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

BMC Pediatrics

Research Article

Jennifer Jelsma¹  Jermaine M Dambi² 

[1] Division of Physiotherapy, Department of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town, Anzio Road, Observatory, Cape Town, South Africa;Research Fellow at University of Cape Town, Lecturer Department of Rehabilitation, College of Health Sciences, University of Zimbabwe, Avondale, Harare, Zimbabwe;

关键词: Cerebral palsy;    Community based rehabilitation;    Institution based intervention;    Rehabilitation;    Zimbabwe;   

DOI  :  10.1186/s12887-014-0301-8

 received in 2014-06-25, accepted in 2014-11-25,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundCerebral 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.MethodQuestionnaires 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.ResultsChildren 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.ConclusionLong term caregiving leads to strain in caregivers and there is a need to design interventions to alleviate the burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findings from this study suggest that the provision of care within a community setting as part of a well-structured outreach programme may be preferable method of service delivery within a resource-constrained context. It was associated with a greater improvement in functioning, greater satisfaction with services and better compliance.

【 授权许可】

CC BY   
© Dambi and Jelsma; licensee BioMed Central Ltd. 2014