Catherine Duff

Leeds Community Healthcare NHS Trust · Quality and Professional Development
4.7 · MSc Clinical Research Methods; BSc (Hons) Physiotherapy
About
5
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Introduction
Current institution
Leeds Community Healthcare NHS Trust
Quality and Professional Development
Current position
Quality Lead for Children's Business Unit
Skills and Expertise
Education
Jan 2013 - Jan 2015
University of Leeds
Clinical Research Methods
Sep 2004 - Jun 2007
Leeds Beckett University
Physiotherapy
Network
Followers (35)View all
University of Leeds
Northumbria University
University Medical Center Utrecht
Newcastle University
Centre Hospitalier Universitaire de Nice
Followers
Following (21)View all
University of Leeds
McMaster University
McMaster University
The University of Sydney
Northumbria University
Following
Projects
Projects (1)
Rebound Therapy in Children with Cerebral Palsy
Research
Research Items (5)
Background: Advancing physical therapy interventions for children and young people is a high research priority. This includes research to describe and specify the control condition, typically "current care", for effectiveness trials. This paper aims to identify physical therapy outcomes commonly targeted, and intervention techniques and approaches commonly used, by physiotherapists working with children (aged 2-19 years) with mobility limitations in the United Kingdom. Methods: A cross-sectional survey. Participants were recruited through the interactive Chartered Society of Physiotherapy members-only online discussion forum, the Association of Paediatric Chartered Physiotherapists, direct emails and snowball sampling within the authors' professional networks, and Twitter. Data were collected using a structured online questionnaire and analysed using descriptive statistics. Results: We received 146 responses, 95/146 (65.1%) of which were fully complete. Therapists reported targeting 367 unique outcome constructs of which 193 (52.6%) mapped onto activities and participation (e.g. moving around using equipment, maintaining body position, walking), 158 (43.1%) on body functions (e.g. muscle strength, joint mobility, gait functions), 11 (3.0%) on body structure (e.g. muscle length), and 3 (0.8%) on environmental factors (e.g. access home environment, access school environment, family confidence). The most commonly used interventions related to postural management (115/133 of respondents, 86.4%) and exercise therapy (116/137, 84.67%), and included techniques such as 'use equipment' (118/137, 86.1%), 'instruct how to do something' (117/137, 85.4%), 'practice' (105/137, 76.6%), and 'stretch' (99/137, 72.3%). Conclusions: In designing trials, current care can be described as a combination of biomechanical and physiological techniques and approaches targeted at body functions and through that to activity and participation. While some environmental behaviour change techniques and strategies were reported, the explicit use of these in current care appears limited.
There is an urgent, agreed need to improve participation outcomes and interventions for children and young people with neurodisability. We worked together with service users and providers to design research into participation outcomes and interventions in neurodisability. We built on existing evidence about participation outcomes and interventions and the WHO International Classification of Functioning, Disability and Health. We: (1) specified seven participation outcome categories for measurement; (2) prioritized these for improvement: self-care, friends and social, and physical activity ranked the highest; (3) identified 11 potential intervention categories for targeting the top priority, self-care, through eight hypothesized change mechanisms and agreed for the interventions to be delivered as a ‘Menu of Interventions’ for personalized self-care support; and (4) designed a before-and-after mixed methods feasibility study to evaluate the Menu with children and young people (0–12 years) and their parents and therapists.
Background and Purpose Rebound therapy, i.e. the therapeutic use of the trampoline, is widely used in a community physiotherapy service to help children with cerebral palsy (CP) develop gross motor skills and participation in physical play. Not only is there very little evidence to demonstrate the effectiveness of rebound therapy in these outcomes but the most recent study has a number of limitations (Witham et al. 2012): non-validated outcome measures, participants with different diagnoses, and use of outcomes that do not measure activity and participation (as per the International Classification of Functioning, Disability and Health model) (Rosenbaum & Stewart 2004). This study aimed to address these limitations. Specifically, this feasibility study aimed to explore whether an intensive 3 week rebound therapy intervention improves gross motor skills and participation in physical play and satisfaction in children with CP. Methods A repeated measures (within-subject) experimental design was used. A convenience sample (n=7) was selected based on the criteria: diagnosis of CP, Gross Motor Function Classification System (GMFCS) level I-II. Participants followed a rebound therapy programme with pre-determined progressions: two 20 minute sessions per week for 3 weeks. Gross Motor Function Measure (GMFM) was administered 6 weeks before intervention, immediately before intervention, and immediately after 3 weeks of rebound therapy. Canadian Occupational Performance Measure (COPM) was administered immediately before and 6 weeks after intervention. Data were analysed using SPSS. Wilcoxon signed rank test was used for all comparisons. Results Children’s COPM scores improved after rebound therapy; this was statistically significant (p<0.046). There was no change in GMFM (p<0.463). Conclusions Rebound therapy may improve participation of children with mild CP. The effect on gross motor skills is inconclusive, possibly due to the ceiling effects of the GMFM. GMFM may not be sufficiently sensitive to detect change in the study population. Further research is required to investigate the mechanisms involved and effectiveness of rebound therapy.
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