Challenges in Toileting Evaluation and Interventions for Children With Cerebral Palsy: A Delphi Study

Importance: Toileting difficulties have a significant impact on the daily lives of children with cerebral palsy (CP), yet research on this issue remains inadequate. There is a critical need to better understand the challenges health care professionals face in addressing toileting difficulties. Objective: To explore challenges faced by health care professionals in toileting evaluation and interventions for children with CP ages 6-18 yr. Design: A mixed-methods study with a two-phase exploratory sequential design and using a global Delphi consensus technique. Setting: Email communication. Participants: Fifty-two national and international allied health professionals and 16 mothers of children with CP were involved in the preparation of the Delphi questionnaire. Additionally, 162 professionals participated in the Delphi study. Outcomes and Measures: Challenges were identified and refined iteratively through the Delphi questionnaire. Consensus was measured using a Likert scale, considering agreement percentages and median scores. Results: The study revealed strong consensus (94.4%), emphasizing the need for comprehensive training, particularly in working with pediatric populations. Concerns about limited research on and training in toileting function (88.9%) and challenges such as inadequate assessment environments and sanitation facilities (96.9%) underscore the need for practical and innovative educational methods to illustrate toileting procedures. Additionally, the findings highlight concerns about toileting issues and diverse commitment levels among professionals. Conclusions and Relevance: This study pinpointed critical challenges in toileting management for children with CP. These high-consensus findings stress the urgent need for holistic strategies, comprehensive education, and interdisciplinary collaboration to improve the quality of life and independence of these children. Plain-Language Summary: Toileting difficulties have a significant impact on the daily lives of children with cerebral palsy (CP), yet research on this issue remains inadequate. This study highlights significant gaps faced by health care professionals in understanding and addressing challenges in toileting evaluation and intervention for children with CP. Insights from professionals stress the critical need for global collaboration, standardized assessments, and improved education to effectively tackle CP-related toileting issues for children.