Mohammed Meeran RA1, Pandyan AD2, Ashford S3,4, Clark T5, Montesinos Ruiz M6, Hoffman K7, Long D8, Playford D9,10
1Holy Cross Hospital, Physiotherapy, Haslemere, United Kingdom, 2Keele University, School of Health and Rehabilitation, Keele, United Kingdom, 3King’s College, Department of Palliative Care, Policy and Rehabilitation, London, United Kingdom, 4Northwick Park Hospital, Regional Hyper-acute Rehabilitation Unit,, London, United Kingdom, 5Royal Hospital for Neurodisability, Physiotherapy, London, United Kingdom, 6Royal Hospital for Neurodisability, London, United Kingdom, 7Royal London Hospital, Barts health NHS trust. & Queen Mary’s University, Occupational Therapy, London, United Kingdom, 8Posture and Mobility Group, Exeter, United Kingdom, 9Warwick University, Warwick, United Kingdom, 10Leamington Spa Hospital, Central England Rehabilitation Unit, Warwick, United Kingdom
Background: Advances in medical sciences and technology have allowed more severely impaired people to survive, leading to an increase in the number of people with a Disorder Of Consciousness (DOC) (Royal College of Physicians, 2013). Disorders of consciousness are a group of disorders where the patients have no or very limited levels of consciousness. A patient in a Vegetative state (VS) or Minimally Conscious State (MCS) will be considered to be with a disorder of consciousness.
The main role of rehabilitation for this client group is to maximise the potential for recovery, maintain their present physical status and to prevent deterioration (Andrews 2005).This is crucial as survival rates in DOC patients are increasing and as a result the long-term cost burden to both the State and/ or an individual will increase (current estimated cost for managing these patients vary from £100,000 to £200,000 / year depending on level of complications).
Purpose: These guidelines have, as a main focus, 24-hr posture management. The practice guidelines will signpost clinicians to other treatment guidelines that are already available in the UK (e.g. COT and ACPIN Splinting Guidelines (2015), Spasticity in adults using Botulinum Toxin guideline (RCP, 2018). The guidelines recommendations are expected to promote best practice in the use of physical management interventions (Contracture, Spasticity and 24-hour Posture management) in adults with a Disorder of Consciousness.
Methods: A Guideline Development Group (GDG) was formed with eight experienced clinicians and academics from varied backgrounds.
A literature scoping review was completed prior to arranging two consensus development meetings with a large group (25 for first meeting and 50 for the second) experienced clinicians and academics.
The project was publicised through professional forums to increase awareness and participation.
In addition to gaining consensus on various topics, professionals shared knowledge (assessment and treatment protocols used in their units) at the first consensus meeting
The literature scoping review and consensus discussions were used by the GDG to prepare drafts of the guideline.
Results: The Guideline drafts were circulated within the GDG and the final draft will be shared with a large group of 50 professionals attending the second consensus meeting in October 2018. Upon obtaining consensus on the recommendations and other content of the document, professional organisations will be approached to secure endorsements before publication.
Conclusion(s): The scarcity of literature related to physical management of people with a DOC was highlighted in the scoping review. It was encouraging to note that there was good consensus among clinicians on what physical management interventions were provided to DOC patients. This guideline will provide a benchmark of how frequently patients in DOC need to be assessed/monitored and treatments suggested as part of their physical management.
Implications: The development of this guideline is expected to result in improved clinical practice in the treatment of DOC patients, who usually need monitoring and treatment for very long periods, often decades. The guideline will be reviewed at regular intervals to ensure latest evidence base is appropriately highlighted in the recommendations.
Keywords: Disorder of consciousness, physical management, practice guidance
Funding acknowledgements: This project was funded by Holy Cross Hospital and Brain Injury is BIG charities.
The main role of rehabilitation for this client group is to maximise the potential for recovery, maintain their present physical status and to prevent deterioration (Andrews 2005).This is crucial as survival rates in DOC patients are increasing and as a result the long-term cost burden to both the State and/ or an individual will increase (current estimated cost for managing these patients vary from £100,000 to £200,000 / year depending on level of complications).
Purpose: These guidelines have, as a main focus, 24-hr posture management. The practice guidelines will signpost clinicians to other treatment guidelines that are already available in the UK (e.g. COT and ACPIN Splinting Guidelines (2015), Spasticity in adults using Botulinum Toxin guideline (RCP, 2018). The guidelines recommendations are expected to promote best practice in the use of physical management interventions (Contracture, Spasticity and 24-hour Posture management) in adults with a Disorder of Consciousness.
Methods: A Guideline Development Group (GDG) was formed with eight experienced clinicians and academics from varied backgrounds.
A literature scoping review was completed prior to arranging two consensus development meetings with a large group (25 for first meeting and 50 for the second) experienced clinicians and academics.
The project was publicised through professional forums to increase awareness and participation.
In addition to gaining consensus on various topics, professionals shared knowledge (assessment and treatment protocols used in their units) at the first consensus meeting
The literature scoping review and consensus discussions were used by the GDG to prepare drafts of the guideline.
Results: The Guideline drafts were circulated within the GDG and the final draft will be shared with a large group of 50 professionals attending the second consensus meeting in October 2018. Upon obtaining consensus on the recommendations and other content of the document, professional organisations will be approached to secure endorsements before publication.
Conclusion(s): The scarcity of literature related to physical management of people with a DOC was highlighted in the scoping review. It was encouraging to note that there was good consensus among clinicians on what physical management interventions were provided to DOC patients. This guideline will provide a benchmark of how frequently patients in DOC need to be assessed/monitored and treatments suggested as part of their physical management.
Implications: The development of this guideline is expected to result in improved clinical practice in the treatment of DOC patients, who usually need monitoring and treatment for very long periods, often decades. The guideline will be reviewed at regular intervals to ensure latest evidence base is appropriately highlighted in the recommendations.
Keywords: Disorder of consciousness, physical management, practice guidance
Funding acknowledgements: This project was funded by Holy Cross Hospital and Brain Injury is BIG charities.
Topic: Neurology; Disability & rehabilitation
Ethics approval required: No
Institution: Holy Cross Hospital
Ethics committee: Holy Cross Hospital Ethics committee
Reason not required: This is a Systematic review and guideline development project
All authors, affiliations and abstracts have been published as submitted.
