Clinical Tools That Measure Sitting Posture, Seated Postural Control or Functional Abilities in Children With Motor Impairments: A Systematic Review.

Clinical tools that measure sitting posture, seated postural control or functional abilities in children with motor impairments: a systematic review.

Clin Rehabil. 2013 Jul 15;
Field D, Livingstone R

Objective:To identify and critically appraise clinical measurement tools used to assess sitting posture, seated postural control or functional abilities for children with motor impairment who are candidates for seating interventions.Data sources:Searches were run in 15 electronic databases along with hand searching. The search included articles published in English to December 2011.Review methods:Key terms included: posture, sitting, sitting posture, seated posture, seated postural control, sitting position, seating, wheelchair(s), outcome and assess(ment). The PRISMA statement was followed with inclusion criteria set a priori. Two reviewers independently screened titles, reviewed abstracts and identified full-text articles that met criteria. Data extraction included tool description and clinical utility. Two quality-rating scales were used to evaluate conduct of the studies and psychometric properties of the tools.Results:Of the 497 titles found in the search, 29 full-text articles met the inclusion criteria and 19 tools were identified. Tools represented all components of the International Classification of Functioning, Disability and Health for Children and Youth (ICF-CY), with emphasis on body structure and function and activity components. Evidence supporting reliability and validity varied, with small sample sizes influencing quality ratings. Evidence of the tools’ reliability was more prevalent than evidence of the tools’ validity. Only four tools reported on responsiveness, an important consideration for evaluating change. Little information on clinical utility was provided.Conclusion:Although a number of tools are available, evidence supporting their use for seating interventions is limited, as is the evidence supporting the strength of their measurement properties. Few tools address participation, environmental factors or the child’s and family’s perspective. HubMed – rehab

A multicentre cluster-randomized controlled study to evaluate a train-the-trainer programme for implementing internal and external participation in medical rehabilitation.

Clin Rehabil. 2013 Jul 15;
Koerner M, Wirtz M, Michaelis M, Ehrhardt H, Steger AK, Zerpies E, Bengel J

Objective:Evaluation of the effect of the train-the-trainer programme ‘Fit for Shared Decision-Making’ on internal (team) and external (patient) participation in medical rehabilitation from a patient and staff perspective.Design:A multicentre, cluster-randomized controlled study.Setting:Eleven medical rehabilitation clinics, divided into intervention and control groups.Subjects:A staff and a patient survey were conducted pre- and post-intervention, plus a further patient survey six months later.Intervention:Train-the-trainer programme ‘Fit for Shared Decision-Making’ for interprofessional settings.Main measures:Each survey measured internal participation with a self-compiled six-item scale (Internal Participation Scale, IPS), and external participation by means of a nine-item Shared Decision-Making Questionnaire (SDM-Q-9) for the patients and for healthcare professionals.Results:Patient samples numbered 402 for the pre-, 463 for the post-intervention data collection period and 461 six months after the intervention. Patients’ appraisal of external participation (Fperiod x group (2) = 0.256, p=0.774, ?(2)=0.000) showed no change, whereas internal participation (Fperiod x group (2) = 3.785, p=0.023, ?(2)=0.007) showed a significant increase. A total of 195 healthcare professionals participated in the pre- and 168 in the post-intervention staff survey. Here external participation was significantly enhanced in the intervention group (Fperiod x group (1) = 4.893, p=0.028, ?(2)=0.014).Conclusions:The train-the-trainer approach can be recommended for implementing internal and external participation in interprofessional settings such as medical rehabilitation clinics. However, there is a need for more intensive staff training for internal participation and an additional intervention for patients to achieve success in all aspects. HubMed – rehab

Intrathecal baclofen in multiple sclerosis and spinal cord injury: complications and long-term dosage evolution.

Clin Rehabil. 2013 Jul 15;
Draulans N, Vermeersch K, Degraeuwe B, Meurrens T, Peers K, Nuttin B, Kiekens C

Objective:To investigate the long-term dosage evolution and complication rate of intrathecal baclofen use in multiple sclerosis and spinal cord injury patients, based on a large population with a long follow-up.Design:Retrospective data analysisSetting:Academic hospitalSubjects:Patients with multiple sclerosis (n = 81) or spinal cord injury (n = 49) having an intrathecal baclofen pump implanted at the University Hospitals Leuven between 1988 and 2009.Intervention:Medical records review of included patients in August 2010.Main measures:Complications linked to intrathecal baclofen therapy. Daily baclofen dosage after 3 and 6 months, and yearly thereafter. Data on dosage evolution were analysed using a mixed-effect linear model.Results:In 130 patients with a mean follow-up of 63 months, comprising 797 pump years, 104 complications were recorded. This corresponds to a complication rate of 0.011 per month, equally divided among both groups. Seventy-eight of these complications were catheter related. The mean dosage of baclofen stabilizes two years after implantation at 323 µg/day in the multiple sclerosis population. In spinal cord injury patients the daily dose only stabilizes after five years at a significantly higher dosage (504 µg/day). No significant increase in dosage is seen in the long term.Conclusions:In multiple sclerosis and spinal cord injury patients, intrathecal baclofen therapy has a complication rate of 1% per month. Complications are mainly due to catheter-related problems (74%). The intrathecal baclofen dosage stabilizes in the long term, indicating that long-term tolerance, defined as progressive diminution of the susceptibility to the effects of a drug, is not present. HubMed – rehab