HEALTH PROFESSIONALS’, CHILDREN’ AND FAMILIES’ VIEWS OF THE IMPORTANCE OF OUTCOMES OF LOWER LIMB ORTHOPAEDIC INTERVENTIONS: A QUALITATIVE STUDY

H. Almoajil1,2, H. Dawes3, S. Hopewell4, F. Toye5, T. Theologis1,6
1University of Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, 2Imam Abdulrahman Bin Faisal University, Department of Physical Therapy, College of Applied Medical Science, Dammam, Saudi Arabia, 3Oxford Brookes University, Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford, United Kingdom, 4University of Oxford, Centre of Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford, United Kingdom, 5Oxford University Hospitals NHS Foundation Trust, Physiotherapy Research Unit, Nuffield Orthopaedic Centre, Oxford, United Kingdom, 6Oxford University Hospitals NHS Foundation Trust, Nuffield Orthopaedic Centre, Oxford, United Kingdom

Background: Lower limb orthopaedic interventions, such as surgery or physiotherapy rehabilitation, for ambulant children with cerebral palsy (CP) can lead to substantial improvements in motor function. However, although several outcomes are commonly measured, these outcomes do not always capture the perspective of diverse stakeholders. For example, what are the expectations and needs of children and their families’ and how do these compare with surgeons and therapists. Qualitative research can enhance our knowledge on perspectives of the different stakeholders involved in these interventions and facilitate core outcome set development.

Purpose: This study aimed to explore the views of different stakeholders on important outcomes of orthopaedic interventions. This knowledge will contribute towards the development of a core outcome set for ambulant children with CP.

Methods: Semi-structured interviews were conducted with 10 healthcare professionals, and 10 children with CP and their parents. Interviews were supported by an interview guide and ‘talking mat’ picture cards aimed to facilitate conversation with younger children. All interviews took place within the UK. Interviews were carried out face-to-face or online. Content analysis was used to explore the outcome priorities of different stakeholders. The outcomes identified in the interviews were mapped to the International Classification of Functioning-Children and Youth (ICF-CY). The ICF linking rules were used alongside inductive thematic analysis.

Results: A comprehensive, deductive and inductively derived list of 48 outcomes. Four themes supported the ICF-CY framework were developed exploring what aspects of surgical and rehabilitation are most important, including Body Function and Structure, Activity and Participation. It also includes Environmental Factors and Personal Factors that may play an important role in shaping participants expectations. Two additional themes were developed concerning Quality of Life and Adverse Events outcomes. The healthcare professionals focused on quality of life outcomes, aesthetic, pain and walking ability, whereas the children and parents interviewed discussed pain, outcomes related to mobility, walking, social life and being independent.
The findings also highlight a divergence between the outcomes reported by participant group (i.e., healthcare professionals, children and parents). For instance, incidence of fall and balance was perceived to be an important outcome merely for patients and parents.

Conclusion(s): This study is valuable as it will help ensure that outcome reflects the experiences of those living with CP or caring for a child with CP, which can be used to assess lower limb orthopaedic interventions routinely and in trials. Although both stakeholders’ group described many of the same areas of functioning, there is notable differences in how these groups prioritise outcomes perspective and construct, which will be contribute in the development of a core outcome set in this field.

Implications:
  • Offer insight to healthcare professionals (clinicians and researchers) on the aspects of care that matter most to children and parents
  • Lead to improvements in clinical practice through relevant outcome measurement
  • Contribute towards the development of a core outcome set for ambulant children with CP

Funding, acknowledgements: Imam Abdulrahman Bin Faisal University, Saudi Arabia
Oxford Medical Research Centre
Elizabeth Casson Trust
NIHR Oxford Health
Biomedical Research Centre

Keywords: Cerebral palsy, Qualitative, Lower limb

Topic: Paediatrics

Did this work require ethics approval? Yes
Institution: University of Oxford
Committee: Oxfordshire Research Ethics Committee B
Ethics number: REC reference 19/SC/0357


All authors, affiliations and abstracts have been published as submitted.

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