Orthopaedic and spinal surgery

The Occupational Therapy team provide inpatient care and pre-operative assessment to the Orthopaedic and spinal service at Great Ormond Street Hospital (GOSH).

Advice is provided in partnership with the other members of the multidisciplinary team involved in your child's care.

We provide advice on managing daily function (eg getting in and out of bed or on and off the toilet) and precautions needed before and after surgery. More specific advice may be given regarding mobility and supporting your child to become more independent in self-care activities, schoolwork and play. We may also advise on the use of appropriate specialist equipment and seating as required.

The Orthopaedic OT team play an important role in preparing children for discharge home and back into their community, following surgery in a safe and timely way.

The team is available to answer your questions and to offer support to local services who may require additional information regarding your child's needs. This is to ensure continuity of care, particularly regarding the provision of equipment such as hoists and wheelchairs.

Developmental dysplasia of the hip (DDH) is a condition characterised by abnormal development of the acetabulum in young children and babies. There are varying levels of hip dysplasia, from mild to severe. If left untreated, it can progress to hip subluxation or dislocation and may require surgery under general anaesthesia to re-shape the acetabulum to allow the femoral head to sit inside the socket. If surgery is needed, the child may require the application of a hip spica to hold structures in place for a period of time. A hip spica is a cast worn after surgery for several weeks. These patients are cared for by the Orthopaedic MDT, including an Occupational Therapist (OT) who helps families to address the child’s activities of daily living (ADLs) such as personal care, transfers and school/nursery attendance and transport.

The hip spica questionnaire was developed by the Orthopaedic OTs for patients and their parents (or carers) to provide feedback regarding the quality and effectiveness of the Occupational Therapy service. It is a patient-reported experience measure for children who are undergoing unilateral or bilateral hip surgery with application of a hip spica. It also gives parents the opportunity to feedback if there are specific areas in which the OT service could improve the overall patient experience either pre-operatively (before surgery) or post-operatively (after surgery).

The questionnaire was given to the patients and their parents following all surgical intervention and OT input, but prior to discharge from hospital. There were 20 questionnaires collected for children aged 6 months to 8 years. All questionnaires were filled in by parents due to the age of the children.

The results are split into the pre-operative period and post-operative period to capture the whole patient journey.

Pre-Operative Stage:

In the pre-operative stage, the child was seen for an outpatient assessment by the OT to gather information about the child’s current function, their home environment and school/nursery. This information was obtained face to face and via telephone due to the Coronavirus pandemic. At that time, the OT provided information about the hip spica and resources to help manage the practicalities of a child in a hip spica. The resources included Steps spica booklet, GOSH spica leaflet, ‘In Car Safety’ leaflet (see links below) and appropriate practical demonstrations e.g., bathing, toileting, transfer method, clothing, pressure care, seating, and positioning. School/nursery attendance was also discussed.

Parents were asked to evaluate whether they found this information given by the OT helpful and relevant.

It is evident that all parents, before surgery, found the idea of managing their child in a hip spica challenging; 65% strongly agreed and 35% agreed with this statement. Regarding the information and resources provided by OT at the pre-operative assessment, via verbal communication, leaflets and some demonstrations, more than 75% of parents strongly agreed or agreed this was relevant.

Not all families received the practical demonstrations at the pre-operative assessment, as some were conducted by phone. This may explain why 25% of parents selected “I don’t know/not applicable”.

Overall following the pre-operative assessment, 50% of parents strongly agreed and 40% agreed that they felt reassured they would be able to manage their child with the hip spica following surgery. Only 10% stated they did not know if this information was helpful.

In conclusion, it is evident all parents who participated in this questionnaire felt the experience of their child undergoing surgery and the application of a hip spica would be challenging. The information provided at the pre-operative stage is educational to prepare parents for what to expect, to problem solve and alleviate any worries or concerns they may have. However, for some, this was too much information too soon. The educational information and practical demonstrations provided at the post-operative stage appear to be better understood once their child has the hip spica in situ and parents themselves lead on the management, before being discharged home.

Overall, the majority of parents/carers are very satisfied with their patient journey experience and the Occupational Therapy service provided at the pre-operative and post-operative stage.

Table 2 reflects the results of the information and practical demonstrations provided following the application of the hip spica while the child was an inpatient. Overall, 90% of the parents strongly agreed and 10% of the parents agreed to being satisfied with the practical input given during their child’s inpatient stay.

The practical demonstrations by the OT on the ward following surgery and application of hip spica were considered most relevant; more than 80% of parents strongly agreed to being satisfied with this input. Furthermore, 80% of the parents strongly agreed or agreed that advice on managing transport was helpful. Only 10% selected “I don’t know/not applicable” regarding the satisfaction of travel input. Most of our children who have the application of a hip spica will not fit in a car seat and are required to use a buggy/wheelchair for all mobility. We recommend our families contact In Car Safety for any car seating needs otherwise we recommended they use a buggy/wheelchair on public transport. GOSH arranges stretcher transport home upon discharge, and to return for spica to be removed. This is always discussed with the parent at the pre-operative assessment and again after surgery.

Additionally, regarding school advice, some of the children had not started school or nursery and thus it would not impact this activity of daily living. This is reflected in the questionnaire with 10% of parents/carers stating, “I don’t know/not applicable” as the child of this respondent was 6 only months old.

At the end of the questionnaire, we asked parents if they had any additional comments on how we could improve our Occupational Therapy service.