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 meetthe needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly inresource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact oftwo models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programmeand the other institution-based.Method: Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after threemonths. Twenty children received rehabilitation services in a community setting and 26 received services as outpatientsat a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of carewas measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modifiedMedrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportionmet 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 theoutreach-based treatment group improved their motor function 6% more than children receiving institution-basedservices.There were no differences detected between the groups with regard to caregiver well-being and 51% of thecaregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that theywere overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden ofcaregiver 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.Conclusion: Long term caregiving leads to strain in caregivers and there is a need to design interventions to alleviatethe burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findingsfrom this study suggest that the provision of care within a community setting as part of a well-structured outreachprogramme 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.