Correlates of Physicians‘ Decisions to Refer Children With Cerebral Pai Sy for Physical Therapy

Abstract

SUMMARY Videotapes of ten children with ‘suspected’ cerebral palsy were used as stimuli to elicit physicians' decisions regarding referral for physical therapy. Respondents were 99 developmental or general pediatricians, orthopaedists, neurologists or physiatrists who were membes of the American Academy of Pediatrics or the American Academy of Cerebral Palsy. They rated their belief in the value of therapy; described their exprience, training and practices relating to management of cerebral palsy; and responded to cases with their assessment of severity, diagnosis and referral decision. The decision to refer was significantly related to perceived severity of the condition, diagnostic certainty, and beliefe in the efficacy of physical therapy. Referral rates did not vary with tendency to use physical therapy for other types of patients, nor with training, experience or self‐rated expertise in cerebral palsy. RÉSUMÉ Corrélations sur les décisions des médecins de demander une rééducation kinésithérapique chez les enfants IMC Des enregistrements vidéo de dix enfants avec suspicion d'IMC ont été utilises pour provoquer les décisions de médecins concernant l'opportunité d'une rééducation kinésithérapique. Les personnes étudiées étaient 99 pediatres généraux ou spécialises dans le dévoloppement, chirurgiens orthopédiques, neurologues ou psychiatres membres de l'Amcrican Academy of Pediatrics ou de l'American Academy of Cerebral Palsy. Iis évaluaient leur croyance dans l'intérêt de la rééducation. décrivaient leur experience, formation et pratique dans l'approche de l'IMC et jugeaient les cas en termes de gravité, de diagnostic et de décision de rééducation. Cette dernière décision était liée à une perception de gravité, une certitude de diagnostique et une croyance dans l'efficacité de la rééducation. Les taux de décision ne variaient pas avec la tendance à faire appel à la rééducation pour d'autres types de patients, avec la formation, l'expeerience ou une auto‐évaluation de competénce en IMC. ZUSAMMENFASSUNG Gründe für die ärztliche Entscheidung, Kinder mil Cerebralparese zur Physiotherapie zu überweisen Von 10 Kindern mit “Verdachf auf Cerebralparese wurden Videotapes benutzt, um ärztliche Entscheidungen hinsichtlich einer Verordnung von Physiotherapie zu überprüfen. Die Ansprechpartner waren 99 Entwicklungs‐ oder Allgemeinpädiater, Orthopäden, Neurologen oder Naturhcilkundler, die Milglicdcr der American Academy of Pediatrics oder der American Academy of Cerebral Palsy waren. Sie begründeten ihr Vertrauen in den Wert der Therapie; beschrieben ihre Erfahrung, Ausbildung und Praxis bei der Behandlung der Cerebralparese; und nahmen Sleliung zu Fällen durch Beurteilung des Schweregrades, der Diagnose und der Überweisungsentscheidung. Die Entscheidung für eine Überweisung korrelierte signifikant mit dem Schweregrad der Erkrankung, der Sicherheit der Diagnose und dem Vertrauen auf den Erfolg der Physiotherapie. Die Überweisungsraten änderten sich weder mit der Tendenz die physikalische Therapie für andere Patientengruppen...

Wait Times for Paediatric Rehabilitation

“…However, we found no differences in waiting times between children who were identified as having moderate or severe functional disabilities and those who had mild disabilities. Our initial hypothesis was that children with mild disabilities would wait longer for rehabilitation services, since there may be a propensity towards providing services sooner to children with severe disabilities (Campbell et al 1995). Our results may reflect a phenomenon whereby those who are diagnosed at a younger age may have a more severe degree of disability.…”

“…These results suggest that coordinators at the rehabilitation centres may prioritize younger children to ensure the greatest benefits from early rehabilitation intervention (Office des personnes handicapées du Québec 1992; American Academy of Pediatrics 1996Pediatrics , 2001Shevell et al 2000Shevell et al , 2001Halfon et al 2004;Majnemer 1998). Perceived diagnostic certainty by physicians has been shown to influence referral of children to rehabilitation (Campbell et al 1995;Majnemer et al 2002;Shevell et al 2001). One study found that the higher the certainty that a child had cerebral palsy, the higher the odds of referral to rehabilitation (Campbell et al 1995).…”

“…One study found that the higher the certainty that a child had cerebral palsy, the higher the odds of referral to rehabilitation (Campbell et al 1995). Physicians may recognize that children have a developmental disability, but do not refer them to rehabilitation (Office des personnes handicapées du Québec 1992; Campbell et al 1995;Bailey et al 2004; American Academy of Pediatrics 2001). Others may refer children with developmental difficulties for specialty evaluations for aetiologic determination and confirmation of diagnosis.…”

“…Perceived diagnostic certainty by physicians has been shown to influence referral of children to rehabilitation (Campbell et al 1995;Majnemer et al 2002;Shevell et al 2001). One study found that the higher the certainty that a child had cerebral palsy, the higher the odds of referral to rehabilitation (Campbell et al 1995). Physicians may recognize that children have a developmental disability, but do not refer them to rehabilitation (Office des personnes handicapées du Québec 1992; Campbell et al 1995;Bailey et al 2004; American Academy of Pediatrics 2001).…”

“…For example, children may be denied access to rehabilitation services provided by Health Maintenance Organizations (HMOs) if the child cannot improve significantly over a short period of time, which is often the case for children with severe disabilities (Fox et al 1993). In other cases, the more severe a physician perceives a child' s disability, the more likely it is that the child will be referred to physical therapy (Campbell et al 1995). Diagnosis may also influence referral times to rehabilitation.…”