Degerstedt F1, Björklund M1,2, Enberg B1
1Umeå University, Department of Community Medicine and Rehabilitation, Umeå, Sweden, 2University of Gävle, Centre for Musculoskeletal Research, Department of Occupational and Public Health Sciences, Gävle, Sweden
Background: Children and young persons with Cerebral Palsy (CP) are often in need of physiotherapeutic interventions throughout life, commonly by habilitations units, and therefore dependent on the physiotherapist for giving them adequate care based on individual needs. In the general Swedish population there is inequity within healthcare regarding for instance gender and ethnicity. To our knowledge little is known about possible inequity regarding physiotherapeutic interventions for children with CP in Sweden.
Purpose: The aim of this study was to investigate how physiotherapeutic interventions (PTI) were distributed in Sweden for children with different severity of CP. The distribution was analyzed from an equity perspective regarding sex, country of birth and region of living.
Methods: Data was collected from the Swedish national quality health care registry, Cerebral Palsy Follow-Up Program (CPUP). Children 0-18 years who participated in the CPUP physiotherapy assessment in 2015 were included in the study. Chi2 and logistic regressions were used for comparison and associations between the PTI variables Received PTI, Received frequent PTI, Participation in intensive training, Physiotherapist presence at interventions and the equity factors Sex, Country of birth and Region of living. Gross Motor Function Classification Scale, Intellectual disability (ID) and Age group were further variables included in the analyses.
Results: Physiotherapeutic interventions were equally distributed between sexes. Children born in Sweden were more likely to receive PTI than children born in other countries. There were differences in the distribution of PTI variables between regions of living. Presence of physiotherapist at interventions was less common for children with ID compared to children without ID.
Conclusion(s): Current study shows inequity in physiotherapeutic interventions for children with CP. Children born outside Sweden were less likely to receive PTI compared to those born in Sweden. The reasons for this bias need further investigations, however, it is important that extra effort is made by physiotherapists and the habilitation services to facilitate for these children to receive the care they need and are entitled to. The regional bias of PTI distribution indicates that other factors than the medical assessments and needs matter for the habilitation services given. Moreover, children with ID had less presence of physiotherapist compared to children without ID. This may lead to poorer quality of interventions due to less professional support.
Implications: The inequity for children with CP shown in this study calls for attention with regard to physiotherapeutic interventions given within the habilitations services. The reasons for the inequity need to be investigated further. Nonetheless, it may indicate a bias in the care of children within the habilitation services. Therefore this is crucial for physiotherapists to be aware of the inequity in order to be able to take measures. Current study also demonstrates unequal distribution of PTI in different regions of Sweden. Regardless the reason for the inequity, it is an important issue for professionals and politicians to consider and analyze further. Results from this work will be published and reported to the CPUP-registry for further distribution to habilitation units.
Keywords: Gender, CPUP, Habilitation
Funding acknowledgements: This research was supported by the Norrbacka-Eugenia foundation [grant number 811/15 2016].
Purpose: The aim of this study was to investigate how physiotherapeutic interventions (PTI) were distributed in Sweden for children with different severity of CP. The distribution was analyzed from an equity perspective regarding sex, country of birth and region of living.
Methods: Data was collected from the Swedish national quality health care registry, Cerebral Palsy Follow-Up Program (CPUP). Children 0-18 years who participated in the CPUP physiotherapy assessment in 2015 were included in the study. Chi2 and logistic regressions were used for comparison and associations between the PTI variables Received PTI, Received frequent PTI, Participation in intensive training, Physiotherapist presence at interventions and the equity factors Sex, Country of birth and Region of living. Gross Motor Function Classification Scale, Intellectual disability (ID) and Age group were further variables included in the analyses.
Results: Physiotherapeutic interventions were equally distributed between sexes. Children born in Sweden were more likely to receive PTI than children born in other countries. There were differences in the distribution of PTI variables between regions of living. Presence of physiotherapist at interventions was less common for children with ID compared to children without ID.
Conclusion(s): Current study shows inequity in physiotherapeutic interventions for children with CP. Children born outside Sweden were less likely to receive PTI compared to those born in Sweden. The reasons for this bias need further investigations, however, it is important that extra effort is made by physiotherapists and the habilitation services to facilitate for these children to receive the care they need and are entitled to. The regional bias of PTI distribution indicates that other factors than the medical assessments and needs matter for the habilitation services given. Moreover, children with ID had less presence of physiotherapist compared to children without ID. This may lead to poorer quality of interventions due to less professional support.
Implications: The inequity for children with CP shown in this study calls for attention with regard to physiotherapeutic interventions given within the habilitations services. The reasons for the inequity need to be investigated further. Nonetheless, it may indicate a bias in the care of children within the habilitation services. Therefore this is crucial for physiotherapists to be aware of the inequity in order to be able to take measures. Current study also demonstrates unequal distribution of PTI in different regions of Sweden. Regardless the reason for the inequity, it is an important issue for professionals and politicians to consider and analyze further. Results from this work will be published and reported to the CPUP-registry for further distribution to habilitation units.
Keywords: Gender, CPUP, Habilitation
Funding acknowledgements: This research was supported by the Norrbacka-Eugenia foundation [grant number 811/15 2016].
Topic: Paediatrics: cerebral palsy; Professional practice: other
Ethics approval required: Yes
Institution: Umeå University
Ethics committee: Regional Ethical Review Board at Umeå University
Ethics number: 2016/343-31
All authors, affiliations and abstracts have been published as submitted.
