Development of a tool to guide clinical decision making in the management of physical function in ambulant adults with cerebral palsy

Abstract

The health disorders experienced by adults ageing with cerebral palsy (CP) are unique and differ from those encountered in the general population and in those ageing with acquired disability. This study aimed to design a clinical decision making tool to enhance person-centred care in the primary care sector for adults with CP. Using participatory action research methodology, fifteen practitioners from a range of health disciplines were interviewed regarding the management of ambulant adults with CP. Thematic analysis of interview transcripts enabled generation of a flow chart and assessment/intervention table to guide management. Recommendations were supported with available evidence. Stakeholder review (three adults with CP) of the pilot version was sought. Issues, prompting questions, suggested options for management, possible outcome measures, suggested referrals and level of evidence were included as key elements of the tool. Seventeen health issues were identified, with particular emphasis on the need to implement strategies to proactively manage mobility decline and falls. A clinical decision making tool to assist the management of ambulant adults with CP by primary care practitioners was developed. It prompts practitioners to consider both acute care issues and health promotion aspects of physical function, mobility and falls prevention. Utility may be enhanced by an electronic version of the tool.