PMID- 24631275 OWN - NLM STAT- MEDLINE DCOM- 20141118 LR - 20140331 IS - 1873-3379 (Electronic) IS - 0891-4222 (Linking) VI - 35 IP - 5 DP - 2014 May TI - A clinical decision framework for the identification of main problems and treatment goals for ambulant children with bilateral spastic cerebral palsy. PG - 1160-76 LID - S0891-4222(14)00039-0 [pii] LID - 10.1016/j.ridd.2014.01.025 [doi] AB - The primary aim of the study was to investigate how a clinical decision process based on the International Classification of Function, Disability and Health (ICF) and the Hypothesis-Oriented Algorithm for Clinicians (HOAC-II) can contribute to a reliable identification of main problems in ambulant children with cerebral palsy (CP). As a secondary aim, to evaluate how the additional information from three-dimensional gait analysis (3DGA) can influence the reliability. Twenty-two physical therapists individually defined the main problems and specific goals of eight children with bilateral spastic CP. In four children, the results of 3DGA were provided additionally to the results of the clinical examination and the GMFM-88 (gross motor function measure-88). Frequency analysis was used to evaluate the selected main problems and goals. For the main problems, pair-wise agreement was calculated by the number of corresponding problems between the different therapists and using positive and negative agreement per problem. Cluster analysis using Ward's method was used to evaluate correspondence between the main problems and specific goals. The pair-wise agreement revealed frequencies of 47%, 32% and 3% for the identification of one, two or three corresponding main problems. The number of corresponding main problems was higher when additional information of 3DGA was provided. Most of the specific goals were targeting strength (34%), followed by range of motion (15.2%) and GMFM-D (11.8%). In 29.7% of the cases, therapists could not prioritize and exceeded the number of eight specific goals. Cluster analysis revealed a logic connection between the selection of strength as a main problem and as specific goal parameters. Alignment as a main problem was very often associated with specific parameters like ROM and muscle length and with hypertonia as a main problem. The results show a moderate agreement for the selection of main problems. Therapists are able to use the proposed model for a logic and structured clinical reasoning. Setting priorities in the definition of specific goals is revealed as a remaining difficulty. Further research is required to investigate the additional value of 3DGA and to improve priority setting. CI - Copyright (c) 2014 Elsevier Ltd. All rights reserved. FAU - Franki, Inge AU - Franki I AD - Ghent University, Rehabilitation Sciences and Physiotherapy, Belgium; KU-Leuven, Department of Rehabilitation Sciences, Belgium. Electronic address: inge.franki@ugent.be. FAU - De Cat, Josse AU - De Cat J AD - University Hospital Pellenberg (UZ Leuven), Clinical Motion Analysis Laboratory, Belgium; KU-Leuven, Department of Rehabilitation Sciences, Belgium. FAU - Deschepper, Ellen AU - Deschepper E AD - Ghent University, Department of Public Health, Biostatistics Unit, Belgium. FAU - Molenaers, Guy AU - Molenaers G AD - University Hospital Pellenberg (UZ Leuven), Clinical Motion Analysis Laboratory, Belgium; KU-Leuven, Department of Paediatric Orthopaedics, Belgium. FAU - Desloovere, Kaat AU - Desloovere K AD - University Hospital Pellenberg (UZ Leuven), Clinical Motion Analysis Laboratory, Belgium; KU-Leuven, Department of Rehabilitation Sciences, Belgium. FAU - Himpens, Eveline AU - Himpens E AD - Ghent University, Rehabilitation Sciences and Physiotherapy, Belgium. FAU - Vanderstraeten, Guy AU - Vanderstraeten G AD - Ghent University, Rehabilitation Sciences and Physiotherapy, Belgium. FAU - Van den Broeck, Chris AU - Van den Broeck C AD - Ghent University, Rehabilitation Sciences and Physiotherapy, Belgium. LA - eng PT - Journal Article DEP - 20140313 PL - United States TA - Res Dev Disabil JT - Research in developmental disabilities JID - 8709782 SB - IM MH - Biomechanical Phenomena MH - Cerebral Palsy/complications/diagnosis/*rehabilitation MH - Child MH - Child, Preschool MH - Cluster Analysis MH - *Decision Support Systems, Clinical MH - Gait Disorders, Neurologic/diagnosis/etiology/*rehabilitation MH - Humans MH - *Needs Assessment MH - *Patient Care Planning MH - Physical Therapy Specialty/*methods MH - Reproducibility of Results OTO - NOTNLM OT - Cerebral palsy OT - Clinical decision OT - Clinical reasoning OT - Goal-setting OT - Physical therapy EDAT- 2014/03/19 06:00 MHDA- 2014/11/19 06:00 CRDT- 2014/03/18 06:00 PHST- 2013/11/21 00:00 [received] PHST- 2014/01/15 00:00 [revised] PHST- 2014/01/24 00:00 [accepted] PHST- 2014/03/18 06:00 [entrez] PHST- 2014/03/19 06:00 [pubmed] PHST- 2014/11/19 06:00 [medline] AID - S0891-4222(14)00039-0 [pii] AID - 10.1016/j.ridd.2014.01.025 [doi] PST - ppublish SO - Res Dev Disabil. 2014 May;35(5):1160-76. doi: 10.1016/j.ridd.2014.01.025. Epub 2014 Mar 13.