Abstract
BackgroundPain in children with cerebral palsy (CP) has its sources in musculoskeletal problems that can influence learning in a school setting. Best pain management is essential for these children, but school staff may not keep up to date with the latest developments and interventions. Therefore, staff’s perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions.ObjectivesThis study investigated how pain management intervention for children with CP in South African schools complied with international scientific knowledge about evidence-based interventions. The intention was to provide support for an update of knowledge on both individual level (i.e. professionals) and system level (i.e. decision makers).MethodFive focus groups were conducted with staff members at five schools for children with special educational needs in South Africa. Manifest and latent content analyses of professional statements identified interventions reported as beneficial and related them to higher and lower levels of intervention evidence as reported at the time of data collection.ResultsMost treatment strategies concerned motor functioning that fell within the framework of physiotherapists and occupational therapists. Access to orthopaedic expertise was limited, waiting times were long and medication for spasticity treatment was not offered.ConclusionA discrepancy between published evidence and clinical practice for pain management in children with CP in South African school settings was noted. Suggestions for improved early intervention to identify children’s hips at risk through surveillance programmes; and orthopaedic management are proposed to prevent deformities and unnecessary suffering in South African children with CP.
Highlights
For children with disability, it is essential to provide current and evidence-based interventions to ensure best treatment
This study, which is part of a larger project that aims to facilitate discussions about best practices (Adolfsson, Johnson & Nilsson 2018; Johnson, Nilsson & Adolfsson 2015; Nilsson, Johnson & Adolfsson 2016), explores how professionals working in South African schools for children with special educational needs perceive pain management intervention for children with cerebral palsy (CP), and how their ideas about interventions comply with knowledge about evidence-based interventions as reported by Novak et al (2013)
From one of the statements, one could understand how a child in pain might affect everyone around: Keeping mind off the pain – she will smile and relax – peers in classroom struggle to attend to their work – they feel sorry for them. (Teacher in FG4, Statement 49)
Summary
It is essential to provide current and evidence-based interventions to ensure best treatment. Professionals may find it difficult to keep up to date with the latest developments in cerebral palsy (CP) intervention because of the substantial increase of systematic reviews published on CP intervention in the last decade (Anttila et al 2008; Donald et al 2014; Novak et al 2013; Reedman, Boyd & Sakzewski 2017; Thomason & Graham 2014; Wiart, Darrah & Kembhavi 2008) Novak and her Australian colleagues reported on the state of evidence for interventions to support children with CP (Novak 2014; Novak et al 2013). Staff’s perceptions of beneficial strategies may not comply with contemporary scientific knowledge about effective evidence-based interventions
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