Previous Work

The Postural Management subgroup has worked on developing a number of areas within the postural management field, and these are summarised below.

Training Needs Questionnaire 2008

The aim of the questionnaire was to identify available training and perceived training needs.

  • 100 Responses - 77% from therapists, 44% of respondents work in LD and 34% in paediatrics.
  • Awareness of training opportunities - 64% of respondents were unaware of any training available to them.
  • Courses/training - respondents identified 30 different courses.
  • Barriers to training
    • 53 respondents quoted availability of appropriate courses
    • 50 Finance
    • 32 Time
    • 28 Location

Respondents expressed interest in receiving training in all areas of postural management.

CONCLUSION

There is a general lack of awareness of appropriate courses available.
There is a high level of interest in receiving appropriate training.

PROPOSED ACTION
Raising awareness of course availability requires to be further investigated by SPMN.

Best Practice

In early 2003 a team was established to look into areas of best practice within the following areas:

  • Known services
  • Manufacturers
  • International work
  • Paediatric and occupational therapy professionals
  • PMG (Posture and Mobility Group)
  • User groups and charities
  • Diagnostic associations

The team put together a Scotland-wide list of potential starting point contacts for the whole range of postural management interventions, which can be found here.

The team also developed a head-to-toe model of triggers for postural management, finalised in May 2007. Its aim is to define typical interventions required to alleviate postural instability (dynamic or static), depending on the level at which that instability occurs. The report can be found here.

Carer and patient training

In 2003 a team was established to look into the training of carers and patients in postural management. A survey was undertaken to identify what type of training was given (if at all) and in what format it was provided. 452 questionnaries were circulated with 178 responses. Results from this survey revealed:

  • A need to ensure that information given to one patient/carer is reliably transferred to other carers in different settings, shifts etc.
  • A need for teaching resources and 'trained trainers'.

The team also reviewed a variety of training materials and learning methods for postural management interventions including adaptive wheelchair seating. A link to the Fife Postural Management Clinic's training programme was also established.

Description of Posture, Function and Outcome

In 2001 a team was initiated to look at 'how we might describe our patients and their outcomes?" They began by looking at a number of established methods including:

  • Canadian Occupational Performance Measure (COPM)
  • Patient Generated Index (PGI)
  • Time trade-off (TTO)
  • Visual Analogue Scale (VAS)

A model was formed to include all aspects of posture, including physiology and anatomical position, comfort, function and skin integrity. Following feedback from a SSWG meeting it was decided to use the Visual Analogue Scale (VAS) due to the following benefits:

  • It captures the most relevant issues from the patient
  • It helps prioritise intervention aims
  • It is quick to administer
  • It highlights areas of improvements to patients, and
  • It incorporates 24 hour postural management equipment being used

A spreadsheet was developed to collate outcomes scores for position, comfort and function across three specific postural management interventions:

  • Wheelchair adaptive seating
  • Static seating
  • Lying

This spreadsheet can be found here.

Evidence for the Effectiveness of Postural Management

Also in 2001 an eight-strong team consisting of a good mix of occupational therapists, physiotherapists and bioengineers was established to look at what evidence existed for the effectiveness of postural management.  The team followed the Scottish Intercollegiate Guidelines Network (SIGN) procedure in search of evidence: identify, locate, sort, grade, synthesis and present.  Using this method the team produced a table of evidence containing 148 references graded using Sackett's five levels of evidence:

  1. Randomised controlled trial with low probability of false positive or negative (i.e. confounding) errors.
  2. Randomised controlled trial with high probability of confounding errors.
  3. Non-randomised concurrent cohort (same age, peer group, diagnosis) comparisons between contemporaneous patients, e.g. single-subject, pre, post or matched case-control series.
  4. Non-randomised historical cohort comparisons, e.g. non-experimental studies such as comparative and correlational descriptive case studies.
  5. Case series without controls, i.e. case reports.

In the areas of physiology, neonate & surgery good scientific evidence was found.  In others areas there was a preponderance of case studies and retrospection reporting of a variety of benefits.  The evidence shows that

  • Body posture influences physiologic function.
  • For paediatric / neonates posture influences musculoskeletal development.
  • Surgical interventions can mechanically correct body shape.
  • Adaptive seating and positioning have a major contribution to activities of daily living, physiology and cognitive function.

No literature survey can ever be all encompassing. However, the evidence group is confident that their work represents a reliable snapshot of the evidence supporting postural management.

The table of evidence can be found here.

Review of Services

In 2001 a team was initiated to survey postural management services available at the time. The team initially piloted a questionnaire from diverse services ranging from therapy services to equipment suppliers. Findings revealed:

  • Multi-disciplinary assessments generally included Occupational Therapists, Physiotherapists, Bioengineers, Speech and Language Therapists and less often medical staff or Orthotists.
  • Little or no pre-programmed maintenance existed for equipment provided by these services
  • Reviews were held on an ad hoc / as requested basis

The team concluded that the questions had not been properly understood, that the data was not compareable statistically and there were different levels of modesty/understanding which made interpretation difficult. A more detailed study was undertaken, with responses from 40 rehabilitation professionals relating to 455 patients, 75% of which were wheelchair dependent. Findings from this study included:

  • Patient age ranged from 5 to 101
  • 50-100% of a therapist's caseload had mobility problems
  • The main diagnostic groups were cerebral palsy (CP), multiple sclerosis (MS), cerebrovascular accident (CVA) and elderly patients with co-morbidity
  • Treatment included the whole range of postural management, though how postural management was prescribed, recorded and reviewed varied greatly across the therapists
  • Therapists were not satisfied with the equipment currently available for provision due to limited resources, training, staff and research data

A report was presented and can be found here.