Prescribing upper limb orthoses for children with cerebral palsy: a Q methodology study of occupational therapists’ decision making

Purpose: This study identified occupational therapists’ viewpoints that guide their practice of upper limb orthosis prescription for children with cerebral palsy (CP).

Methods: A qualitative study utilising Q methodology explored participants’ viewpoints. Thirty-nine occupational therapists (38 females) were purposively recruited to rank statements generated from interviews of experienced clinicians and peer reviewed and published literature. Statements about reasons for orthoses prescription, were ranked according to what guides decision making the most to least. Data from ranked statements were analysed using by-person factor analysis to reveal the different ways statements were grouped. The resultant factors, based on the average arrangement of statements associated with each factor, were interpreted and named as viewpoints.

Results: Viewpoints identified: 1. Potential effect of the orthosis (n = 12 sorts); 2. Biomechanical presentation (n = 12 sorts); and 3. Client/therapist relationship (n = 10 sorts). The “Client’s goals” statement was ranked highest across all viewpoints.

Conclusions: Viewpoints identified may inform development of clinical guidelines. Further research is required to (i) identify valid and reliable classification and assessment tools to guide decision making; and (ii) establish the mechanism of the effect of orthotic intervention by considering the link between the biomechanical purpose of the orthosis (e.g., mobilise tissue) and aim of intervention (prevent contracture).

Implications for rehabilitation
Q methodology provided an opportunity to identify viewpoints of occupational therapists that guide their upper extremity orthosis prescription decision making.

Consistent with best-practice, clients’ goals were the primary focus of decision making in each viewpoint.

It is recommended that clinicians consider the identified viewpoints; 1) the potential effects of the orthosis, 2) the biomechanical presentation of the child, within 3) an established client/therapist relationship when prescribing upper extremity orthoses.

Practice guidelines to inform upper limb orthotic intervention may be developed using the identified viewpoints.