The analytic framework (Figure 1) outlines the path of care for individuals with CP and feeding difficulties; numbers in circles on the diagram represent key questions. The framework illustrates multiple indications of disrupted nutrition among this population, including signs of malnourishment or failure to thrive, episodes of aspiration or pneumonia, swallowing difficulties, or other clinical concerns for nutritional support. Individuals typically undergo a feeding and nutrition assessment, which could be followed by a behavioral (Key Question 1a) or nutritional (Key Question 2a) feeding intervention or a combination of such approaches, or the placement of a tube for feeding (Key Questions 3a–c). Individuals with reflux may undergo tube placement with fundoplication to help alleviate reflux (Key Question 3b). Individuals without pre-existing reflux who undergo a tube placement may develop reflux following the procedure and require additional treatment via a jejunostomy tube or fundoplication (Key Question 3c). Possible intermediate or surrogate outcomes resulting from these interventions can include a change in growth status, improved swallowing, or various adverse effects. At this point on the pathway, individuals with CP may undergo another feeding and nutrition assessment followed by an alternative intervention. Patient-centered and health outcomes following intermediate outcomes can include mortality, incidences of hospitalizations, antibiotic use, quality of life, patient and family satisfaction and stress, changes in time spent on feeding activities, physical and mental health of the primary caregiver, pain or comfort, and various adverse effects. Certain factors may influence the pathway at all stages and can include the type and severity of CP, age, race, intellectual and clinical comorbidities, severity of intellectual disability, and caregiver or family needs (Key Questions 1b, 2b, 3d specifically address potential modifiers of treatment effectiveness). Numbers in circles within the diagram indicate the placement of key questions in relation to the treatment process.

Figure 1Analytic framework

Note: Numbers in circles represent Key Questions.

From: Methods

Cover of Interventions for Feeding and Nutrition in Cerebral Palsy
Interventions for Feeding and Nutrition in Cerebral Palsy [Internet].
Comparative Effectiveness Reviews, No. 94.
Ferluga ED, Archer KR, Sathe NA, et al.

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