The benefits of providing a local serial casting service for children and young people in Powys.

Purpose

Serial casting is a common conservative intervention for children and young people who are idiopathic toe walkers, or who have cerebral palsy and develop calf muscle contracture. The main aims of serial casting are to improve calf muscle length, walking pattern and efficiency. There is a strong evidence base showing serial casting is effective in improving calf muscle length. Historically in the large and rural county of Powys serial casting has been provided by out-of-county hospitals, making access difficult and involving children, young people and their families travelling long distances. A local physiotherapy-led serial casting service has been piloted within Powys for the last 1 year and 9 months, with capacity to provide treatment in local hospitals and schools as well as client´s homes. A retrospective audit was carried out to assess the benefits and effectiveness of this service.

Total time saved for the families was 213 hours
equivalent to 33 school days or mean 1.6 school days/child
Over 1 year and 9 months
the local service has provided a cost saving of £26,552

Approach

Data was collected to determine the diagnosis, number and ages of children and young people who had received treatment; the number of contacts, episodes of care and casts provided. In addition the distance travelled and time involved for families, as well as the financial costs of the local service was calculated as compared to similar provision in out of county hospitals. Changes in calf muscle length immediately post casting were calculated using goniometry from standardised photographs. Client satisfaction questionnaires were conducted to gauge families´ opinions about the local service

Outcomes

21 children and young people, aged 18 months to 15 years of age, have received treatment, with the most common diagnoses Cerebral Palsy (10), Ideopathic Toe Walking (3) and Syndromes (3). The service provided 124 contacts, 48 episodes of care and applied 125 casts. Total mileage saving for the families was 5,705 miles, mean 272 miles/child, 119 miles/episode of care and 46 miles/contact. Total time saved for the families was 213 hours, equivalent to 33 school days or mean 1.6 school days/child. Mean improvement in ankle dorsiflexion range was 8.87 degrees for knee bent slow stretch (R2), 11.68 degrees for knee straight (R2) and 9.53 degrees for knee straight fast stretch (R1). Client feedback questionnaires reported a range of benefits including easier access; clients more at ease in local settings with familiar staff; flexibility with appointment times and location; better co-ordination of care and having a local contact for help if needed.  

A local physiotherapy-led serial casting service in a rural area can provide effective treatment to improve calf muscle tightness, time savings and reduced travel distances for children, young people and their families as well as delivering significant cost savings. However further work is needed to establish effectiveness to improve functional goals and gait patterns.

Cost and savings

Cost savings were substantial; based on NHS England payment by results tariffs the local service has provided a cost saving of £26,552 over 1 year and 9 months.

Implications

Children and young people´s long-term independence is supported by maintaining their calf muscle length with a conservative physiotherapy led intervention. Long term surgical and care costs may also be reduced.

Fund acknowledgements

No funding has been provided for this work.

Additional notes

This work was presented at Physiotherapy UK 2019