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Section on Developmental and Behavioral Pediatrics |
Fall 1999Printable Version (pdf)Section Home
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Outcomes Researchby Charlene Butler, Ed.D. Making Sense of Research in Developmental Disabilities: A Conceptual Framework for Reviewing Treatment OutcomesThe American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) will soon be providing summaries of evidence to help clinicians evaluate the efficacy of interventions used within and across the various professional disciplines who care for children with developmental disabilities. These summaries will be published periodically in Developmental Medicine and Child Neurology and cumulatively at www.aacpdm.org on the Internet. We use a model called the Dimensions of Disablement. The model consists of five areas of human function in which disability (and its treatment) can have an impact. We will be creating evidence tables that summarize available evidence concerning the 5 dimensions for different clinical conditions. These tables will highlight the quality of evidence as well as document gaps in knowledge to guide future research. Five Dimensions of DisablementPathophysiology: Interruption or interference of normal physiology and developmental processes or structures Impairment: Loss or abnormality of body structure or function Functional Limitation/Activity: Restriction of ability to perform activities Disability/Participation: Inability to function fully in typical societal roles Societal Limitation/Context Factors: Barriers to full participation in society that result from attitudes, architectural barriers, and social policies and other factors that are external to the affected individuals such as family circumstances Example: Cerebral PalsyLet’s see how this model would apply to a specific condition: Cerebral Palsy.
An untested assumptionIt has been assumed that treatment at one level (decreasing impairment through treatment of spasticity) may positively affect another "level" (functional limitation or disability). Yet this has been a largely untested assumption. As a result of this assumption, studies have rarely incorporated measures in multiple dimensions to test specifically for associated effects of an intervention. This may result in inconsistent and confusing advice from the multiple specialists parents have consulted. Interventions do not always have simple effects on a single dimension of disablement. For example, assistive technology, such as powered mobility, may compensate for functional limitations by providing an alternative means of efficient locomotion. It may decrease disability by allowing a student to be independent and to move about the school faster with less effort. Its use may or may not have positive or negative effects in the impairment dimension, such as improved head control (positive), skin breakdown (negative), or increased knee contractures (negative). We hope that our colleagues in the Section on Developmental and Behavioral Pediatrics will find the evidence summaries helpful in their practice. Feel free to contact me for further information at: Further ReadingButler, et al. (1999) Making sense of research in developmental disabilities: A conceptual framework for reviewing treatment outcomes. DMCN.41 (1): 55-59. Butler, et al. (1998) Methodology for Developing Evidence Tables and Reviewing Treatment Outcomes. Available http:/www.aacpdm.org Fuhrer, MJ. (1997) Assessing
Medical Rehabilitation Practices: The Promise of Outcomes Research. (Paul H. Brookes
Publishing Co.; Baltimore) |
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