Australian pediatricians and physiotherapists said sharing skills and good communication between multidisciplinary clinical teams is essential to improve diagnosis and manage hip displacement in children with cerebral palsy.
The study, “Health professionals’ experiences and barriers encountered when implementing hip surveillance for children with cerebral palsy,” was published in the Journal of Pediatrics and Child Health.
Hip displacement is common in young people with cerebral palsy, with studies reporting rates as high as 35 percent. If left undetected, it can progress to a severe state marked by pain and lead to difficulties with positioning, sitting, standing, and walking, and negatively impact quality of life.
Population-based hip surveillance programs have resulted in a significant reduction in the incidence of hip dislocation through active screening, detection of hip displacement, and appropriate surgical interventions.
Additional evidence also supports the benefits of hip surveillance for achieving better hip morphology in young adults with cerebral palsy and an associated decrease in hip pain.
Hip surveillance clinical guidelines
Although health professionals recognize the importance of hip surveillance, some remain unaware of clinical guidelines.
To help establish a statewide model for hip surveillance, researchers surveyed clinicians in Victoria, Australia, who work with young people who have cerebral palsy.
The survey included a total of 84 health professionals — 32 pediatricians, two rehabilitation specialists, and 50 physiotherapists — about their experience working with cerebral palsy children.
Most respondents (80 percent) were aware of the national hip surveillance guidelines and reported confidence (varying from moderate to high) in using the guidelines to determine the frequency for hip surveillance in cerebral palsy children. But a fraction of those survey remained unaware of the existence of clinical guidelines.
Respondents were comfortable and confident using the Gross Motor Function Classification System (GMFCS) to evaluate children’s movement capacity — a five-level clinical classification system that describes the gross motor function of cerebral palsy patients on the basis of self-initiated movement abilities.
Pediatricians were less confident than physiotherapists in identifying gait impairments (difficulties with walking) using the Winters Gage and Hicks (WGH) tool, a gait classification system developed for children with spastic hemiplegia — a form of spastic cerebral palsy characterized by impairments in muscle function affecting only one side of the body.
Radiology practice inconsistencies
The larger challenge, identified by 35 percent of respondents, was the lack of consistency in radiology practices and reporting: 43 percent reported directly referring children for pelvic X-rays for hip surveillance, of which 36 percent stated they did not routinely receive a written radiology report.
And 44 percent of respondents estimated that hip analysis (assessed by the migration percentage) was reported in less than 30 percent of the radiology reports.
Additional challenges included parent engagement and lack of communication between clinicians, reported by 30 percent of the respondents; lack of clarity about who is responsible for surveillance (27 percent); and forgetfulness to undertake surveillance (reported by 26 percent).
Four major areas identified
The outcomes of the survey identified four major areas for implementing hip surveillance, starting by recognizing the importance of clinical guidelines, and the lead role of pediatricians.
There should also be a shared sense of responsibility between the multidisciplinary team of clinicians along with maintaining good communication channels to ensure awareness of a child’s surveillance status.
“Hip surveillance can be supported by using the skills of each person in the team around the child, by sharing responsibility and through good communication,” the authors added.