Implementation of the Early Diagnosis of Cerebral Palsy Guidelines: Exploring E-Learning for Practice Change and Improved Patient Outcomes

Abstract

Background: Health professionals can provide an early cerebral palsy (CP) diagnosis and intervention in a critical neuroplastic window, but late diagnosis and generic intervention are common. Clinical guidelines must be implemented to improve outcomes. Education is key to guideline adoption; e-learning is wanted but evidence for its learning design and practice change is limited. This thesis explores CP diagnosis implementation strategies to drive practice change for early CP diagnosis and intervention.

Methods: Theory-based CP guideline implementation studies were conducted: systematic review of impact of CP guideline adoption on patient outcomes; Delphi study of physician barriers to early diagnosis; guidelines for communicating CP diagnosis; scoping review of differential motor impairment interventions; development of physician adaptive and non- adaptive e-learning and e-book for early CP diagnosis; validation of physician key-features examination of CP diagnosis decision-making; e-learning clinical trial to evaluate physician practice, patient outcomes and costs; and tailoring e-learning to other contexts.

Results: CP guideline adoption reduces age of diagnosis by 7.5 months; physician communication, referrals, decision-making delay diagnosis; SPIKES protocol aids CP diagnosis communication; therapies specific to motor impairment type exist; adaptive e- learning converges behaviour and practice change specific to users, and e-book provides point of care information; validity evidence established with Kane’s framework for key- features assessment of CP diagnosis decision-making; e-learning trial collects evidence of CP diagnosis, physician practice and patient outcomes, comparing designs and costs; e-learning tailored to high- and low-income contexts.

Conclusions: Implementing CP diagnosis guidelines improves patient outcomes. Clinical trial data will provide e-learning comparative effectiveness outcomes and clarify practice change drivers, enabling replication.