2009 APA Conference Week Abstracts - Australian Physiotherapy ...

National Paediatric Group
and development of allied health paediatric staff equivalent
full time positions and built expertise in the management
of infants at risk of developmental delay. For example:
the 3-day per week, part time service provided by 2.2
equivalent full time allied health staff in 2004 has grown to
become a full-time service offered across two campuses and
comprising 10.8 equivalent full time allied health staff, plus
sessional developmental paediatricians and 0.6 equivalent
full time paediatric fellows. A pilot project to investigate
the need for an allied health developmental service in the
special care nursery informed a successful business case
that has resulted in 2.3 equivalent full time allied health
staff employed into this service. This is an overall allied
health paediatrics workforce increase from 2.2 equivalent
full time in 2004 to 13.1 equivalent full time in 2008. This
paper will outline the successes and challenges of this
service growth and discuss strategies for sustainability and
further development
6
Treatment of the recurrent clubfoot with the Ponseti
technique
Evans KG, Gibbons P, Latimer M
The Children’s Hospital at Westmead, Sydney
The successful use of the Ponseti Technique in the
treatment of recurrent clubfoot has been documented but not
quantified in the literature. Prior to the introduction of this
technique, those children with recurrent congenital talipes
equinovarus deformity were treated with surgery. It is now
well established that extensive surgery leads to poor long
term outcomes. At The Children’s Hospital at Westmead
it has become common practice to treat the recurrent
clubfoot with the same Ponseti serial casting technique
used in neonates. A retrospective chart audit of 55 patients
with 96 clubfeet who underwent Ponseti serial casting for
congenital talipes equinovarus between 2001–2008 was
performed. Our aim was to quantify the outcome of these
patients following serial casting. Outcome was measured
according to surgical intervention required after casting.
Major surgery was considered a failure; minor or no surgery
was considered a success. Major surgery was defined as
intra-articular procedures including posteromedial soft
tissue release. Minor surgery was defined as extra-articular
procedures including tibialis anterior tendon transfer. Our
results post casting showed a marked decrease in surgery
with 4 feet requiring major surgery (4%); 25 feet (26%)
undergoing minor surgery and 67 feet (70%) requiring no
surgery. Thus there was an overall success rate of 96%. The
use of the Ponseti technique for the treatment of recurrent
talipes equinovarus is recommended to reduce the need for
both major and minor surgery in this population and thus
produce good long term outcomes.
Improving reliability of the clinical assessment of
spasticity: the Australian Spasticity Assessment Scale
Gibson N, 1,2,4 Love SC, 1,2,3,4 Blair E 1,2,4
1
Princess Margaret Hospital, Perth, 2 University of Western Australia,
Perth, 3 Curtin University of Technology, Perth, 4 The Telethon Institute
for Child Health, Perth
We sought to improve our current methods of identifying
and assessing spasticity by developing a more valid,
reliable and clinically applicable tool, the Australian
Spasticity Assessment Scale. The most frequently used
tool, the Modified Ashworth Scale does not conform to the
definition of spasticity and has poor to mediocre reliability.
The Australian Spasticity Assessment Scale was developed,
using the framework of the Modified Ashworth Scale but
conforming to the definition of spasticity. An explicit yet
simple standardised test protocol is provided together
with unambiguous, mutually exclusive scoring criteria,
so that every muscle tested fits into one and only one
category. Inter-rater reliability of the Australian Spasticity
Assessment Scale was assessed in an outpatient setting of a
tertiary paediatric hospital. Three raters used the Australian
Spasticity Assessment Scale to independently assess the
spasticity of muscles in 23 children with a wide range of
subtypes and functional levels of spastic cerebral palsy (n =
322 muscle groups). Agreement was measured with kappa,
and, in order to compare with estimates of reliability of preexisting
methods, with intra-class correlation. Substantial
agreement was demonstrated by kappa = 0.71 (95% CI 0.67–
0.75). Intraclass correlation was 0.88 (95% CI 0.86–0.90),
significantly better than that published for other methods
of assessment. The Australian Spasticity Assessment Scale
conforms to the definition of spasticity, is easily clinically
applicable and reliability exceeds that of other commonly
used spasticity scoring systems and we suggest it should
be the tool of choice for assessing spasticity in the clinical
setting.
Towards a sustainable clinical education model for
paediatric physiotherapy: the experience of building
capacity for physiotherapy students at the Children’s
Health Service District in Queensland
Henderson DR, 1 Wright S, 1 Maharaj S, 2 Moller M 1
1
Dept of PT, Royal Children’s Hospital, Brisbane, 2 Queensland
Paediatric Rehabilitation Service, Brisbane
It is well recognised nationally that clinical education for
entry level physiotherapy students faces building pressure
from increasing clinical demands, growing student numbers
and reducing educational funding. The way forward is
unclear with systematic review of physiotherapy clinical
education literature concluding that ‘no model is more
effective than another’. How does a busy physiotherapy
department build sustainable capacity to support the next
generation of therapists? What model of clinical education
best supports the local needs, what steps are involved in its
formation and are they transferable to other physiotherapy
departments? The purpose of this study is to analyse the
efficacy of an innovative pilot model of clinical education and
describe the lessons learnt to facilitate broader adaptation.
This model aims to incorporate strategies to unload busy
clinicians while supporting students’ learning curve of skills
attainment. A mixed action research design used features
of qualitative semi-structured interviews, focus groups and
observational analysis combined with quantitative time/
motion study tools and survey data. Innovative models
for assessing student attainment of competencies e.g the
MiniCEX, an assessment tool of clinical skills validated in
medicine, are investigated. Participants include members
of the paediatric physiotherapy services in the Children’s
Health Service District of Queensland based at Royal
Children’s Hospital (RCH) in Brisbane, and other key
stakeholders such as students, parents and patients. The
results of the pilot are still being gathered in collaboration
with university educators in Queensland and the project is
due to report in August 2009.
The e-AJP Vol 55: 4, Supplement