Parent Perspectives Regarding Care Delivery for Children With Idiopathic Toe Walking to Inform an American Physical Therapy Association Clinical Practice Guideline

Abstract

Purpose: This study summarizes experiences and perceptions of parents whose children received physical therapy for idiopathic toe walking (ITW) to inform clinical practice guideline development and identify perceived strengths and gaps in care. Methods: A US-based survey was distributed to parents of children with ITW. Data from 98 respondents were compiled through descriptive statistics of item responses and review of comments. Results: Parents reported variability in timing of diagnosis and intervention, ITW care, and extent they felt educated and involved in decision making. Rates of confidence, satisfaction, and effectiveness of physical therapy care varied. Conclusions: A parent-informed clinical practice guideline for physical therapy management of ITW and family-friendly supplemental knowledge translation tools could reduce care variability, optimize shared decision making, and increase satisfaction of outcomes. Recommendations for Clinical Practice: Clinicians should be knowledgeable about ITW diagnosis, prognosis, and treatment options, educating families and engaging them in shared decision making around ITW care. (Pediatr Phys Ther 2021;33:260-266

Exploration of physiotherapists’ use of motor control strategies for the treatment of idiopathic toe walking in children: a qualitative study

“… 6 These are the common driving factors for parents to seek care from physiotherapists when their child is diagnosed with ITW. 7 …”

“… 8 9 Parents have described seeking care from multiple health providers and experiencing contradictory messages and treatment options. 7 9 Clinicians have also described challenges in knowing when to initiate treatment. Further, having limited evidence to support ITW treatments, clinicians have observed variable success with some children and treatment failures with other children.…”

“…6 These are the common driving factors for parents to seek care from physiotherapists when their child is diagnosed with ITW. 7 Clinicians and families express significant challenges in navigating effective, evidencebased interventions for children with ITW. 8 9 Parents have described seeking care from multiple health providers and experiencing contradictory messages and treatment options.…”

“…Sustained toe walking has been associated with ankle equinus,2 which can contribute to poor performance in motor tasks,3 lower participation in physical activity,4 musculoskeletal deformity5 and pain 6. These are the common driving factors for parents to seek care from physiotherapists when their child is diagnosed with ITW 7…”

“…Clinicians and families express significant challenges in navigating effective, evidence-based interventions for children with ITW 8 9. Parents have described seeking care from multiple health providers and experiencing contradictory messages and treatment options 7 9. Clinicians have also described challenges in knowing when to initiate treatment.…”