Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

Abstract

Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services. Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective. Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS). Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028). Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.

Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden—A national registry study

“…A plausible explanation could be that the question may have appeared less relevant to them since their physical limitations were mild. This group of children with mild motor impairments also engage more in leisure time physical activity and physically active children seem to receive less physiotherapist supervision . As one of the roles of the physiotherapist is to promote physical activity it is a reasonable assumption that levels of physical leisure activity may affect physiotherapeutic interventions; however, this issue is not explored in current study.…”

“…Factors presumed to affect need for physiotherapeutic intervention were selected as independent variables. 5,8,24,25 The study procedures followed the principles of the declaration of Helsinki 26 and the data were presented in a way that prevents individual child or caregiver identification. Approval from the Regional Ethical Review Board at Umeå University was obtained (reg.…”

“…Qualitative studies from eight European countries, including Sweden, have reported that children in vulnerable life situations, such as those with functional—or socioeconomic disadvantages or in ethnical minorities, have limited knowledge of their rights and also limited experience of being listened to in general . Furthermore, an uneven distribution of physiotherapy for children with Cerebral Palsy has been detected between northern geographical regions of Sweden, in a previous study, as well as a tendency for boys to receive physiotherapy to a higher degree compared with girls . Inequity in care and perceived discrimination may affect health negatively, and decrease function, well‐being and further the willingness to seek medical treatment .…”

“…7 Furthermore, an uneven distribution of physiotherapy for children with Cerebral Palsy has been detected between northern geographical regions of Sweden, in a previous study, as well as a tendency for boys to receive physiotherapy to a higher degree compared with girls. 8 Inequity in care and perceived discrimination may affect health negatively, and decrease function, well-being 9,10 and further the willingness to seek medical treatment. 9,11 Considering the risk of discrimination, adverse healthrelated consequences, and a limited knowledge and ability to assert their own rights, it seems important to ensure that children with disabilities receive adequate care on equal terms with regard to social belonging as well as medical needs.…”

Intersections between gender and other relevant social determinants of health inequalities

“…Zhang’s paper also takes this approach, to assess health disparities among the elderly in rural China focusing on gender and ethnicity [5]. To a certain extent, Grace´s systematic review analyzing gendered differences in the detection of leprosy [6], and Degerstedt et al’s analysis of physiotherapeutic interventions and physical activity for children living with cerebral palsy in Northern Sweden could also be included in this group [7]. …”