The results of a clinician-led study will inform a new evidence based guide for therapists prescribing sleep positioning systems for patients with neuro disabilities. It is hoped that this guide will help to outline the potential benefits and risks associated with the systems in practice as far as possible.
Sleep positioning systems (SPS) can be prescribed for adults and children with neuro disabilities to help reduce or prevent hip deformity, provide comfort, ease pain, and improve sleep.
Some clinicians have been recommending this type of equipment for many years, however, due to the lack of definitive evidence of the effectiveness of the treatment, its use has been questioned. As commercial sleep positioning systems can be expensive, and as there are risks, the need for evidence-based guidance to support decisions as to their use has been recognised.
Prompted by a call to action by the Posture and Mobility group, a team of clinicians set out to create a best practice guide to inform therapists. They began by conducting a systematic review, which aimed to collect evidence on the use of SPS and the apparent effects on patients with neuro disabilities. The research was supported and informed by researchers in the Peninsula Cerebra Research Unit (PenCRU) and the Evidence Synthesis team at PenCLAHRC.
Associate Professor in Evidence Synthesis, Jo Thompson-Coon, advised the clinicians on their approach to the study, and helped them to develop their own research methods. Jo has praised the novel approach of the review being clinician rather than academic led, and cites it as an example of how academics can work with clinicians to build research capacity.
“We always have clinicians involved in our reviews, but we usually lead and we usually push it forward. This project was different in that the clinicians were in control, ran all the meetings and expressed what elements they needed help with. Normally we would approach clinicians with ‘we don’t quite understand what this means – can you help us?’ But with this project, it was the clinicians coming to us and saying ‘we don’t really know what you mean by critical appraisal- how does that work?’ So in that way it’s a different model.”
Dr Ginny Humphreys, Clinical Director of Vranch House, was one of three clinicians who led the study. Ginny remarks that working with academics gave power to the publication, and inspired the clinicians to reconsider the suitability of the evidence they had initially selected to review.
“Working with the academics inspired lots of changes in the way we were working, and helped to make the whole process much clearer. Throughout the project the methodological journey was discussed and we were pointed in a direction we wouldn’t have necessarily gone down. Collaboration with the academics in Exeter has definitely made the end result a more robust piece of research.
Reading the papers that might be included in the review has brought home how important it is for clinicians to carefully consider their methodology and to write up the studies they have undertaken, properly. It will be helpful to agree appropriate outcome measures for new studies in this field so that we can better compare studies in the future.”
The next phase of this project will look at moving the review forwards to create and implement an evidence based guide for therapists prescribing SPS.
Ginny is hopeful that, though they still won’t be able to say with clarity whether SPS should or should not be prescribed, the guide will help to highlight the potential benefits and risks associated with them.
“With an expert consensus we can say that this is what people who have used SPS think, and these are the things to be aware of. We still won’t be able to say ‘Do this and it works’, but we can map out the risks and the potential benefits, and suggest how to go about measuring impact in terms of choosing your outcome measures.”
The study, entitled Sleep positioning systems for children and adults with a neurodisability: A systematic review, has been published in the British Journal of Occupational Therapy.
Ginny has also written an article detailing her experiences working on the systematic review alongside members of PenCRU and EST. You can read this on the EST blog.
For information about previous research conducted by PenCRU on sleep positioning for children with Cerebral Palsy, visit the project page.
Ginny Humphreys, Tanya King, Jo Jex, Morwenna Rogers, Sharon Blake, Jo Thompson-Coon, and Christopher Morris (2018) Sleep positioning systems for children and adults with a neurodisability: A systematic review British Journal of Occupational Therapy . DOI: 10.1177/0308022618778254