Indian Hip Surveillance Guidelines for Children with Cerebral Palsy

Guidelines Preamble: Hip displacement is the second most common musculoskeletal impairment in children with cerebral palsy (CP). More than one-third of the children are affected by this problem. Hip displacement in children with CP is often asymptomatic until the hip is partially or fully dislocated, resulting in pain, gait disturbances, impaired sitting balance, difficulty in perineal care and pressure sores. The incidence of hip displacement is much higher in non-ambulatory children. It is now well-known that hip surveillance programmes can effectively detect hip displacement early, leading to earlier proactive management with better outcomes. National and provincial hip surveillance programmes have been developed and adopted in various regions of the world, with evidence supporting the role of surveillance in preventing dislocations and avoiding the need for salvage surgery. To offer similar benefits to Indian children with CP, a guidelines development project on National Hip Surveillance Program for Cerebral Palsy was initiated in May 2020. Based on the outcome of the one-year guidelines’ development project, this guidelines document was prepared from an Indian practice perspective. About development of this Indian guideline: Professional organisations whose members are involved in the care of children with CP were involved in the formation of this guideline. A National Expert Committee was constituted with representatives of these organisations. Advice was sought from international experts on this topic who acted as the Advisory Committee. In phase 1: The Expert Committee reviewed more than 80 published research articles related to various aspects of hip displacement in CP. Key points from these articles were listed. National guidelines from other countries/regions were also reviewed, discussed and referred. In phase 2: All important questions related to hip surveillance were listed. These questions were circulated to all the members of the expert committee. The Delphi process was used to develop consensus on these practical questions. When more than 80% of group members agreed to a particular viewpoint, it was considered as a consensus. With two rounds of the Delphi process, the committee reached a consensus on every single question. Consensus statements were listed. In phase 3: The guideline was drafted based on these consensus statements. The main document was written keeping the from a healthcare professional’s perspective. A simple version of this guideline was also prepared to spread awareness about this important message to the caregivers / family / healthcare aid workers.