Managing Cranial Deformities: Ability Developing Best Practices for CRO Therapy
Ability Prosthetics & Orthotics is developing best practices for the orthotic management of patients with bracycephaly and plagiocephaly. The undertaking is part of Ability’s commitment to continuously improve quality of care and is an important first step in objectively quantifying outcomes resulting from cranial remolding orthoses (CROs) in patients with cranial deformity for physicians, payers, and parents.
“We are looking closely at our patient outcomes in order to refine our treatment protocol and continuously improve our practices,” says Julie McCulley, MPO, MS, ATC/L, resident prosthetist/orthotist and Ability Exton.
McCulley is assisting Ability clinicians Taffy Bowman, CPO; Marlies Cabell, CPO; and Amira Mouad, CPO, with data collection, evaluation, and development of the best practices.
“We’re looking at each aspect of our helmeting therapy program to ensure the treatment has been effective,” she says.
The Ability clinicians evaluated the outcomes associated with CRO interventions over an 11-month period by pulling de-identified patient data, including age, cephalic ratio (CR), and cranial vault asymmetry index (CVAI), from their electronic medical records (EMR) system. CR is one of the most common measurements taken in the evaluation of bracycephaly, and CVAI is one of the most common measurements taken in the evaluation of plagiocephaly.
“Our results were encouraging in showing that cranial deformity was reduced through our CRO treatment.”
In all, 20 patient records were evaluated — seven with bracycephaly and 13 with plagiocephaly. The records show that the severity of the deformity was reduced for the majority of patients in both groups. All of the patients with bracycephaly showed a reduction in CR, and 85 percent of patients with plagiocephaly showed a reduction in CVAI. In the bracycephaly group, 43 percent of the patients reached a normal threshold, and in the plagiocephaly group, 38 percent of the patients improved to severity level 2.
“Our results were encouraging in showing that cranial deformity was reduced through our CRO treatment,” McCulley says. “This sample is representative of all the positive patient outcomes Ability has achieved for many years. Reviewing outcome measures allows us to monitor the successful reduction of plagiocephaly and bracycephaly with cranial remolding orthoses in each patient.”
The group will use these findings as a starting point for adopting best practices for documenting patient outcomes in all 10 practice locations and use them to optimize the orthotic management of patients with cranial deformity. Due to the many variables associated with each patient, they say, it may not be feasible to follow a strict guideline and expect uniform results for each patient; however, documenting and monitoring outcomes of CRO therapy is important to help clinicians gauge whether their techniques, modifications, and overall treatment plans are meeting patient needs.
The clinicians plan to present their outcomes at an upcoming national conference. Future analyses will include age, duration of treatment, and circumference measurements, in order to better understand how the growth rate of each patient affects the outcome. “We’ll continue to benchmark our patient outcomes and disseminate our results within the O&P community,” McCulley says.