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Inequity in physiotherapeutic interventions for children with Cerebral Palsy in Sweden: a national registry study
Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi.
Umeå universitet, Samhällsvetenskapliga fakulteten, Umeå centrum för genusstudier (UCGS). Umeå Universitet. (Britt-Inger Keisu)ORCID-id: 0000-0002-9627-4625
Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Avdelningen för fysioterapi. Centre for Musculoskeletal Research, Department of Occupational Health Sciences and Psychology, Faculty of Health and Occupational Studies, University of Gävle, Gävle, Sweden.ORCID-id: 0000-0001-7543-4397
2020 (Engelska)Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 109, nr 4, s. 774-782Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Aim: The aim of this study was to investigate the distribution of physiotherapeutic interventions for children with Cerebral Palsy in Sweden from an equity perspective, considering sex, country of birth and geographical region.

Method: This national cross‐sectional registry study includes children with Cerebral Palsy aged 0‐18 years who participated in 2015 in the Swedish national quality registry, the Cerebral Palsy follow‐up programme, CPUP. Comparisons and associations between physiotherapeutic interventions and sex, country of birth and geographical regions were conducted using chi‐square and logistic regression analysis, controlling for cognitive level, level of motor function, age group and dominating symptom.

Results: Of the 2855 participants, 2201 (79%) had received physiotherapy. Children born in Sweden had 1.60 times higher odds (95% CI 1.10‐2.33) of receiving physiotherapy compared with children born in foreign countries. Distribution of physiotherapeutic interventions differed significantly between geographical regions. No associations between sex and physiotherapeutic interventions were observed.

Conclusion: The results of this study indicate inequity in care in Sweden towards children with Cerebral Palsy born in other counties. Further, physiotherapeutic interventions were not equally distributed in different geographical regions of Sweden. Knowledge of inequity is crucial in order to address the problem.

Ort, förlag, år, upplaga, sidor
John Wiley & Sons, 2020. Vol. 109, nr 4, s. 774-782
Nyckelord [en]
adolescents, cerebral palsy, CPUP, inequity, physiotherapy
Nationell ämneskategori
Sjukgymnastik Genusstudier Pediatrik
Identifikatorer
URN: urn:nbn:se:umu:diva-163637DOI: 10.1111/apa.14980ISI: 000488167100001PubMedID: 31435959Scopus ID: 2-s2.0-85073965380OAI: oai:DiVA.org:umu-163637DiVA, id: diva2:1356173
Tillgänglig från: 2019-10-01 Skapad: 2019-10-01 Senast uppdaterad: 2023-05-10Bibliografiskt granskad
Ingår i avhandling
1. Equity among children and youth with cerebral palsy: physical leisure activity, physical education, physiotherapy and quality of life
Öppna denna publikation i ny flik eller fönster >>Equity among children and youth with cerebral palsy: physical leisure activity, physical education, physiotherapy and quality of life
2023 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Jämlikhet bland barn och unga med cerebral pares : fysisk fritidsaktivitet, skolidrott, fysioterapi och livskvalitet
Abstract [en]

Background & aim: Cerebral palsy (CP) is the most common reason for movement difficulties among children and youth in Sweden. Physiotherapy is usually introduced early in order to develop mobility and prevent further impairment, which in turn facilitates activity and participation. Physiotherapy is closely connected with physical activity, both as a goal and a mean, and physical activity contributes to aspects of health, in turn associated with quality of life (QoL). Physical education in school as well as physical leisure activity are important parts of the total physical activity participation among children and youth. Participation in physical leisure activity and physical education, as well as access to physiotherapeutic interventions, is insufficiently explored from an equity perspective regarding function, gender and ethnicity or birth country. The overall aim of the current thesis is to explore participation in physiotherapeutic interventions, physical leisure activity and physical education, as well as analyze the association between physical activity and quality of life, from an equity perspective for children and adolescents with CP in Sweden.

Methods: The four papers that comprise this thesis are based upon three empirical studies: a National cross-sectional registry study (Papers I and II), based on the National Quality Registry Cerebral Palsy Follow-up Program (CPUP); an interview study with a qualitative approach (Paper III); and a national QoL survey complemented with registry data (IV). Quantitative data were analyzed with multivariable logistic-, linear- or quantile regressions. For the interview study, qualitative content analysis was used.

Results: The number of participants in the registry studies were 2855 aged 0-18 years (Paper I) and 1935 aged 6-18 years (Paper II). The interview study (Paper III) included 11 participants aged 15-18 years, and the survey study (Paper IV) 149 participants, aged 15-18 years. Being born in Sweden entailed higher odds for participating in physiotherapy, physical leisure activity, physical education and physiotherapy, respectively, compared to those born outside Sweden (Paper I) or outside Europe (Paper II). More severe gross motor function difficulties were positively associated with higher odds of receiving physiotherapy, and negatively associated with physical activity participation (Paper II). Participants in the interviews report several examples of exclusion, struggles and (in-) sufficient support and inclusion through the categories ‘Exclusion and lack of support’, ‘Resistance, struggle and guilt’, and ‘Empowerment and support’. Gender as a vector in physical activity is mainly seen through the qualitative results, referring to physical education (Paper III). Frequent participation in physical leisure activity was associated with the domain Communication and physical health. Domains of QoL that referred to participation or function were negatively associated with having greater motor function difficulties, although not significantly associated with domains of social- and school wellbeing. Pain and bother is negatively associated with all five domains of QoL. Low educational level among the caregivers was associated with higher QoL-scores in the domain of social well-being (Paper IV).

Discussion & Conclusions: The results that reveals differences regarding birth country indicates the relevance to raise awareness about possible inequity in participation in physical leisure activity, physical education, and physiotherapy for children and youth who have CP, as a prerequisite for improvement. Physiotherapists, school, and leisure sport leaders, as well as their organizations, need to be attentive to norms and bias in order to prevent inequity and discrimination due to for example birth country, gender or function, and provide support, which is included in the compensatory assignment of the schools and health care. This is emphasized by the experiences of exclusion expressed by participating youth with CP. Frequent physical activity participation is in part associated with higher QoL while Pain and bother is negatively associated with QoL, as is partly gross motor function difficulties. Prevention and treatment of pain and facilitation of physical activity is therefore important for children and youth with CP. Future studies should carefully consider targeting youth with a non-Nordic birth country and with large gross motor function difficulties or associated difficulties to widen knowledge about equity in physical activity- and physiotherapy participation, and QoL.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå universitet, 2023. s. 75
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 2245
Nyckelord
Birth country, Cerebral palsy, equity, disability, gender, physical activity, physiotherapy, quality of life
Nationell ämneskategori
Sjukgymnastik
Forskningsämne
fysioterapi
Identifikatorer
urn:nbn:se:umu:diva-208145 (URN)978-91-8070-075-7 (ISBN)978-91-8070-076-4 (ISBN)
Disputation
2023-06-09, Hörsal UB.A.220 - Lindellhallen 2, Umeå, 09:00 (Svenska)
Opponent
Handledare
Forskningsfinansiär
Stiftelsen Sunnerdahls HandikappfondNorrbacka-EugeniastiftelsenStiftelsen drottning Silvias jubileumsfondLinnéa och Josef Carlssons stiftelse
Tillgänglig från: 2023-05-17 Skapad: 2023-05-10 Senast uppdaterad: 2023-05-12Bibliografiskt granskad

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Degerstedt, FridaEnberg, BirgitKeisu, Britt-IngerBjörklund, Martin

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