Variations in the orthotic management of cerebral palsy

Objective Anecdotal reports that children with cerebral palsy were provided different orthoses in two adjacent UK health districts were investigated using an observational comparative case study. Method The populations were compared using an epidemiological register of children with cerebral palsy, which confirmed that a comparable health service response could be expected. Merging data from the register with the orthotic patient database facilitated comparison of the orthoses prescribed in each district. A survey questionnaire was used to gather the perceptions of clinicians in both districts to understand how each team decides which orthosis to prescribe. Results There was considerable variation in the types of orthoses prescribed between districts, and particularly of ankle foot orthoses. Survey respondents from the same profession described having the same roles, although clinicians expressed different responsibilities for initiating and sanctioning orthotic prescriptions in their district programmes. The survey also suggested that most clinicians were uncertain when prescribing orthoses, and clinical practice was therefore largely determined by professional preference. Conclusion Defining the spectrum of activity limitation in geographically defined populations would enhance health services research and assist in the development of trials using different interventions to reduce those limitations.