Patients' and parents' views about lower limb orthopaedic surgery for ambulant children and young people with cerebral palsy: a qualitative evidence synthesis

Hajar Almoajil; Tim Theologis; Helen Dawes; Jackie Parsonage; Jo Pierce; Sally Hopewell; Francine Toye

doi:10.1302/1863-2548.14.200139

Patients' and parents' views about lower limb orthopaedic surgery for ambulant children and young people with cerebral palsy: a qualitative evidence synthesis

J Child Orthop. 2020 Dec 1;14(6):562-573. doi: 10.1302/1863-2548.14.200139.

Authors

Hajar Almoajil^{1

2}, Tim Theologis^{1

3}, Helen Dawes^{4

5}, Jackie Parsonage⁴, Jo Pierce⁶, Sally Hopewell¹, Francine Toye³

Affiliations

¹ Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, UK.
² Department of Physical Therapy, College of Applied Medical Science, Imam Abdulrahman Bin Faisal University, Saudi Arabia.
³ Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Foundation Trust Oxford, UK.
⁴ Centre for Movement, Occupation and Rehabilitation Sciences, Oxford Institute of Nursing, Midwifery and Allied Health Research, Oxford Brookes University Oxford, UK.
⁵ Oxford Health NHS Foundation Trust, Oxford, UK.
⁶ Faculty of Health and Life Sciences, Oxford Brookes University, Oxford, UK.

Abstract

Purpose: The article identifies the aspects of health and outcomes that are considered important from the perspective of ambulatory children with cerebral palsy (CP) and their parents regarding lower limb orthopaedic surgery and explores how they experience surgical interventions.

Methods: Four databases (Embase, MEDLINE (Ovid), CINAHL and PsycINFO) were searched from inception to 11 April 2020. Studies were included if they: 1) they involved children or young adults diagnosed with ambulant CP or their family, 2) participants had experience with lower limb orthopaedic surgery and 3) studies employed qualitative research methods. The Critical Appraisal Skills Programme was used to appraise identified studies. The 'Best-fit framework' synthesis approach was used by applying the International Classification of Functioning-Children and Youth (ICF-CY) linking rules and thematic synthesis. The review process was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Six studies were included. Four themes were generated which were linked to the ICF-CY framework: Body function and structure, Activity and participation, Environmental factors, Personal factors, as well as non-ICF-CY themes including Emotional well-being and Goal setting. Important surgical outcomes identified were pain, fatigue, movement-related function, mobility, walking ability, community life, emotional well-being, and adequate provision of public and health services.

Conclusion: These findings are important for understanding patient-centred outcomes in lower limb ortho-paedics surgery and providing focus for future interventional studies aimed at improving outcomes of importance to children with CP. These findings highlight the importance of long-term support to help people negotiate the challenge of surgical regimes and to achieve good outcomes after orthopaedic surgery. The outcomes identified will contribute to the development of a core outcome set in this field.

Level of evidence: III.

Keywords: cerebral palsy; core outcome set; orthopaedic; qualitative evidence synthesis; surgery.