Date Presented 04/05/19
Postural management in the lying orientation should be routinely addressed for those with impaired movement. This study found that the implementation of a nighttime positioning (NTP) program yielded significant improvements in the health-related quality of life (HRQoL) of those with multiple disabilities, including difficulty moving independently. Highlighting the therapeutic benefits of supporting the body at nighttime will advance OT practice.
Primary Author and Speaker: Kourtni Reed
PURPOSE: The inability to move independently or to change positions freely leads to the development of habitual lying postures; which, then results in the onset of body shape distortions (Hill & Goldsmith, 2010). These body shape distortions could significantly reduce the quality of life of those with multiple disabilities (Hill, 2011). Lying, sitting, and standing are the three orientations obtainable to human beings (Kittelson-Aldred & Hoffman, 2017). Sitting and standing orientations are regularly addressed in North America in order to protect body shape. However, the lying orientation is often overlooked (Kittelson-Aldred & Hoffman, 2017) even though adults spend approximately one third of their time in the lying positioning, with this proportion being even higher during childhood (Hill & Goldsmith, 2010). Twenty-four-hour postural care includes symmetrical positioning intervention over the entire 24-hour period while sitting, standing, and lying (Posture 24/7, n.d.). The purpose of this research study was to measure the outcomes of an established night-time positioning program, an intervention addressing the lying orientation, on health-related quality of life (HRQoL). This study sought to see if the provision of a therapeutic night-time positioning program would improve the HRQoL of those impacted by multiple disabilities.
METHOD: This study utilized a pretest-posttest design. Participants of this study included students enrolled at a southeastern United States residential and intermediate care facility. For this study, only the students beginning the night-time positioning program after the start of this research study were included. Once legal guardian informed consent was secured, the participants were shown a short in-service presentation that was created by the facility to describe the program. The researcher received de-identified data of the participants’ pretest and posttest scores on the following instruments: The Caregiver Priorities & Child Health Index of Life with Disabilities (CPCHILD), Non-communicating Children’s Pain Checklist-Revised (NCCPC-R), Posture and Postural Ability Scale (PPAS), and range of motion (ROM) measurements. For data analysis, SPSS Version 25 was utilized.
RESULTS: Seven individuals diagnosed with cerebral palsy (CP) along with multiple other disabilities participated in the study, including five males and two females who ranged in ages from 15 to 27 (M=21.71, SD=4.786). The total amount of days spent in the program ranged from 13 to 111 days (M= 53, SD=46.293). Results showed statistically significant improvements in the CPCHILD and the NCCPC-R instruments.
CONCLUSION: Protecting and supporting the body while lying has positive effects on HRQoL, along with the pain levels experienced, by individuals who have multiple disabilities including difficulties moving independently. Overall, there is a dearth of evidence on the effectiveness of night-time positioning (NTP); including, the effect of sleep positioning intervention in regards to HRQoL indicators. This study will increase the evidence on the outcomes of night-time positioning; therefore, informing for best practice. Results may influence the development and implementation of night-time positioning programs for those with multi challenges including impaired movement by occupational therapy professionals. Occupational therapists are in an opportune position to advocate on the importance of postural support throughout the night-time period.
References
Hill, S. (2011). A one year postural care training programme for the workforce supporting the needs of those with complex and continuing healthcare needs: Project evaluation. Postural Care CIC, 1-59.
Hill, S., & Goldsmith, J. (2010). Biomechanics and prevention of body shape distortion. Tizard Learning Disability Review, 15, 15-29. https://doi.org/10.5042/tldr.2010.0166
Kittelson-Aldred, T., & Hoffman, L.A. (2017). Rehab management. 24-hour posture care management: Supporting people night and day. Retrieved from: http://www.rehabpub.com/2017/09/24-hour-posture-care-management-supporting-people-night-day/
Posture 24/7. (n.d.). What is 24 hour postural care? Retrieved from: https://posture24-7.org/what-is-24-hour-postural-care/
