The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study

Abstract

Background: Cerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based. Method: Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments. Results: Children receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services. There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain. Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (p < .001) as compared to recipients of institution-based services.

Caregiver satisfaction with a multidisciplinary community-based rehabilitation programme for children with cerebral palsy in South Africa

“…15 This study used an adapted tool 13 and, although the output of the level of satisfaction questionnaire was overall positive and valuable as it directly impacts treatment outcomes, 3 the exploratory discussions highlighted significant areas for assisting the rehabilitation of children living with CP by advocating the view of the caregivers.…”

“…In an analogous resourcelimited African setting a study revealed that caregivers of children with CP need added financial and emotional support. 3 Researchers in the study adopted a decentralised community approach by basing the study at the clinics; this negated the environmental limitations, improved social support and improved the outcomes of a rehabilitation intervention programme compared with an institutional based health setting making specific appointments for rehabilitation sessions. 3 This is supported by another South African study advocating that community-based interventions provide psychosocial support, support relationships and improve social functioning and selfesteem.…”

“…3 Researchers in the study adopted a decentralised community approach by basing the study at the clinics; this negated the environmental limitations, improved social support and improved the outcomes of a rehabilitation intervention programme compared with an institutional based health setting making specific appointments for rehabilitation sessions. 3 This is supported by another South African study advocating that community-based interventions provide psychosocial support, support relationships and improve social functioning and selfesteem. 17 In another study in Turkey looking at the quality of life of mothers of children with CP as primary caregivers, researchers corroborate that lack of resources and transport limitations pose a challenge to caregivers' primary role.…”

“…10 Compliance with rehabilitation is directly related to levels of satisfaction and influences commitment to the intervention. 3 In the rehabilitative care of children with CP, the involvement of the caregivers and their level of satisfaction is of importance as their participation has an impact on the rehabilitation goals. 3 Furthermore, satisfaction with rehabilitation intervention is an imperative outcome that is believed to influence the emotional well-being of carers and impacts on a child's psychology.…”

“…3 In the rehabilitative care of children with CP, the involvement of the caregivers and their level of satisfaction is of importance as their participation has an impact on the rehabilitation goals. 3 Furthermore, satisfaction with rehabilitation intervention is an imperative outcome that is believed to influence the emotional well-being of carers and impacts on a child's psychology. 11 Scarcity in caregiver satisfaction and perception of rehabilitation is evident in resource-poor settings such as South Africa, thus this study is crucial in informing research for rehabilitation professionals involved in the management of children with CP.…”