A study to determine the physiotherapy management of children with cerebral palsy in public hospitals of KwaZulu-Natal.

Abstract

Background: Medical advances have resulted in the survival of infants born prematurely, placing them at risk and escalating the number of children diagnosed with Cerebral Palsy (CP). CP is a permanent yet changing condition and is one of the leading childhood disabilities with many physiological, mental and secondary complications requiring therapy. Physiotherapy forms an important role in the management of children with CP. However, in KwaZulu-Natal (KZN), limited rehabilitation equipment, poor provision of assistive devices and restrictions on the employment of health care professionals places major strain on the overall management of children with CP. Aim and Objective: To determine the physiotherapy management of children with CP in KZN public hospitals, with the objective of identifying current management practices of children with CP in urban and rural public hospitals, in order to improve the management of these children with CP. Study Design: The study was a cross sectional survey study using a self-designed open and closed-ended questionnaire based on the aim and objectives of this study. Physiotherapists (PTs) employed at various levels of public hospitals in KZN were selected to make up the study population. A quantitative approach was utilised and the sample size of the study was 152. The data collected was systematically and thematically analysed. Results: The response rate of the study was 72 (52.6%) of which 63 (87.5%) were female and 9 (12.5%) were male. The mean age of the participants was 32 years old. Forty one (56.9%) of the PTs worked in a rural hospital while 31 (43.1%) of the participants were employed in an urban hospital. The majority 35 (48.6%) of the respondents treated one to 10 children with CP a month. A limited number of participants 25 (34.7%) used outcome measures to evaluate their children with CP. A Likert scale was used to rate the importance of the common treatment techniques and the most important treatment techniques used by the PTs in this study were postural stabilising activities 68 (94.4%), respiratory care 67 (92.9%) and positioning 67 (92.9%). Most of the participants 32 (45.0%) reported that managing children with CP in a multidisciplinary team (MDT) resulted in a significant difference (p=0.002) between rural and urban based PTs. The Majority of the rural based PTs 39 (95.1%) predominantly managed children with CP in a MDT, while most urban based PTs 24 (77.4%) preferred an individual approach. Twenty one (51.2%) of the rural based PTs predominantly managed children with CP on a monthly basis significantly different (p=0.001) from those 19 (61.3%) of the urban based PTs in this study who managed children with CP on a bi-monthly basis. Seventy one (98.6%) of the respondents in this study included the caregiver (CG) in their management approach. Handover management 69 (97.2%) and back care techniques 64 (90.2%) were the most important CG management approaches as rated on a Likert scale. Thirty two (44.4%) of the participants reported having insufficient skills to manage children with CP, while only 12 (16.7%) participated in CP postgraduate training. Sixty three (87.5%) of the participants reported experiencing one or more challenges whilst managing children with CP; CG complications 21 (34.1%) and a lack of resources 19 (29.7%) were the most common. Fifty eight (80.6%) of the participants provided recommendations for improving the management of children with CP in KZN. The recommended suggestions provided by 19 (33.5%) of the participants were to refine the undergraduate training curriculum and to improve the accessibility of post graduate CP training. Conclusion: The results of this study revealed that the management of children with CP in KZN encourages a MDT approach. This study found that the majority of the rural based PTs managed children with CP in a MDT on a monthly basis reflecting differently from those urban based PTs who managed children with CP individually and on a bi-monthly basis. In this study there were many challenges expressed by the PTs regarding the management of children with CP. It would therefore seem that implementing clinical protocols, procuring assistive devices and employing additional PTs and other health care professionals is a viable option in assisting those PTs already employed in the KZN public health sector. Despite these challenges the overall management of children with CP in KZN is viewed as holistic and favourable.