Clinical practice guidelines developed for orthotic management of deformational plagiocephaly

BROOMFIELD Colo. — The Clinical Standards Committee of Hanger Clinic recently developed clinical practice guidelines for cranial remolding orthoses in the management of deformational plagiocephaly. The process for the creation of the guidelines was presented by Curt A. Bertram, CPO, FAAOP, national orthotics specialist for Hanger Clinic in Hartland, Wis., at the Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting, here.

Bertram and colleagues wanted to develop guidelines through consensus that led to definable and actionable standards for clinicians.

“At Hanger Clinic, one of our number-one [goal]s was to provide guidance to our novice clinicians while respecting the expertise of our established clinicians, and not overly prescriptive mandates but establish boundaries and stay within these guidelines,” Bertram said.

Curt Bertram

Curt Bertram


The researchers conducted an online survey of clinicians based on best practice standards presented as postulates. The postulates were created by an advisory panel of 10 multidisciplinary subject matter experts (SMEs) and refined by a group of 30 cranial orthotists. The first round of surveys asked respondents to rate their level of agreement with the postulates on a five-point Likert scale and to include feedback. Initial response rate was 77%, and 47 of the original 54 postulates were accepted by a consensus (greater than 70%) of respondents.

Of those, six postulates needed revision. Ultimately, 13 of the original 54 postulates went through a second round of surveys. Ultimately, all 13 items reached consensus.

Bertram and colleagues learned not to make topics too broad, as the group spent 2 years refining the guidelines for this topic.

“This was difficult to implement and very time-consuming,” he said.

Hanger Clinic’s clinical standards committee is developing additional guidelines for other diagnoses and technologies in O&P.

“Our ultimate goals [are] to ensure comprehensive, informed evaluations and decision-making, and begin evidence-based O&P,” he said. “It also helps to prepare us for a large-scale outcomes data collection.” – by Amanda Alexander


Bertram C. Development of clinical practice guidelines for the orthotic management of deformational plagiocephaly. Presented at: Association of Children’s Prosthetic-Orthotic Clinics Annual Meeting; April 13, 16, 2016; Broomfield, Colo.

Bertram C, et al. Cleft Palate Craniofac J. 2015; doi:10.1597/15-007.

Disclosure: Bertram reports no relevant financial disclosures.

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