Evidence-based assessment practices for children with cerebral palsy

Abstract

Evidence-based practice has been adopted by the healthcare sector as a framework to achieve safer, scientifically defensible and cost-effective clinical care. Consistent with this framework is an increasing expectation for healthcare professionals to be evidence-based in relation to assessment. Evidence-based assessment uses research to guide tool selection and integrates the assessment tool findings with health professional expertise and family preferences, within the context of available resources. Evidence-based assessment tools can provide objective information about a child’s capabilities, strengths and difficulties, guide goal setting and interventions, and objectively evaluate outcomes and progress over time, thereby, potentially assisting families to anticipate future resources. Many assessment tools have been developed and evaluated psychometrically for use with children who have cerebral palsy. Routine use of evidence-based assessment tools can prevent and assist with the management of secondary musculoskeletal impairments and their sequelae for children with cerebral palsy. Despite the availability, promotion and reported benefits of use of many assessment tools, the uptake of evidence-based assessment tools by paediatric therapists (occupational therapists, physiotherapists and speech pathologists) in day-to-day practice has been slow. Outcomes from knowledge translation studies to embed use based on known barriers have been modest, suggesting further investigation is needed to understand why evidence-based assessment is not easily adopted in practice. The aim of this thesis was to develop an in-depth understanding of what is needed for therapists to embed evidence-based assessment tools for children with cerebral palsy into their practice. The research to achieve this aim addressed objectives related to: 1) the published literature; 2) understanding therapists’ assessment practices in different organisational contexts; and 3) the evidence-based assessment experiences of parents of children who have cerebral palsy. Three empirical studies were completed. A systematic review investigating the extent and types of assessment tools being used by therapists for children with cerebral palsy was conducted following PRISMA guidelines in Study 1. A mixed-methods approach was taken in Study 2 to investigate therapists’ assessment behaviours in two different Australianbased organisations. Findings from Study 2 suggested further investigation of the parent perspective would be helpful to fully understand therapists’ behaviours. A scoping review of the published literature preceded a qualitative study using interpretive description to understand parents’ experiences of evidence-based assessment for their child with cerebral palsy in Study 3. The systematic review identified that only a few of the available evidence-based assessment tools were used often, and all focused on gross motor function. The mixed method approach utilised in Study 2 confirmed therapists’ low overall use of evidence-based assessment tools, however, therapists’ use varied across organisations. Therapists’ assessment tool behaviours could be categorised on a continuum that ranged from I don’t to We do. Factors related to the organisation, the assessment tool and collaboration with families were influential. The ‘Cultural Cone for Evidence-based Assessment’ framework was developed, representing the relationships among contextual influences and therapist use of evidence-based assessment. Investigation of the assessment interactions from parents’ perspectives identified protection of child identity and self was central to parents’ experience of assessment. The interpretive description—the ‘Steering Wheel for Collaborative Assessment’—that emerged from the results suggests involving parents at the start rather than the end of an evidence-based assessment process is important. This thesis explored evidence-based assessment practices through the lens of organisations, practitioners and parents. Findings suggest knowledge translation strategies that align evidence-based assessment with family-centred care and focus on how evidence-based assessment tools are used with families is needed. This proposed shift in practice may make it easier for therapists to embed evidence-based assessment tools within therapy practice.