The Design, Implementation, and Evaluation of a Physiotherapist-Led Clinic for Orthopedic Surveillance for Children with Cerebral Palsy

ABSTRACT

Aim: To describe the development process and the evaluation results of a new physiotherapy-led clinic for orthopedic monitoring of secondary impairments for children with cerebral palsy (CP). Methods: A new clinic model was developed and implemented, guided by the Framework for the Development of Advanced Practice Roles and the Model for Improvement. Patient visits and wait-time statistics were measured during the implementation phase. Once implemented, an evaluation of the clinic model objectives was conducted. The Visit Specific Satisfaction (VSQ-9) Instrument and the Measure of Processes of Care (MPOC-20) questionnaire measured parent satisfaction, while the Collaboration and Satisfaction about Care Decisions (CSACD) surveyed staff's satisfaction. Means and frequencies described the data, and the Mann–Wittney U test was used to compare the VSQ-9 and MPOC-20 scores of the physiotherapist-led and the traditional physician-led model. Results: Ninety-eight additional children were seen in 1 year. Mean wait time decreased by 930 days. No statistically significant difference was demonstrated in the VSQ-9 total score (p =.84) or any of the five MPOC-20 subscales (Enabling and Partnership: p =.55; Providing General Information: p =.99; Providing Specific Information: p =.46; Coordinated and Comprehensive Care for the Child and Family: p =.33; Respective and Supportive Care: p =.86) when the two models were compared. Physiotherapist-led clinic staff members were satisfied with physician collaboration. Conclusions: A physiotherapist-led clinic model for orthopedic monitoring provides increased access to service for children with CP and their families without compromising the perceived quality of care.

KEYWORDS:

• Cerebral palsy
• orthopedic monitoring
• physiotherapy
• program development
• program evaluation
• service delivery

Acknowledgments

We would like to sincerely thank the administration team, physicians, other clinician colleagues, and the parents and children of the Neuromotor Program at the Alberta Children's Hospital for their dedication and support throughout the design, implementation, and evaluation phase of this program. We also would like to express our appreciation to Shauna Langenberger, quality improvement consultant, for her wisdom and guidance during the project and for her assistance in reviewing this manuscript.

Declaration of Interest

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of this article. The preliminary evaluation plan was developed by Robin Shanks as part of the course requirement for RHSC 507: Developing Effective Rehabilitation Programs, Master of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada.

About the Authors

Karen Hurtubise, Reg PT, MRSc, BScPT, is a doctoral candidate at the University of Sherbrooke, Faculty of Medicine and Health Sciences, and an associate professor at the University of British Columbia, Faculty of Medicine, Department of Physical Therapy. Her research has focused on family-centered care, parent learning, and the design, implementation and evaluation rehabilitation services, using participatory approaches, to improve access for youth with chronic conditions (including cerebral palsy) and their families.

Robin Shanks, Reg PT, MSc, BScPT, is the program facilitator of the Rehabilitation and Education Day Program, at Alberta Children's Hospital, Calgary, Alberta, Canada. Robin's interests include the measurement of family-centered care practices, participation and quality of life in health and community service provision for children with chronic neurodevelopmental conditions and what relationship exists between these concepts.

Laura Benard, Reg PT, MSc, BScPT, is the unit manager for the Vi Riddell Children's Pain & Rehabilitation Centre, Alberta Children's Hospital, Calgary, Alberta, Canada. Her research has focused on the effectiveness of spasticity interventions for children with cerebral palsy and the development of care pathways to improve the efficiency of medical, pharmaceutical, and surgical management for this population.