	78%
Physical education adaptations	127	29%	42%	17%	12%	88%
Hydrotherapy	129	27%	19%	28%	25%	75%
Cardiovascular exercise with gym equipment	129	25%	19%	32%	24%	76%
Muscle endurance exercise with gym equipment	130	18%	19%	29%	34%	66%
Muscle strengthening exercise with gym equipment	128	18%	23%	29%	30%	70%
Lycra	132	17%	32%	29%	22%	78%
Resistance training with free weights or resistance bands	127	14%	22%	24%	40%	60%
Botulinum toxin	131	12%	35%	34%	19%	81%
Serial casting	132	12%	22%	42%	24%	76%
Advice on weight management	131	10%	30%	44%	16%	84%
Rebound therapy	123	10%	9%	10%	71%	29%
Pilates	125	10%	16%	20%	54%	46%
Treadmill training	127	8%	11%	20%	61%	39%
Disability horse riding	128	8%	13%	20%	59%	41%
Taping	130	4%	12%	24%	60%	40%
MOVE programme	124	4%	5%	6%	85%	15%
Functional electrical stimulation	124	2%	2%	13%	82%	18%
Conductive education	125	2%	5%	5%	88%	12%
Body-weight supported treadmill training	125	2%	7%	11%	80%	20%

¹Calculated as the sum of percentages in frequently, sometimes, and rarely for each intervention.

Table 6. Percentage of participants, working in private practice and the NHS respectively, reporting that they used the following interventions frequently, sometimes, rarely, and never in the past year.

	Private practice (n = 19)					NHS (n = 96)
	n	Frequently	Sometimes	Rarely	Never	n	Frequently	Sometimes	Rarely	Never
Cardiovascular exercise with gym equipment	19	42.1%	31.6%	5.3%	21.1%	90	17.8%	17.8%	38.9%	25.6%
Muscle strengthening exercises with gym equipment	17	35.3%	29.4%	5.9%	29.4%	91	12.1%	20.9%	36.3%	30.8%
Resistance training with free weights or resistance bands	17	29.4%	41.2%	5.9%	23.5%	91	8.8%	18.7%	28.6%	44.0%
Pilates	16	12.5%	43.8%	18.8%	25.0%	90	7.8%	11.1%	21.1%	60.0%
Treadmill training	17	17.6%	29.4%	23.5%	29.4%	90	3.3%	8.9%	21.1%	66.7%
Conductive education	17	5.9%	5.9%	11.8%	76.5%	89	0%	1.1%	3.4%	95.5%
Serial casting	19	0%	0%	57.9%	42.1%	93	15.1%	25.8%	37.6%	21.5%
Taping	18	22.2%	16.7%	33.3%	27.8%	93	1.1%	10.8%	19.4%	68.8%
Advice on weight management	17	35.3%	23.5%	41.2%	0%	95	6.3%	27.4%	46.3%	20.0%