Supports and barriers to implementation of routine clinical assessment for children with cerebral palsy: A mixed-methods study

Purpose: The purpose of this study is to investigate supports and barriers to evidence-based routine clinical assessment of children with cerebral palsy. Method: This mixed methods study included physiotherapists, occupational therapists and speech pathologists providing services to children with cerebral palsy (3–18 years) within five organizations across Australia. Four organizations initiated standardized routine clinical data collection (Commencing organizations), and one had previously mandated routine assessment (Comparison organization). Participants completed the Supports and Barriers Questionnaire (n = 227) and participated in focus groups (n = 8 groups, 37 participants). Quantitative data were summarized descriptively, qualitative data were analyzed thematically and comparisons between organizations assessed. Results: Organizational structures, resources, therapists within organizations, assessment tools, and children and families were, on average, viewed as supportive of routine clinical assessment. There were no differences between the Comparison and Commencing organizations except ‘therapists within the organization’ were viewed as more supportive by the Commencing organizations (p = 0.037). Five themes were derived from qualitative analyzes: motivation to adopt routine clinical assessment; acquiring and utilizing expertise; ensuring effective ongoing communication; availability and distribution of resources; and therapist perceptions of child and family wishes. Conclusions: Organizations experience challenges to effective and sustained implementation of routine clinical assessment. Adequate resourcing and positive, clear communication were perceived as critical for success

Treatment expectancy in individuals with chronic pain attending a pain management program

Professional Doctorate - Doctorate of Clinical and Health PsychologyThe experience of chronic pain and subsequent treatment outcomes, as guided by the biopsychosocial models of pain, is influenced by both physical and psychosocial variables. The cognitive variable of expectancy requires further investigation within this population group. Treatment expectancy is a predictor of treatment outcome for people with chronic pain, both for active and passive treatment strategies. Multi-disciplinary pain management programs are considered gold standard in the treatment of chronic pain, however non-adherence and relapse rates remain high. The current study aimed to explore changes in treatment expectancy, as well as the influence of psychosocial factors on self-reported expectancy in patients referred to a pain management program. In an effort to gain further insight into how treatment expectancy may influence relapse. Seventy-one chronic pain patients completed self-report measures over four time points (pre-program; post-program; one-month; three-month follow-up). These measures assessed variables of depression, catastrophizing, fear of movement/(re)injury, self-efficacy, disability and pain intensity. Factor analysis, correlation, Linear Mixed Model and regression analysis were undertaken with results highlighting changes in treatment expectancy, influenced over time by poor coping and self-efficacy. These results lend support to the targeting of treatment expectancy by health care practitioners as a modifiable cognitive variable that should be considered when determining treatment, monitored throughout intervention and at follow-up. Addressing treatment expectancy throughout treatment may support efforts to reduce dropout rates and subsequent relapse within the chronic pain population. It is recommended that future research extend on these findings, further evaluating the influence and adaptability of treatment expectancy within a pain program