Are You Trendy? survey of Pediatric Physical Therapists on Current Practice for Children with Spina Bifida

Purpose/Hypothesis: The purpose of this study was to gain an understanding of contemporary physical therapist practice for children with spina bifida (SB).

Number of Subjects: 217 physical therapists (PTs)

Materials/Methods: Over 600 pediatric PTs across the nation were sent an online survey. A survey link was posted in the APTA Pediatrics monthly newsletter for 6 months. PTs were asked to identify impairments, activity limitations, participation restrictions, outcome measures, treatment interventions and the characteristics that impact treatment effectiveness in pediatric clients with SB. Content analysis was used to examine PT answers to the survey questions. Two researchers performed independent open coding. To expand trustworthiness, a third researcher reviewed the codes and categories. All three researchers met regularly to discuss each question until strong consensus was reached. The International Classification of Functioning, Disability and Health (ICF) model was used as a framework for codes and categories.

Results: Respondents were from 32 states and various practice settings. PT experience ranged from 1 to 48 years with 41 Board-Certified Clinical Specialists in Pediatric Physical Therapy. The primary area of practice was outpatient hospital or private practice (51.98%). Six categories were identified for the coded data: Assessments, Impairments, Activity limitations, Participation restrictions, Interventions, and Contextual Factors.

PTs identified 33 assessment tools or outcome measures that assessed body functions and structures (25.12%), activities (73.49%), and participation (10.7%). Of the 24 impairments at the body functions and structures level, the most common were decreased strength (17.92%), impaired balance (17.69%), and decreased range of motion (15.33%). Out of 16 activity limitations, impaired ambulation (22.51%) was the most reported. For 19 participation restrictions, the most reported was limited socializing / playing with peers or siblings (22.59%). For 26 interventions documented, strength training (13.17%) and gait training (10.49%) were most frequent. One intervention theme emerged from open-ended questions: PTs have knowledge about evidence-based treatment for children with SB, but feel limited by barriers such as access, cost, reimbursement, and caregiver burden. Overwhelmingly, PTs reported better outcomes in their patients who had consistent family compliance and carryover of a home program.

Conclusions: A variety of assessment and intervention techniques for children with SB are used by PTs. The psychometric properties of the 4 most common assessments have not been established for the SB population. For the top 5 most common interventions, 4 focused on the activity domain. More evidence is needed to support PT trends in the assessment and treatment of children with SB. A clinical practice guideline may assist PTs in choosing the most appropriate outcome measures and interventions for children with SB.

Clinical Relevance: This study provides PTs with an understanding of contemporary practice for children with SB, including the outcome measures and interventions currently used in this population.