Current clinical practice in 24-hour postural management and the impact on carers and service users with severe neurodisability

May Stinson,Shelley Crawford,Emma Madden

doi:10.1177/0308022620944739

May Stinson, Shelley Crawford + Show 1 more

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https://doi.org/10.1177/0308022620944739

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Abstract

Introduction The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. The aim of this research was to investigate the use of 24-hour postural management by occupational therapists and to explore its impact on service users with neurodisability and their carers. Methods Quantitative and qualitative methods were employed in two phases: (a) online survey with 96 occupational therapists across one UK region, with data analysed by descriptive statistics and correlations; (b) focus groups with service users and/or carers ( n = 9), with data analysed by thematic analysis. Results Findings showed moderate positive correlation between frequency of use and (a) all key intervention skills and (b) knowledge of night-time positioning ( p < 0.001). Moderate positive correlations were found between level of training and (a) assessment skills and (b) knowledge of night-time positioning ( p < 0.001). The overarching theme from focus groups was ‘reliance on individualised equipment’, with overwhelming frustration from lack of support, loss of identity, equipment cost, insufficient focus on preventative strategies and accessibility issues. Conclusion A clinical practice guideline, including training, is crucial to direct practice. Providers must engage with service users and carers to address their frustrations.

Highlights

The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions
Twenty-four-hour postural management is both a treatment and preventative strategy used by occupational therapists to address body positions over a 24-hour period to optimise function and minimise disability (Hutton and Coxon, 2011; McDonald and Surtees, 2007; Maher et al, 2011; Wynn and Wickham, 2009)
Phase 1 comprised an online survey investigating the current use of 24-hour postural management among occupational therapists, the healthcare professional group predominantly involved with postural management within this UK region

Summary

Introduction

The clinical benefits of 24-hour postural management are widely recognised by occupational therapists, but little is known about its impact on service users and carers or whether clinical practice is consistent across regions. Twenty-four-hour postural management is both a treatment and preventative strategy used by occupational therapists to address body positions over a 24-hour period to optimise function and minimise disability (Hutton and Coxon, 2011; McDonald and Surtees, 2007; Maher et al, 2011; Wynn and Wickham, 2009). It usually involves provision of adaptive seating and/or moulded wheelchairs, orthoses, night-time positioning equipment ( known as ‘sleep systems’), showering equipment and occasionally standing frames. Over the last 2 decades there has been increasing awareness and emphasis on the clinical importance of 24-hour postural management (Clarke et al, 2014; Goldsmith, 2000; Humphreys and Pountney, 2006; Pountney et al, 2002) to facilitate musculoskeletal alignment, function and participation in everyday life (Farley et al, 2003; Stephens et al, 2018)

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