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문제 정의
- This study is online survey to professionals in the pediatric rehabilitation in Korea about clinical application of CIMT in children with hemiplegic cerebral palsy. Although CIMT has been recommended by many national clinical guidelines and has been advocated by the largest CIMT study performed to date, the findings of the present study suggest that many physiatrists and therapists (41.
제안 방법
- The questionnare was based on a modification of previously published surveys (Eliasson et al., 2014; Page et al., 2002; Pedlow et al., 2014) and comprised 5 sections: background information (3 questions), CP care (3 questions), knowledge of CIMT (3 question), application of CIMT in practice (6 questions), and challenges for CIMT implementation (9 questions). Questions included a mixture of open, closed, and response choice questions, and the questionnaire was designed such that none of the questions could be missed.
- In order to organize the survey items in a professional and objective way, two physiatrists and one occupational therapists, who have more than 10 years of experience in pediatric rehabilitation at training hospital, were reviewed the questionnaire. Appendix includes a copy of the questionnaire.
- Google survey, an online survey tool, was used to ensure easy distribution via e-mail. The questionnaire was designed such that only those who read the participant information sheet and met the inclusion criteria could complete the questionnaire.
대상 데이터
- This study was online survey to the members of academic association regardless their locations in Korea. E-mails were sent to a total of 510 members (204 physiatrists and 306 therapists) of the Korean Society of Pediatric Rehabilitation and Developmental Medicine (KSPRDM). The KSPRDM is an academic association of professionals who work with children with disabilities in South Korea.
- A total of 179 questionnaires were completed by 39 physiatrists, 89 physiotherapists, 48 occupational therapists, and 3 speech therapists. The response rate was 35.
데이터처리
- Aggregated data were used for frequencies of physiatrist, physiotherapist and occupational therapist responses. Chi-square calculations were conducted to test for correlation.
성능/효과
- 1% (n=104) of the responders had used CIMT. Experienced responders who were asked about the common indications of CIMT in CP via a multiple choice question, answered that good patient compliance (73.1%, n=76), good caregiver compliance (48.1%, n=50), and limited effect with bimanual training (39.4%, n=41) were important.
- The CIMT protocols used included modified CIMT (52.5%, n=53), forced use therapy (44.6%, n=45), and CIMT (28.7%, n=29), whereas the common components included task practice (86.4%, n=89), home skills assignment (58.3%, n=60), and constraint (39.8%, n=41). The training environments were the rehabilitation facility for 90.
- The major limitations of clinical application included limited staff in the rehabilitation facility and an inappropriate clinical setting (35.1%, n=61), lack of understanding by physiatrists and therapists (19.5%, n=34), and developmental issues of function on the unaffected side during constraint application (13.8%, n=24) (Fig. 2).
- In the tools of assessment and measurement, the Quality of Upper Extremity Skills Test (QUEST, 19.4%, n=47), Jebsen-Taylor Test of Hand Function (15.2%, n=37), Manual Ability Classification System (MACS, 14.4%, n=35), Pediatric Motor Activity Log (PMAL, 12.4%, n=30) and Assessment of Motor and Process Skills (AMPS, 7.2%, n=18) were the common clinical outcome measures of CIMT (Fig. 3).
- In our results, major tools of assessment and measurement were Quality of Upper Extremity Test (QUEST), Jebsen-Taylor Test of Hand Function, Manual Ability Classification System (MACS), Pediatric Motor Activity Log (PMAL) and Assessment of Motor and Process Skills (AMPS). It revealed the similar tendency with tools used in the previous clinical studies (Chiu et al.
- First, the low response rate and the relatively small sample size could limit the external validity of the results. Second, it could not demonstrate whether the opinions are represented with general consensus of Korean professionals in the pediatric rehabilitation area because the regional distribution of respondents was not identified. However, this study has academic value as the first online survey to investigate the current status of the recognition and clinical practice of CIMT in hemiplegic cerebral palsy in Korea.
후속연구
- Importantly, this limits the confidence through which CIMT model can be chosen for implementation in clinical practice in children with hemiplegic cerebral palsy. Therefore it is necessary to assess what is the current issues of CIMT in children with hemiplegic CP and identify the gaps in the current knowledge and limitations in practice that need to be addressed to advance this area of pediatric rehabilitation. Several survey to demonstrate the current status of clinical application of CIMT in children with cerebral ppalsy in other countries (Eliasson et al.
- , 2018). Further study is necessary to confirm safety and effectiveness of baby-CIMT including developmetal issues on unaffected side and investigate the optimal age of CIMT application.
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