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Commentary on “Clinical Decision Making Regarding Intervention Needs of Infants With Torticollis”

Harbst, Kimberly PT, PhD; Grabinski, Tanya PT, MHS, PCS

Pediatric Physical Therapy: October 2011 - Volume 23 - Issue 3 - p 257
doi: 10.1097/PEP.0b013e318228e46f
Clinical Bottom Line

University of Wisconsin-LaCrosse LaCrosse, Wisconsin

University of Wisconsin-LaCrosse, LaCrosse, Wisconsin

The authors declare no conflicts of interest.

“How should I apply this information?”

This study identified factors affecting pediatricians' and physical therapists' decision making for infants with torticollis. There was strong support for the need for intervention in infants with torticollis, but little knowledge about pediatricians' or physical therapists' decisions regarding appropriate interventions. Therapists must be mindful of factors influencing these decisions to assure objective assessment, program planning, and intervention revision.

The factors were mapped using the International Classification of Functioning, Disability and Health-Children and Youth (ICF-CY). Physical therapists identified 21 determinants of clinical decision making including parent's awareness and understanding of the problem, parent's ability to perform exercises, parental anxiety, parental motivation, parental coping strategies, parent-child interaction, parent's mental state, parental fear of moving their baby, parents' capacity to collaborate with physical therapy, and family network. Factors attributed to the infant included age, personality, response to exercises, birth complications, and associated health conditions. It seems important for physical therapists to gather information from parents regarding environmental factors when determining the plan of care.

Finally, a subset of factors regarding health professionals' personal attitudes/preferences and availability of services was influential in determining intervention. Physical therapists' experience and role perception, as well as other health professionals' attitudes, were influential highlighting the importance of therapists being aware of individual biases brought to the clinical decision-making process.

“What should I be mindful about in applying this information?”

Physicians and physical therapists identified similar factors, but pediatricians' perspectives were restricted to fewer factors. Among ICF-CY domains, all identified activities and participation factors and many of the body structures and body functions factors had been previously reported. However, sensory integration, alertness, primitive reflexes, tone, and weak suck had not been previously identified but were influential in this study. To date, little attention has been given to environmental factors. In addition, therapists should note that differences in health care management and payment structure may have affected these Canadian clinicians' decisions differently than those made by physical therapists in the United States.

Kimberly Harbst PT, PhD

University of Wisconsin-LaCrosse

LaCrosse, Wisconsin

Tanya Grabinski, PT, MHS, PCS

University of Wisconsin-LaCrosse

LaCrosse, Wisconsin

Copyright © 2011 Academy of Pediatric Physical Therapy of the American Physical Therapy Association