Development of a consensus classification of physiotherapy interventions in paediatric neurorehabilitation

David Young, Rob Forsyth, Kathryn Mares

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Background and Aims: Physiotherapy within paediatric neurorehabilitation is a complex process whereby the relationship between treatments delivered and resultant severity-adjusted patient outcomes have been difficult to demonstrate. An essential prerequisite for analysing physiotherapy input at the point of its delivery to the patient is to have clear descriptions and categories of physiotherapy interventions. Recent work in this area has focussed on grouping treatments based on their common essential ingredients. The aim of this work is to develop an expert-lead consensus classification of physiotherapy interventions used in paediatric neurorehabilitation, categorised according to their essential ingredients, actions and mediators. 
Method: Comprehensive literature searches of five electronic databases (MEDLINE, EMBASE, AMED, CINAHL and PsychINFO) together with supplementary hand searching identified 4,194 studies which were separated into 34 different interventions following cross-referencing with other sources. These were then divided into eight distinct categories according to their essential treatment ingredients. A panel of 13 expert physiotherapists specialising in the field of paediatric neurorehabilitation were consulted in two rounds of an online modified-Delphi survey (a method commonly used to glean expert consensus).
Results: In modified-Delphi survey rounds 1 and 2 respectively, eight (62%) and nine (69%) of the experts responded. Utilising a threshold of ≥75% agreement set a priori to represent expert consensus, there was agreement that the eight categories are comprehensive (complete) and unambiguous (easily understood). What remains less clear is the extent to which these categories are independent of one another. 
Discussion: This categorisation of physiotherapy interventions within paediatric neurorehabilitation is the first of its kind to group treatments according to their essential treatment ingredients. Such work adds the potential for gleaning greater understanding regarding how physiotherapy leads to improved patient outcomes within paediatric neurorehabilitation. Further work is required in this area to better understand the extent to which different categories are truly independent or where similarities exist between them. 
Original languageEnglish
Pages (from-to)4-19
Number of pages16
JournalAssociation of Paediatric Chartered Physiotherapists Journal
Issue number2
Publication statusPublished - 23 Dec 2019

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