Multicenter Improvement in Screening for Dystonia in Young People With Cerebral Palsy

Abstract

Background and objectives: Dystonia is a common, debilitating, and often treatment-refractory motor symptom of cerebral palsy (CP), affecting 70%-80% of this population based on research assessments. However, routine clinical evaluation for dystonia in CP has failed to match these expected numbers. Addressing this diagnostic gap is a medical imperative because the presence of dystonia rules in or out certain treatments for motor symptoms in CP. Therefore, our objective was to optimize rates of clinical dystonia screening to improve rates of clinical dystonia diagnosis.

Methods: Using the quality improvement (QI) infrastructure of the Cerebral Palsy Research Network (CPRN), we developed and implemented interventions to increase the documentation percentage of 5 features of dystonia in young people with CP, aged 3-21 years. This QI initiative was implemented by 7 physiatry and pediatric movement disorders physicians at 4 tertiary-care pediatric hospitals between October 10, 2021, and July 1, 2023. Using a prospective cohort study design, we collected visit data across all participating sites every 2 weeks and tracked our progress using control charts.

Results: We assessed 847 unique visits, mostly for established patients (719/847, 85%) who were 9.2 years old on average (95% CI 8.8-9.5). By April 10, 2022, the mean percentage of dystonia screening elements documented across all sites increased from 39% to 90% and the mean percentage of visits explicitly documenting the presence or absence of dystonia increased from 65% to 94%. By October 23, 2022, the percentage of visits diagnosing dystonia increased from 57% to 74%. These increases were all sustained through the end of the study period on July 1, 2023.

Discussion: Using a rigorous QI-driven process across 4 member sites of a North American learning health network (CPRN), we demonstrated that we could increase screening for dystonia and that this was associated with increased clinical dystonia diagnosis, matching expected research-based rates. We propose that similar screening should take place across all sites caring for people with CP.