Models of care for hypertonia in childhood: a scoping review

BACKGROUND: Hypertonia is a common presentation in Paediatric clinics, but unifying operationalised models of care to guide a coordinated treatment approach currently lacking. AIM: We reviewed the published literature on models of care for paediatric hypertonia, with the goal of identifying unifying themes successfully implemented globally that could underpin the development of a future care delivery model in the UK. METHODS: We performed a scoping review as per the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Extension-Scoping Reviews. Our research question was: 'what existing data are available regarding models of care in paediatric hypertonia?'. A comprehensive search strategy was applied, using commonly used terms relating to healthcare models. We searched Embase, CINAHL and PubMed for relevant articles. Extracted data from included studies were qualitatively analysed for relevant themes. RESULTS: 13 studies were included in the final analysis. We identified five themes: (1) patient-centred approach, (2) multidisciplinary team-working, (3) clear patient pathways, (4) evidence-based medicine and (5) integration of telemedicine. No study identified described an overall coordinated approach for the management of CYP with hypertonia, with individual studies instead focussing on either specific symptoms (eg, spasticity) or deliveries of specific interventions (eg, deep brain stimulation or Botox) to particular patient populations. No study specified national practice, with all studies outlining practices in particular hospitals/healthcare networks. CONCLUSION: This scoping review identified useful themes that can be used to inform a unifying model of care for paediatric hypertonia, including considering how primary/secondary/tertiary/quaternary services can optimally organise service provision.