1. After the OR: Exploring variation in therapy intervention and the relationship between therapy dose and outcomes after SEMLs
Amy F Bailes PT PhD.
Cincinnati Children’s
University of Cincinnati Department of Rehabilitation Science.
CPRN Houston Investigators Meeting May 31-June 1, 2018

2. McGinley Single event multi level surgery for children with cerebral palsy: a systematic review DMCN 2011
Evidence base is limited.
Statistical synthesis of data was not conducted, trend towards favorable outcomes in gait.
Limited information with regard to intensity , frequency and type of outpatient rehabilitation, orthotics etc.
There is little information in the available literature to guide clinicians or researchers as to the optimum post SEMLS rehabilitation.

3. Dequeker G. Evolution of self-care and functional mobility after SEMLS in children and adolescents with spastic diplegic cerebral palsy DMCN 2018
GMFCS I-III Decrease in function at 2 months post
Most preoperative scores are regained at 6 months after SEMLS.
Further improvement is seen until 18 months.
PT 5x week at home PROM and proprioceptive training
After 1 month admitted to rehab PT (strength, gait, positioning) , OT
D/C with up to 5x week for 6 months then up to 1 year

4. Aims Describe variation in physical therapy practice after SEML’s
Explore associations between frequency , intensity , time and type of intervention with outcomes

5. Methods: Practice Based Evidence Design
Patient Characteristics
Age, GMFCS Level, Distribution, Gender
Race, Insurance type, Maternal educational level
Co morbidities , Prior surgeries (SDR)
Outcomes 3, 6 12 months
GMFM 66
Gait analysis if available
PRO GOAL (I-III)
PRO CP CHILD ((V V)
PRO Child engagement in daily life (CEDL)
Other
Interventions
Type of surgery uni/bilateral , soft tissue, bone, both
Intervention Dose* Frequency, Intensity, Time Type
Other outside activities

6. *9 year old GMFCS I Clinical Scenario

7. *Documentation of Dose15
This information is the property of Amy Bailes PT PhD. PCS and should not be distributed or otherwise used without express written permission of the author.

8. 4=Above average effort towards meeting session objectives
Automatically adds up your total focus area minutes
This information is the property of Amy Bailes PT PhD. PCS and should not be distributed or otherwise used without express written permission of the author.

9. Improvement science methods Jan17- Jan 18

10. Balancing measure: Agreement between what is in EHR and what therapist completes on paper after watching video recording
This information is the property of Amy Bailes PT PhD. PCS and should not be distributed or otherwise used without express written permission of the author.

11. Sample size TBD Cincinnati Requirements Other Centers
51 patients Nov 16 – Dec 17
GMFCS I-III n=31
GMFCS IV-V n=20
Unilateral n=23
Bilateral n=28
Ages years (mean 8)
Other Centers
# PROCEDURES
GMFCS I-III
GMFCS IV-V
Unilateral
Bilateral
Ages
Requirements
All /most of therapy at that center
Volume
Motivation
Culture for change
51 individuals with a mean of 8 years old (3 to 24 years old) were seen for PT services and underwent SEMLS. 29 (57%) were male and 22 (43%) were female, and 10 (20%) GMFCS Level I, 16 (31%) GMFCS Level II, 5 (10%) GMFCS Level III, 5 (10%) GMFCS Level IV, 15 (29%) GMFCS Level V (Gross Motor Function Classification System). 23 (45%) unilateral and 28 (55%) bilateral limbs underwent SEMLS. The SEMLS consisted of 10 (20%) soft tissue only procedures, 2 (4%) bony only procedures, and 39 (76%) combined soft tissue and bony procedures. Thirty-seven (73%) received a pre-operative outpatient PT evaluation and 17 of 30 (57%) ambulatory individuals received a pre-operative gait analysis. Forty-eight (94%) received inpatient PT directly following SEMLS and 21 (41%) received a post-operative outpatient PT. Pain was documented in 13 (25%) of patients using various pain scales. Ongoing assessments were inconsistently completed 1 or 2 times during the first year. At 1 year post-operatively, 2 OF 2 (100%) received a repeat gait analysis. An average of 11 (0 to 49) outpatient post-operative PT visits were completed.
24 year

12. Funding sources TBD 5 year
1st train and spread use of flowsheet to clinicians, IRB approvals
2nd year enroll
3rd year enroll and begin follow up
4th follow up
5th analysis and dissemination

13. Timeline YR 1 YR 2 YR 3 YR 4 YR 5 Train PTs and spreadX
Obtain IRB approval
Enroll
Follow up
XXX
Analysis
Dissemination

14. Importance to CPRN community
Research CP (manuscript under review)
Which interventions [surgeries, injections, medications and therapies (orthotics, equipment, training)] are associated with better functional outcomes (important to child/ family) controlling for GMFCS level, age and co- morbidities

15. Thank you

17. Electronic record: Session Information
©2018 Epic Systems Corporation. Used with permission.
This information is the property of Amy Bailes PT PhD. PCS and should not be distributed or otherwise used without express written permission of the author.

18. Electronic record: Focus Areas + Interventions = Type
©2018 Epic Systems Corporation. Used with permission.

19. Electronic record: FITT
Frequency
Intensity
What you believe to be the child’s effort in the session towards meeting the objectives of the session (Adapted from Westcott-McCoy 2010, Horn 2015)
0= absence of effort, 3 average effort , 6 superior effort
Timing
©2018 Epic Systems Corporation. Used with permission.

20. Electronic Record: Summary & Recommendations
©2018 Epic Systems Corporation. Used with permission.
This information is the property of Amy Bailes PT PhD. PCS and should not be distributed or otherwise used without express written permission of the author.