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O'Neill M, Bourke-Taylor H, Bhopti A, Cotter C. The experiences of families of children with cerebral palsy and complex disability after three years accessing the National Disability Insurance Scheme. Aust Occup Ther J 2024. [PMID: 38839565 DOI: 10.1111/1440-1630.12973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 05/21/2024] [Accepted: 05/22/2024] [Indexed: 06/07/2024]
Abstract
INTRODUCTION In Australia, children with cerebral palsy and complex disability receive funded supports through the National Disability Insurance Scheme (NDIS). This individualised funding scheme requires parents to navigate and advocate on behalf of their child, supported by expert reports, recommendations, and allied health services. Supports aim to enable participation in all areas of daily life, which may be otherwise largely inaccessible to children with complex disability and their families. This study aimed to explore the experiences of families of children with complex disability after 3 years accessing the NDIS. METHODS A qualitative research design with a demographic questionnaire and in-depth interview was undertaken. Purposive sampling was used to recruit participants from one organisation providing occupational therapy and other allied health services. Data analysis implemented Braun and Clarke's thematic approach to examine the experiences of participants. CONSUMER AND COMMUNITY INVOLVEMENT This research was conducted with a registered National Disability Insurance Scheme provider to give voice to parent consumers who raise children with complex disability. FINDINGS Seven mothers and one father (N = 8) of children with complex disability were interviewed. Most parents reported increased success and satisfaction navigating the scheme. Five overall themes were generated from the data: pivotal roles of families, parental empowerment, life-changing equipment, the fallibility of the scheme, and a critical scheme. CONCLUSION Parents reported reliance on the scheme for their child's basic daily care and a more enriched life for their child and family. Parents were grateful for the scheme but experienced inconsistencies, navigation difficulties, and variable choice and control. Most parents had fears about the sustainability of the scheme, translating into uncertainty about their child's future. Allied health professionals, including occupational therapists, are key advocates for children with complex disability and their families. Collaboration through sharing knowledge and skills to support children, their families, and carers is key to empowering parents to navigate the NDIS. PLAIN LANGUAGE SUMMARY The National Disability Insurance Scheme (NDIS) provides funding for people with permanent and significant disability. Children with cerebral palsy (and other complex disability) are lifetime users of the NDIS. For children with complex disability, their families are crucial to ensuring that their daily needs are being met, including providing medication. Previous research indicated that parents rely on the NDIS to support their children; however, there have been various challenges such as long wait times for equipment and difficulty understanding how to use the scheme. This study explored the experiences of families of children with complex disability, after more than 3 years of being an NDIS participant. Eight parents from one therapy service provider completed a short questionnaire about themselves, their child, and their family, followed by an interview with the first author. Four authors (occupational therapists) worked together to design and implement this study. The findings highlighted several key points: the important role of parents as caregivers; parents became more knowledgeable and confident to navigate the NDIS with time; equipment funded by the NDIS was life-changing; the NDIS has ongoing issues; and the crucial nature of the NDIS. Occupational therapists can be extremely important to families, including with supporting families to navigate the NDIS and advocating for them. Occupational therapists must stay current with their knowledge of the NDIS as they provide lifetime support, including prescribing equipment, technology, and home modifications.
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Affiliation(s)
- Maddison O'Neill
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Helen Bourke-Taylor
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Anoo Bhopti
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Claire Cotter
- Cerebral Palsy Education Centre, Glen Waverley, VIC, Australia
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Shuttleworth H, Hickey L, Toovey R. Pathways to participation in gymnastics for children with disability. Disabil Rehabil 2024; 46:2365-2373. [PMID: 37287346 DOI: 10.1080/09638288.2023.2221460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Accepted: 05/31/2023] [Indexed: 06/09/2023]
Abstract
PURPOSE To understand the pathways of children with disability participating in gymnastics in Victoria, Australia. MATERIALS AND METHODS A sequential explanatory mixed-method study design was used. Participants completed an online survey, with selected participants purposively invited to undertake semi-structured interviews via videoconference. Quantitative survey data was analysed using descriptive statistics with preliminary findings informing the invitation of interview participants and refinement of interview questions. Qualitative survey and interview data were analysed together using thematic analysis to create themes. Data was combined to create a conceptual model. RESULTS Fifty-eight parents consented to participate in the study with eight interviews conducted. Key themes were: (1) Tailored, accessible, supportive environments and programs make a difference, (2) An explicitly inclusive club culture helps young people get and stay involved, (3) Coach knowledge about engaging children with disability is valued, (4) Enjoyment, recognition, and achievement facilitate ongoing participation, and (5) Gymnastics has physical and social benefits for children with disability. The findings inform a conceptual model that describes three key stages along a pathway to participation including; choosing gymnastics as a sport, selecting a club, and ongoing participation. CONCLUSION To our knowledge, this is the first study to explore participation of children with disability in gymnastics in Australia. These findings provide guidance to those supporting children with disability to participate in gymnastics (e.g., policy makers, club owners, coaches, and allied health professionals) regarding creating more inclusive environments and experiences at each stage of participation.
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Affiliation(s)
- Holly Shuttleworth
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Australia
| | - Lyndal Hickey
- Department of Social Work, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Australia
| | - Rachel Toovey
- Department of Physiotherapy, Faculty of Medicine, Dentistry and Health Sciences, Melbourne School of Health Sciences, The University of Melbourne, Carlton, Australia
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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods and Practice for Integrating Maternal, Fetal, and Child Health Outcomes, and Family Spillover Effects into Cost-Utility Analyses. PHARMACOECONOMICS 2024:10.1007/s40273-024-01397-5. [PMID: 38819718 DOI: 10.1007/s40273-024-01397-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 05/12/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND Maternal-perinatal interventions delivered during pregnancy or childbirth have unique characteristics that impact the health-related quality of life (HRQoL) of the mother, fetus, and newborn child. However, maternal-perinatal cost-utility analyses (CUAs) often only consider either maternal or child health outcomes. Challenges include, but are not limited to, measuring fetal, newborn, and infant health outcomes, and assessing their impact on maternal HRQoL. It is also important to recognize the impact of maternal-perinatal health on family members' HRQoL (i.e., family spillover effects) and to incorporate these effects in maternal-perinatal CUAs. OBJECTIVE The aim was to systematically review the methods used to include health outcomes of pregnant women, fetuses, and children and to incorporate family spillover effects in maternal-perinatal CUAs. METHODS A literature search was conducted in Medline, Embase, EconLit, Cochrane Collection, Cumulative Index to Nursing and Allied Health Literature (CINAHL), International Network of Agencies for Health Technology Assessment (INAHTA), and the Pediatric Economic Database Evaluation (PEDE) databases from inception to 2020 to identify maternal-perinatal CUAs that included health outcomes for pregnant women, fetuses, and/or children. The search was updated to December 2022 using PEDE. Data describing how the health outcomes of mothers, fetuses, and children were measured, incorporated, and reported along with the data on family spillover effects were extracted. RESULTS Out of 174 maternal-perinatal CUAs identified, 62 considered the health outcomes of pregnant women, and children. Among the 54 quality-adjusted life year (QALY)-based CUAs, 12 included fetal health outcomes, the impact of fetal loss on mothers' HRQoL, and the impact of neonatal demise on mothers' HRQoL. Four studies considered fetal health outcomes and the effects of fetal loss on mothers' HRQoL. One study included fetal health outcomes and the impact of neonatal demise on maternal HRQoL. Furthermore, six studies considered the impact of neonatal demise on maternal HRQoL, while four included fetal health outcomes. One study included the impact of fetal loss on maternal HRQoL. The remaining 26 only included the health outcomes of pregnant women and children. Among the eight disability-adjusted life year (DALY)-based CUAs, two measured fetal health outcomes. Out of 174 studies, only one study included family spillover effects. The most common measurement approach was to measure the health outcomes of pregnant women and children separately. Various approaches were used to assess fetal losses in terms of QALYs or DALYs and their impact on HRQoL of mothers. The most common integration approach was to sum the QALYs or DALYs for pregnant women and children. Most studies reported combined QALYs and incremental QALYs, or DALYs and incremental DALYs, at the family level for pregnant women and children. CONCLUSIONS Approximately one-third of maternal-perinatal CUAs included the health outcomes of pregnant women, fetuses, and/or children. Future CUAs of maternal-perinatal interventions, conducted from a societal perspective, should aim to incorporate health outcomes for mothers, fetuses, and children when appropriate. The various approaches used within these CUAs highlight the need for standardized measurement and integration methods, potentially leading to rigorous and standardized inclusion practices, providing higher-quality evidence to better inform decision-makers about the costs and benefits of maternal-perinatal interventions. Health Technology Assessment agencies may consider providing guidance for interventions affecting future lives in future updates.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
- The Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
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Easton T, Boyd RN, Scuffham PA, Downes MJ. Health care resource use in preschool children with cerebral palsy. Dev Med Child Neurol 2024. [PMID: 38773730 DOI: 10.1111/dmcn.15964] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 04/26/2024] [Accepted: 04/30/2024] [Indexed: 05/24/2024]
Abstract
AIM To estimate the burden of disease and evaluate which factors affect health care resource use (HCRU) in young children with cerebral palsy (CP). METHOD Data were collected as part of a prospective, longitudinal cohort study of children with CP born in Queensland, Australia between 2006 and 2009. HCRU questionnaires were administered at six time points. Data on resource use, socio-demographics, and disease severity were collected. Costs were sourced from Medicare, the Australian National Hospital Cost Data Collection, and market prices. A generalized linear model was used to identify factors influencing CP-related costs. RESULTS A total of 794 questionnaires were completed by 222 participants (mean = 3.6 per participant). Physiotherapy (94%, n = 208) was the most widely accessed allied health care therapy; almost half of the participants (45%; 354 of 794) reported one or more hospital admissions. From the health care funder perspective, a child with CP costs on average A$24 950 per annum (A$12 475 per 6 months). Higher costs were associated with increased motor impairment (Gross Motor Function Classification System, p < 0.001) and increased comorbidities (p = 0.012). INTERPRETATION HCRU in preschool children with CP can be analysed according to disease severity. Both increased motor impairments and increased comorbidities were associated with higher health care costs.
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Affiliation(s)
- Tiffany Easton
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Briabane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research, Child Health Research Centre, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Paul A Scuffham
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Briabane, Queensland, Australia
| | - Martin J Downes
- Centre for Applied Health Economics, Menzies Health Institute Queensland, Griffith University, Brisbane, Queensland, Australia
- School of Medicine, Griffith University, Briabane, Queensland, Australia
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Lamsal R, Yeh EA, Pullenayegum E, Ungar WJ. A Systematic Review of Methods Used by Pediatric Cost-Utility Analyses to Include Family Spillover Effects. PHARMACOECONOMICS 2024; 42:199-217. [PMID: 37945777 PMCID: PMC10810985 DOI: 10.1007/s40273-023-01331-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/25/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND A child's health condition affects family members' health and well-being. However, pediatric cost-utility analysis (CUA) commonly ignores these family spillover effects leading to an incomplete understanding of the cost and benefits of a child's health intervention. Methodological challenges exist in assessing, valuing, and incorporating family spillover effects. OBJECTIVE This study systematically reviews and compare methods used to include family spillover effects in pediatric CUAs. METHODS A literature search was conducted in MEDLINE, Embase, EconLit, Cochrane collection, CINAHL, INAHTA, and the Pediatric Economic Database Evaluation (PEDE) database from inception to 2020 to identify pediatric CUAs that included family spillover effects. The search was updated to 2021 using PEDE. The data describing in which family members spillover effects were measured, and how family spillover effects were measured, incorporated, and reported, were extracted. Common approaches were grouped conceptually. Further, this review identified theories or theoretical frameworks used to justify approaches for integrating family spillover effects into CUA. RESULTS Of 878 pediatric CUAs identified, 35 included family spillover effects. Most pediatric CUAs considered family spillover effects on one family member. Pediatric CUAs reported eight different approaches to measure the family spillover effects. The most common method was measuring the quality-adjusted life years (QALY) loss of the caregiver(s) or parent(s) due to a child's illness or disability using an isolated approach whereby family spillover effects were quantified in individual family members separately from other health effects. Studies used four approaches to integrate family spillover effects into CUA. The most common method was to sum children's and parents/caregivers' QALYs. Only two studies used a theoretical framework for incorporation of family spillover effects. CONCLUSIONS Few pediatric CUAs included family spillover effects and the observed variation indicated no consensus among researchers on how family spillover effects should be measured and incorporated. This heterogeneity is mirrored by a lack of practical guidelines by Health Technology Assessment (HTA) agencies or a theoretical foundation for including family spillover effects in pediatric CUA. The results from this review may encourage researchers to develop a theoretical framework and HTA agencies to develop guidelines for including family spillover effects. Such guidance may lead to more rigorous and standardized methods for including family spillover effects and better-quality evidence to inform decision-makers on the cost-effectiveness of pediatric health interventions.
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Affiliation(s)
- Ramesh Lamsal
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - E Ann Yeh
- Division of Neurology, Department of Pediatrics, University of Toronto, Toronto, ON, Canada
- Neurosciences and Mental Health, SickKids Research Institute, Toronto, ON, Canada
| | - Eleanor Pullenayegum
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada
| | - Wendy J Ungar
- Child Health Evaluative Sciences, Peter Gilgan Centre for Research and Learning, The Hospital for Sick Children, 686 Bay Street, 11th Floor, Toronto, ON, M5G 0A4, Canada.
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.
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Henry G, Webb A, Galea C, Pearce A, Balde I, Garrity F, Marmont S, Espie J, Badawi N, McIntyre S. Out-of-pocket costs for families and people living with cerebral palsy in Australia. PLoS One 2023; 18:e0288865. [PMID: 37471345 PMCID: PMC10358956 DOI: 10.1371/journal.pone.0288865] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/06/2023] [Indexed: 07/22/2023] Open
Abstract
The most recent cost estimates of cerebral palsy (CP) in Australia did not include out-of-pocket costs for families. This study aimed to: 1) describe and estimate out-of-pocket costs for people with CP and their families by age and gross motor function classification system (GMFCS) level; 2) measure financial distress. A cross-sectional quantitative survey design was used with qualitative approaches to analyse open-ended questions. A CP-specific out-of-pocket costs survey was co-designed with people with lived experience. Adults with CP and carers were recruited from Australian population-based CP Registers and via social media. Sociodemographic variables were analysed descriptively and median (IQR) expenses for health, assistive technology, personal care, housing, occupation, transport, leisure, respite and holidays, by age (0-6; 7-17; 18 years +) and gross motor function [GMFCS level I-II vs III-V] were calculated. The In Charge Financial Distress/Financial Wellbeing Scale measured financial distress. Regression analyses were conducted to investigate costs and financial distress. Additional out-of-pocket costs itemised in open-ended questions were charted. Comments were thematically analysed using the framework approach. 271 surveys were completed for children 0-6 years (n = 47), children/adolescents 7-17 years (n = 124) and adults (n = 100). 94% of participants had out-of-pocket costs associated with CP, with an overall annual median of $4,460 Australian dollars (IQR $11,955). After controlling for income, private insurance and disability funding, the GMFCS III-V group had costs two times higher than the GMFCS I-II group (2.01; 95% CI 1.15-3.51). Age was not significantly associated with costs. 36% of participants had high to overwhelming financial distress; this was not associated with age or GMFCS level after controlling for financial factors. Families had several additional disability costs. Open-ended responses revealed experiences of financial concern were influenced by funding scheme experiences, reduced income, uncertainty, access to support networks and an inability to afford CP-related costs. Cost estimates and financial distress indicators should inform policy, funding and clinical decisions when planning interventions to support people with CP and their families.
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Affiliation(s)
- Georgina Henry
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Annabel Webb
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Claire Galea
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Alison Pearce
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, New South Wales, Australia
- Sydney School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Isabelle Balde
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Fiona Garrity
- CP Quest, Cerebral Palsy Alliance, Sydney, New South Wales, Australia
| | - Sophie Marmont
- CP Quest, Cerebral Palsy Alliance, Sydney, New South Wales, Australia
| | - James Espie
- CP Quest, Cerebral Palsy Alliance, Sydney, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
- Grace Centre for Newborn Care, Children's Hospital at Westmead, Sydney, New South Wales, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, The University of Sydney, Sydney, New South Wales, Australia
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Zappas MP, Devereaux A, Pesch MH. The Psychosocial Impact of Congenital Cytomegalovirus on Caregivers and Families: Lived Experiences and Review of the Literature. Int J Neonatal Screen 2023; 9:30. [PMID: 37367211 DOI: 10.3390/ijns9020030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Revised: 05/18/2023] [Accepted: 05/22/2023] [Indexed: 06/28/2023] Open
Abstract
Caring for a child with congenital cytomegalovirus (cCMV) can be costly for families, not only in terms of out-of-pocket expenses, but also in terms of caregiver time, relationships, career trajectories, and mental health. These additional burdens are sometimes referred to as "spillover effects". As parents of children with cCMV, we, the authors of this article, discuss the impact that cCMV has had on our families. While multiple studies have reported on the epidemiology, prevention, screening, diagnosis, and management of cCMV, there has been minimal research regarding the possible impact on the family unit. In this narrative review, we discuss the various areas of the lives of families and caregivers that may be impacted by raising a child with cCMV. Whether children are minimally or severely affected by the sequelae of cCMV, they and their families merit the progression of awareness of the virus and governmental policies to help end cCMV. As the existing cCMV-specific literature is limited, we correlate studies of other childhood disabilities and find the mutuality experienced by families affected by cCMV.
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Affiliation(s)
- Michelle P Zappas
- Department of Nursing, Suzanne Dworak-Peck School of Social Work, University of Southern California, Los Angeles, CA 90015, USA
| | | | - Megan H Pesch
- National CMV Foundation, Tampa, FL 33606, USA
- Division of Developmental and Behavioral Pediatrics, Department of Pediatrics, University of Michigan Medical School, Ann Arbor, MI 48109, USA
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Katumba KR, Tann CJ, Webb EL, Tenywa P, Nampijja M, Seeley J, Greco G. The economic burden incurred by families caring for a young child with developmental disability in Uganda. PLOS GLOBAL PUBLIC HEALTH 2023; 3:e0000953. [PMID: 37075043 PMCID: PMC10115281 DOI: 10.1371/journal.pgph.0000953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 02/14/2023] [Indexed: 04/20/2023]
Abstract
Each year, nearly 30 million children globally are at risk of developmental difficulties and disability as a result of newborn health conditions, with the majority living in resource-constrained countries. This study estimates the annual cost to families related to caring for a young child with developmental disability in Uganda. Nested within a feasibility trial of early care and support for young children with developmental disabilities, this sub-study estimated the cost of illness, the cost of paternal abandonment of the caregiver and the affordability of care by household. Seventy-three caregivers took part in this sub-study. The average annual cost of illness to families was USD 949. The main cost drivers were the cost of seeking care and income lost due to loss of employment. Households caring for a child with a disability spent more than the national average household expenditure, and the annual cost of illness for all households was more than 100% of the national GDP per capita. In addition, 84% of caregivers faced economic consequences and resorted to wealth-reducing coping strategies. Families caring for a child with severe impairment incurred USD 358 more on average than those with mild or moderate impairment. Paternal abandonment was common (31%) with affected mothers losing an average of USD 430 in financial support. Caring for a young child with developmental disability was unaffordable to all the study households. Programmes of early care and support have the potential to reduce these financial impacts. National efforts to curb this catastrophic health expenditure are necessary.
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Affiliation(s)
- Kenneth R. Katumba
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Cally J. Tann
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
- Neonatal Medicine, University College London Hospitals NHS Trust, London, United Kingdom
| | - Emily L. Webb
- Department of Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Patrick Tenywa
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Margaret Nampijja
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
| | - Janet Seeley
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
| | - Giulia Greco
- Medical Research Council/Uganda Virus Research Institute and London School of Hygiene & Tropical Medicine (MRC/UVRI and LSHTM) Uganda Research Unit, Entebbe, Uganda
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, United Kingdom
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Wizinsky AM, Donawerth M, Badgley M, Hemphill-Morytko B, Laughlin E, Rogan M. Stability of the Gross Motor Function Classification System in children with cerebral palsy in the two to four year age band. J Pediatr Rehabil Med 2023; 16:321-329. [PMID: 37005905 DOI: 10.3233/prm-220106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/04/2023] Open
Abstract
PURPOSE This study aimed to investigate the stability of the Gross Motor Function Classification System (GMFCS) in children with cerebral palsy (CP) in the two to four year age band, the frequency at which children were reclassified, and trends of reclassification to higher or lower ability. METHODS This retrospective study included 164 children with CP between 24 to 48 months old with two or more GMFCS ratings at least 12 months apart between their second and fourth birthdays. GMFCS ratings were captured closest to 24, 36, and 48 months. Stability and reclassification trends were analyzed using inferential statistics. Frequency of reclassification, age at ratings, duration between ratings, and corresponding change rate were analyzed using descriptive statistics. RESULTS When comparing ratings closest to second and fourth birthdays, a linear weighted kappa of 0.726 was found. Of the total population, 46.95% changed GMFCS levels at any time between two to four years of age, the majority of which were reclassified to a higher level of ability. CONCLUSION Findings suggest the GMFCS is less stable in the two to four year age band compared to older age bands. Due to the importance of providing accurate guidance for caregivers and high rate of reclassification, it is recommended GMFCS levels be reassessed every six months during this period of time.
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Affiliation(s)
- Amanda M Wizinsky
- Perlman Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Molly Donawerth
- Perlman Center, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Mitchell TK, Bray L, Blake L, Dickinson A, Carter B. 'I feel like my house was taken away from me': Parents' experiences of having home adaptations for their medically complex, technology-dependent child. HEALTH & SOCIAL CARE IN THE COMMUNITY 2022; 30:e4639-e4651. [PMID: 35715967 PMCID: PMC10083937 DOI: 10.1111/hsc.13870] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Revised: 04/28/2022] [Accepted: 05/28/2022] [Indexed: 06/15/2023]
Abstract
Technology-dependent children are a sub-population of seriously ill children with life-limiting conditions who are being cared for at home by their families. Although home-based care has been the model of care for these children since the late 1980s, there is a paucity of literature about parents' experiences of having home adaptations made to enable their home to be a place of care for their child. Using the findings from auto-driven photo-elicitation interviews conducted between August 2017 and June 2018 with 12 parents (10 mothers and 2 fathers) who have a technology-dependent child (aged 5-25 years) living in England, Scotland and Wales and David Seamon's five concepts of at-homeness (appropriation, at-easeness, regeneration, rootedness and warmth) as a conceptual framework, this paper addresses how parents' experienced home adaptations. Thematic analysis generated a meta-theme of 'Home needs to be a home for all family members' and the three key themes: (1) 'You just get told' and 'you're not involved'; (2) It's just the 'cheapest', 'quickest', 'short-term' approach; (3) Having 'control' and 'thinking things through.' The need to involve parents in decision-making about adaptations that are made to their home (family-informed design) is clear, not only from a cost-saving perspective for the state, but for creating an aesthetic and functional home that optimises health, well-being and feelings of at-homeness for the entire family.
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Affiliation(s)
- Tracy Karen Mitchell
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
- Present address:
Department of Public Health, Policy and Systems, Institute of Population HealthUniversity of LiverpoolLiverpoolUK
| | - Lucy Bray
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
| | - Lucy Blake
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
- Present address:
Department of Health and Social SciencesUniversity of the West of England (UWE)BristolUK
| | | | - Bernie Carter
- Faculty of Health, Social Care and MedicineEdge Hill UniversityOrmskirkLancashireUK
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11
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Müller V, Gerdtham U, Alriksson‐Schmidt A, Jarl J. Parental decisions to divorce and have additional children among families with children with cerebral palsy: Evidence from Swedish longitudinal and administrative data. HEALTH ECONOMICS 2022; 31:2170-2186. [PMID: 35778857 PMCID: PMC9543549 DOI: 10.1002/hec.4567] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Revised: 05/03/2022] [Accepted: 06/08/2022] [Indexed: 06/15/2023]
Abstract
This study analyzes the relationship of having a child with the early-onset disability cerebral palsy (CP) and the parental decision to divorce and to have additional children. We use longitudinal matched case-control data from multiple linked Swedish National Population Registers between 2001 and 2015 and perform Cox proportional hazards regressions with interval-censoring. Although we do not find a general excess parental divorce risk on CP relative to the comparison group without CP, we find that having a child with CP increases the risk of divorce for parents with low education. We also find that having a child with CP reduces the likelihood of having additional children, especially for mothers in the older age range (maternal age at delivery >33 years) and parents with low education. The severity level of the disability, as indicated by gross motor function, is not related to the results. These findings should be understood in the Swedish context, which provides extensive welfare support (e.g., personal assistance). If future studies would find adverse results in countries with less social care and benefits, our results may indicate that it is possible to mitigate negative consequences for the family of a child with disability.
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Affiliation(s)
- Vibeke Müller
- Department of Clinical Sciences, MalmöHealth Economics UnitLund UniversityLundSweden
| | - Ulf Gerdtham
- Department of Clinical Sciences, MalmöHealth Economics UnitLund UniversityLundSweden
- Department of EconomicsLund UniversityLundSweden
| | | | - Johan Jarl
- Department of Clinical Sciences, MalmöHealth Economics UnitLund UniversityLundSweden
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12
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Mitchell TK, Bray L, Blake L, Dickinson A, Carter B. 'It doesn't feel like our house anymore': The impact of medical technology upon life at home for families with a medically complex, technology-dependent child. Health Place 2022; 74:102768. [PMID: 35219047 DOI: 10.1016/j.healthplace.2022.102768] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 12/18/2021] [Accepted: 02/11/2022] [Indexed: 11/16/2022]
Abstract
The study aimed to identify how medical technology impacts upon the home and life at home. Inductive auto-driven photo-elicitation or semi-structured interviews were conducted with technology-dependent children/young people (n = 2) and their family members (n = 15) from 10 families. Thematic analysis generated three themes: Altered physicality and look of the home; Altered sounds in the home; and 'It's worth it! Technology enables us to stay as a family'. Fundamentally, the detrimental impacts of living with medical technology were perceived as worth it as these enabled their child to be at home. Home was not home, and families were incomplete without their child at home.
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Affiliation(s)
- Tracy Karen Mitchell
- Department of Public Health, Policy and Systems, Institute of Population Health, University of Liverpool, UK.
| | - Lucy Bray
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
| | - Lucy Blake
- Department of Health and Social Sciences, University of the West of England (UWE), Bristol, UK
| | | | - Bernie Carter
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, Lancashire, UK
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13
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Rambo A, Rhodes L, Lomax J, Cao X, Steele J, Romer K, Spence D, Sheffer BW, Warner WC, Sawyer JR, Kelly DM. Factors that Influence Acquisition of Lower Extremity Braces in the Pediatric Orthopaedic Population. J Pediatr Orthop 2022; 42:40-46. [PMID: 34723893 DOI: 10.1097/bpo.0000000000001998] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Lower extremity brace-wear compliance has been studied in pediatrics, but failure to acquire a prescribed brace has not been included. The purpose of this study was to evaluate brace acquisition as a component of brace-wear compliance. METHODS Records of patients (0 to 21 y) prescribed lower extremity braces from 2017 to 2019 were reviewed. Diagnoses included cerebral palsy, spina bifida, short Achilles tendon, clubfoot, and other. Brace type was categorized as clubfoot foot abduction orthosis, ankle-foot orthosis, knee, hip, or custom/other braces. Brace prescription and acquisition dates were recorded. Insurance was classified as government, private, or uninsured. Patient demographics included age, sex, race, and calculated area deprivation index. RESULTS Of the 1176 prescribed lower extremity braces, 1094 (93%) were acquired while 82 (7%) were not. The odds ratios (OR) of failure to acquire a prescribed brace in Black and Hispanic patients were 1.64 and 2.71 times that in White patients, respectively (95% confidence interval: 1.01-2.71, P=0.045; 1.23-5.6, P=0.015); in patients without insurance, the OR was 8.48 times that in privately insured patients (95% confidence interval: 1.93-31.1, P=0.007). The ORs of failure to acquire were 2.12 (P=0.003) in patients 4 years or more versus 0 to 3 years, 4.17 (P<0.0001) in cerebral palsy versus clubfoot, and 4.12 (P=0.01) in short Achilles tendon versus clubfoot. There was no significant association between sex or area deprivation index and failure of brace acquisition. CONCLUSIONS In our cohort, 7% of prescribed braces were not acquired. Black or Hispanic race, lack of insurance, and older age were associated with failure to acquire prescribed braces. Braces prescribed for clubfoot were acquired more often than for cerebral palsy or short Achilles tendon. Brace-wear compliance is an established factor in treatment success and recurrence. This study identified risk factors for failed brace acquisition, a critical step for improving compliance. These results may help effect changes in the current system that may lead to more compliance with brace wear. LEVEL OF EVIDENCE Level III-retrospective cohort study.
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Affiliation(s)
- Anna Rambo
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
| | | | - Justin Lomax
- College of Medicine, University of Tennessee Health Sciences Center
| | | | - Jack Steele
- Center for Orthotics and Prosthetics Inc., Memphis, TN
| | - Karen Romer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
| | - David Spence
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
| | - Benjamin W Sheffer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
| | - William C Warner
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
| | - Jeffrey R Sawyer
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
| | - Derek M Kelly
- Department of Orthopaedic Surgery and Biomedical Engineering, University of Tennessee-Campbell Clinic
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14
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Mitterer S, Zimmermann K, Bergsträsser E, Simon M, Gerber AK, Fink G. Measuring Financial Burden in Families of Children Living With Life-Limiting Conditions: A Scoping Review of Cost Indicators and Outcome Measures. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2021; 24:1377-1389. [PMID: 34452718 DOI: 10.1016/j.jval.2021.03.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 01/25/2021] [Accepted: 03/16/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES This study aimed to provide a comprehensive overview of cost indicators and outcome measures used to measure financial burden in families of children with life-limiting conditions. METHODS A scoping review methodology was used to map the existing literature and provide an overview of available cost indicators and outcome measures. Key medical, economic, and scientific databases were systematically searched to identify relevant articles published in 2000 or later. RESULTS The database search yielded 7194 records, including 30 articles eligible for final inclusion. Retrieved cost indicators and outcome measures fell into 3 broad categories: direct costs, indirect costs, and financial support. No study comprehensively assessed all 3 categories. Cost indicators used to measure direct costs were grouped into 5 medical and 11 nonmedical out-of-pocket expenses categories, of which 5 were commonly assessed (ie, treatment and diagnostics, travel and transport, accommodation, food, childcare and home help). Half of the reviewed studies included assessments of indirect costs, most commonly estimating work-related income loss by evaluating employment disruptions. Assessments of opportunity costs arising from informal caregiving and of financial support were rarely included. CONCLUSIONS Current estimates of the financial burden faced by families of children with life-limiting conditions are inconsistent and often incomplete, likely resulting in severe underestimations of the costs these families incur. We hope that the framework presented in this article will contribute to a more comprehensive assessment of illness-related financial burden and help guide future policies in this area.
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Affiliation(s)
- Stefan Mitterer
- Department Public Health - Nursing Science, University of Basel, Basel, Switzerland
| | - Karin Zimmermann
- Department Public Health - Nursing Science, University of Basel, Basel, Switzerland; Paediatric Palliative Care and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland.
| | - Eva Bergsträsser
- Paediatric Palliative Care and Children's Research Center, University Children's Hospital Zurich, Zurich, Switzerland
| | - Michael Simon
- Department Public Health - Nursing Science, University of Basel, Basel, Switzerland
| | - Anne-Kathrin Gerber
- Department Public Health - Nursing Science, University of Basel, Basel, Switzerland
| | - Günther Fink
- Household Economics and Health Systems Research, Swiss Tropical and Public Health Institute, Basel, Switzerland
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Smethurst G, Bourke-Taylor HM, Cotter C, Beauchamp F. Controlled choice, not choice and control: Families' reflections after one year using the National Disability Insurance Scheme. Aust Occup Ther J 2020; 68:205-216. [PMID: 33372302 DOI: 10.1111/1440-1630.12715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Revised: 11/22/2020] [Accepted: 12/12/2020] [Indexed: 11/30/2022]
Abstract
INTRODUCTION At least 40 percent of children with cerebral palsy and their families rely on access to allied health services, assistive technology, and require funding and expertise to achieve skills and participate in daily life. Implementation of the National Disability Insurance Scheme (NDIS) has resulted in a shift to public funding and emphasis on choice and control of services, support and assistive technology to promote social and economic participation. Families of children with cerebral palsy are invested in scheme success and their subjective experiences require consideration if the NDIS is to meet participation targets. OBJECTIVE The aim of this research was to explore the experiences of families with a child with cerebral palsy, who have been in receipt of the NDIS for 12 months, comparisons to previous funding systems, and recommendations for the NDIS going forward. METHODS Purposive sampling was utilised within one specialised paediatric setting. All families received occupational therapy intervention for their child. A qualitative approach using semi structured interviews was employed. Braun and Clarke's six phases of thematic analysis was utilised to analyse the data and explore participants lived experiences. FINDINGS Eight (n = 8) mothers of children with cerebral palsy were interviewed. Three overarching themes were derived from the data: Equipment impacts on all areas of life; Frustration navigating the National Disability Insurance Scheme; and Gratitude, hope and suggestions. CONCLUSION Families reported challenges navigating the NDIS including administrative challenges and extensive wait times for assistive technology, as well as gratefulness for increased opportunities for support. Occupational therapists and other allied health professionals can assist by: being proactive in service delivery and advocating for the needs of individual families and children; and finding ways to increase the preparedness of the NDIS to better understand the needs of children with cerebral palsy and their families.
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Affiliation(s)
- Gabrielle Smethurst
- Occupational Therapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Helen M Bourke-Taylor
- Occupational Therapy Department, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Frankston, VIC, Australia
| | - Claire Cotter
- Cerebral Palsy Education Centre, Glen Waverley, VIC, Australia
| | - Fiona Beauchamp
- Cerebral Palsy Education Centre, Glen Waverley, VIC, Australia
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Alriksson-Schmidt AI, Jeglinsky I, Jonsdottir G, Kedir Seid A, Klevberg G, Buschmann E, Jahnsen R. Living life with cerebral palsy? A description of the social safety nets for individuals with cerebral palsy in the Nordic countries. Scand J Public Health 2020; 49:653-665. [PMID: 33323047 PMCID: PMC8512245 DOI: 10.1177/1403494820974564] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Aims: This report reviews major laws, acts and regulations of social benefits and
services for individuals with disabilities, focusing on cerebral palsy in
the five Nordic countries. It summarizes the available benefits and services
and the re-application process and provides comparative analyses among the
countries. Methods: Published reports, articles and relevant government and municipal websites
were reviewed for each respective country and used to compile an overview
and comparison between the countries. Results: In the Nordic countries, there are a number of laws and regulations in place
to support individuals with cerebral palsy and their families. In addition,
there are numerous social benefits available for which individuals with
disabilities can apply. Although there are national differences, the
similarities across the five countries regarding laws, social benefits
offered for individuals with cerebral palsy and the application processes
are clear. However, the application processes seem cumbersome and, at times,
redundant. Physicians and other healthcare specialists repeatedly need to
write ‘medical certificates’ describing the diagnosis and its consequences
for a disability that is chronic and lifelong. Conclusions: Participation in society for individuals with cerebral palsy disabilities can
be enabled by social benefits. By extension, social benefits may indirectly
have implications for public health in individuals with disabilities.
Although the lives of individuals with cerebral palsy – as with others – can
improve in certain areas, the need for social benefits will generally
increase, not decrease, over time. Although it is clearly important to have
checks and balances that prevent system misuse, it might be worthwhile from
a cost-benefit perspective to investigate whether the current systems could
be improved to better manage time and resources and avoid emotional distress
by streamlining the application process.
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Affiliation(s)
- Ann I Alriksson-Schmidt
- Department of Clinical Sciences Lund, Orthopedics, Lund University, Skane University Hospital, Lund, Sweden
| | - Ira Jeglinsky
- Department of Health and Welfare, Arcada University of Applied Sciences, Helsinki, Finland
| | - Gudny Jonsdottir
- Endurhaefing, Rehabilitation Centre of Excellence, Kopavogur, Iceland
| | - Abdu Kedir Seid
- Centre for Alcohol and Drug Research, Aarhus University, Aarhus, Denmark
| | - Gunvor Klevberg
- Cerebral Palsy Follow-up Program, Department of Neurosciences for Children, Oslo University Hospital, Oslo, Norway
| | - Eva Buschmann
- The Norwegian Cerebral Palsy Association, Oslo, Norway
| | - Reidun Jahnsen
- Cerebral Palsy Follow-up Program, Department of Neurosciences for Children, Oslo University Hospital, Oslo, Norway.,Faculty of Medicine, Research Center of Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
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Assenza C, Cacciatore D, Manica M, Iosa M, Foti C, Gobbetti T, Paolucci S, Morelli D. Assistive products and childhood neurodisability: a retrospective study on factors associated with aids/orthoses prescription. Eur J Phys Rehabil Med 2020; 56:412-420. [PMID: 32406225 DOI: 10.23736/s1973-9087.20.06224-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
BACKGROUND Children affected by pathologies causing neurodisability go through motor, cognitive, sensory and other limitations. The selection of assistive products can influence their level of independence and quality of life. AIM The present study investigated the possibility to assess the equipment needs of children with neurodisabilities, based on their clinical characteristics. DESIGN A retrospective observational study. SETTING Outpatients. POPULATION Inclusion criteria: diagnosis of cerebral palsy or genetic/chromosomal/syndromic disorders, age range 0-18 years, intelligence quotient evaluation, medical history of positive or negative presence of epilepsy and of communication disorders, admission at our neurorehabilitation service between 2007 and 2017, and registration of all equipment prescribed to each child. METHODS In 192 children (111 males, 57.81%) we evaluated the relationship between several independent variables (diagnosis, sex, Gross Motor Function Classification System level, intelligence quotient, history of epilepsy and communication disorders) and equipment prescription by means of logistic regression models. RESULTS Our data showed significant correlation between the Gross Motor Function Classification System level and the equipment prescribed. A history of seizures was negatively correlated with walker prescriptions (the log odds of prescription decreases by -2.156; CI: -4.16 to -0.65) and positively with those of stroller (the log odds increases by 1.427; CI: 0.22 to 2.69). Stroller and knee-ankle-foot orthoses and hip-knee-ankle-foot orthoses prescriptions were negatively correlated with the cerebral palsy diagnosis. The prescription of foot orthoses was positively correlated with mental retardation (the log odds increases by 0.358; CI: 0.12 to 0.61). A negative correlation between communication disorders and the prescription of ankle-foot orthoses and communication/learning devices was also found (the log odds decreases by -0.833; CI -1.66 to -0.01). CONCLUSIONS Several clinical characteristics correlate with specific equipment needs. CLINICAL REHABILITATION IMPACT The definition of the clinical characteristics with a potential predicting value, may facilitate the task of physician on choosing what is more appropriate to prescribe, as well as the authorizing office responsible for evaluating the appropriateness of prescriptions. Furthermore, it could be possible to foresee the care needs in terms of type and number of aids/orthoses and to guarantee every disabled child the possibility to take advantage of the same opportunities.
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Affiliation(s)
- Carla Assenza
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy - .,Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy -
| | - Denise Cacciatore
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | | | - Marco Iosa
- Clinical Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | - Calogero Foti
- Physical and Rehabilitation Medicine, Tor Vergata University, Rome, Italy
| | - Tiziana Gobbetti
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | - Stefano Paolucci
- Clinical Laboratory of Experimental Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
| | - Daniela Morelli
- Department of Pediatric Neurorehabilitation, Scientific Institute for Research and Health Care Santa Lucia Foundation, Rome, Italy
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West P, Van Riper M, Wyatt G, Lehto R, Douglas SN, Robbins L. Adaptation to Technology Use in Families of Children With Complex Communication Needs: An Integrative Review and Family Theory Application. JOURNAL OF FAMILY NURSING 2020; 26:153-178. [PMID: 32389060 DOI: 10.1177/1074840720915536] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/11/2023]
Abstract
Families with children who have developmental disabilities and complex communication needs (CCNs) face challenging demands affecting family adaptation. Many children with CCNs use augmentative and alternative communication (AAC) devices to support communication, yet little is known about family adaptation to such technology. To fill this gap, an integrative review, guided by the Resiliency Model of Family Stress, Adjustment, and Adaptation was conducted to assess conceptual foundations and the state of the science of family adaptation among children utilizing AAC. Web-based searches were conducted using the Preferred Reporting Items for Systematic Reviews and Meta-Analysis and the Mixed Methods Appraisal Tool. Thirty-three studies met eligibility. Findings demonstrated that to enhance the science underpinning family adaptation to AAC use, future research should be grounded conceptually and address important components of the Resiliency Model. Work in this emerging area will identify and facilitate nursing efforts to assist families as they adapt to communication technology.
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Affiliation(s)
| | | | - Gwen Wyatt
- Michigan State University, East Lansing, USA
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Alriksson-Schmidt AI, Ahonen M, Andersen GL, Eggertsdóttir G, Haula T, Jahnsen R, Jarl J, Jeglinsky-Kankainen I, Jonsdottir G, Seid AK, Ásgeirsdóttir TL, Møller-Madsen B, Nordbye-Nielsen K, Saha S, Steskal D, Sääksvuori L, Hägglund G. CP-North: living life in the Nordic countries? A retrospective register research protocol on individuals with cerebral palsy and their parents living in Sweden, Norway, Denmark, Finland and Iceland. BMJ Open 2019; 9:e024438. [PMID: 31575533 PMCID: PMC6797311 DOI: 10.1136/bmjopen-2018-024438] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
INTRODUCTION Cerebral palsy (CP) is one of the most common neurodevelopmental disabilities. Yet, most individuals with CP are adults. How individuals with CP fare in terms of health, quality of life (QoL), education, employment and income is largely unknown. Further, little is known about the effects of having a child with CP on the parents. The Nordic countries are known for their strong welfare systems, yet it is unknown to what extent the added burden related to disability is actually compensated for. We will explore how living with CP affects health, QoL, healthcare utilisation, education, labour market outcomes, socioeconomic status and mortality throughout the lifespan of individuals with CP and their parents. We will also investigate if these effects differ between subgroups, within and across the Nordic countries. METHODS AND ANALYSES: CP-North is a multidisciplinary 4-year (1 August 2017 to 31 July 2021) register research project. The research consortium comprises researchers and users from Sweden, Norway, Denmark, Iceland and Finland. Data from CP registries and follow-up programmes, or cohorts of individuals with CP, will be merged with general national registries. All individual studies are structured under three themes: medical outcomes, social and public health outcomes, and health economics. Both case-control and cohort designs will be included depending on the particular research question. Data will be analysed in the individual countries and later merged across nations. ETHICS AND DISSEMINATION The ethics approval processes in each individual country are followed. Findings will be published (open access) in international peer-reviewed journals in related fields. Updates on CP-North will be published online at http://rdi.arcada.fi/cpnorth/en/.
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Affiliation(s)
- Ann I Alriksson-Schmidt
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
| | - Matti Ahonen
- Department of Pediatric Surgery, Helsinki Children's Hospital, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
| | - Guro L Andersen
- The Cerebral Palsy Registry of Norway, Habilitation Center, Vestfold Hospital, Tønsberg, Norway
| | | | - Taru Haula
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Reidun Jahnsen
- Cerebral Palsy Follow-up Program, Department of Neurosciences for Children, Oslo University Hospital, Oslo, Norway
- Faculty of Medicine, Research Center of Habilitation and Rehabilitation Models and Services (CHARM), University of Oslo, Oslo, Norway
| | - Johan Jarl
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
| | | | - Gudny Jonsdottir
- Endurhaefing, Rehabilitation Centre of Excellence, Kopavogur, Iceland
| | - Abdu Kedir Seid
- Centre for Alcohol and Drug Research, Aarhus Universitet, Aarhus, Denmark
| | | | - Bjarne Møller-Madsen
- Department of Children's Orthopaedics, Aarhus Universitetshospital, Aarhus, Denmark
| | | | - Sanjib Saha
- Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden
| | | | - Lauri Sääksvuori
- Centre for Health and Social Economics, National Institute for Health and Welfare, Helsinki, Finland
| | - Gunnar Hägglund
- Orthopedics, Department of Clinical Sciences, Skåne University Hospital, Lund University, Lund, Sweden
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20
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Badaru UM, Abdulrahman H, Ahmad RY, Lawal IU, Zakari MK. Analysis of Direct Monthly Cost of Outpatient Hospital-Based Care for Children With Cerebral Palsy in Kano, Nigeria. Value Health Reg Issues 2019; 19:145-150. [PMID: 31472422 DOI: 10.1016/j.vhri.2019.07.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/04/2019] [Accepted: 07/15/2019] [Indexed: 11/24/2022]
Abstract
BACKGROUND Children with cerebral palsy require effective, accessible and affordable medical and rehabilitation care. OBJECTIVE The aim of this study was to evaluate the direct monthly cost of outpatient hospital-based care for children with cerebral palsy (CP) in Kano City, Nigeria. METHODS The study was a cross-sectional survey. Consenting participants were recruited using the purposive sampling technique. Data on cost of medical and physiotherapy consultations, number of consultations per month, cost of diagnostic investigations, and out-of-pocket expenditures were captured using a researcher-designed questionnaire. Data were analyzed with descriptive statistics using Microsoft Excel and SPSS version 20. RESULTS A total of 106 children with CP and their caregivers participated in this study. The mean age of the children was 3.18 ± 1.90 years and that of their caregivers was 27.32 ± 4.63 years. The average direct cost of outpatient care per month was ₦14 295.38 (Nigerian naira) ($46.87) ± ₦13 211.52 ($43.32). The average monthly cost of physiotherapy was ₦503.77 ($1.65) ± ₦220.79 ($0.72), whereas those for transportation and radiological investigations were ₦1861.49 ($6.10) ± ₦1435.06 ($4.71) and ₦3771.46 ($12.37) ± ₦5135.32 ($16.84), respectively. CONCLUSION The average direct monthly cost of providing outpatient hospital-based care for children with CP in Kano City, Nigeria may not be affordable because most of the participants earned very meager monthly incomes. The highest medical cost was incurred from radiological investigation, whereas transportation was the most important out-of-pocket cost. The Nigerian government should make a policy decision for the automatic enrollment of all children diagnosed with CP into the National Health Insurance Scheme.
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Affiliation(s)
- Umaru M Badaru
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria.
| | - Hassan Abdulrahman
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Rufai Y Ahmad
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Isa U Lawal
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
| | - Musa K Zakari
- Department of Physiotherapy, Faculty of Allied Health Sciences, Bayero University, Kano, Nigeria
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Armstrong EL, Boyd RN, Kentish MJ, Carty CP, Horan SA. Effects of a training programme of functional electrical stimulation (FES) powered cycling, recreational cycling and goal-directed exercise training on children with cerebral palsy: a randomised controlled trial protocol. BMJ Open 2019; 9:e024881. [PMID: 31213443 PMCID: PMC6589006 DOI: 10.1136/bmjopen-2018-024881] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
INTRODUCTION Children with cerebral palsy (CP) experience declines in gross motor ability as they transition from childhood to adolescence, which can result in the loss of ability to perform sit-to-stand transfers, ambulate or participate in leisure activities such as cycling. Functional electrical stimulation (FES) cycling is a novel technology that may provide opportunities for children with CP to strengthen their lower limbs, improve functional independence and increase physical activity participation. The proposed randomised controlled trial will test the efficacy of a training package of FES cycling, adapted cycling and goal-directed functional training to usual care in children with CP who are susceptible to functional declines. METHODS AND ANALYSIS Forty children with CP (20 per group), aged 6-8 years and classified as Gross Motor Function Classification System (GMFCS) levels II-IV will be recruited across South East Queensland. Participants will be randomised to either an immediate intervention group, who will undertake 8 weeks of training, or a waitlist control group. The training group will attend two 1 hour sessions per week with a physiotherapist, consisting of FES cycling and goal-directed, functional exercises and a 1 hour home exercise programme per week, consisting of recreational cycling. Primary outcomes will be the gross motor function measure and Canadian occupational performance measure, and secondary outcomes will include the five times sit-to-stand test, habitual physical activity (accelerometry), power output during cycling and Participation and Environment Measure-Children and Youth. Outcomes will be assessed at baseline, postintervention (8 weeks) and 8 weeks following the intervention (retention). ETHICS AND DISSEMINATION Ethical approval has been obtained from Griffith University (2018/037) and the Children's Health Queensland Hospital and Health Service (CHQHHS) Human Research Ethics Committee (HREC/17/QRCH/88). Site-specific approval was obtained from CHQHHS research governance (SSA/17/QRCH/145). Results from this trial will be disseminated via publication in relevant peer-reviewed journals. TRIAL REGISTRATION NUMBER ACTRN12617000644369p.
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Affiliation(s)
- Ellen L Armstrong
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Roslyn N Boyd
- Queensland Cerebral Palsy and Rehabilitation Research Centre, The University of Queensland, Brisbane, Queensland, Australia
| | - Megan J Kentish
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
| | - Christopher P Carty
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Queensland Paediatric Rehabilitation Service, Children's Health Queensland Hospital and Health Service, South Brisbane, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
- Gold Coast Orthopaedic Research Engineering and Education Alliance, Griffith University, Gold Coast, Queensland, Australia
| | - Sean A Horan
- School of Allied Health Sciences, Griffith University, Gold Coast, Queensland, Australia
- Menzies Health Institute Queensland, Griffith University, Gold Coast, Queensland, Australia
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22
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Downie A, Chamberlain A, Kuzminski R, Vaz S, Cuomo B, Falkmer T. Road vehicle transportation of children with physical and behavioral disabilities: A literature review. Scand J Occup Ther 2019; 27:309-322. [PMID: 30856035 DOI: 10.1080/11038128.2019.1578408] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: A literature review in 2001 found that children with disabilities were frequently transported in unsafe conditions and further research was required to investigate the gap between regulations, standards and actual transportation practices.Objectives: To synthesize available evidence on the transportation of children with disabilities in road vehicles.Methods: Four databases were systematically searched: CINAHL; Medline; National Transport Library Catalogue (Sweden); and Transport Research International Documentation.Results: Nineteen studies ranging in methodological quality from poor to excellent were included in the review. The findings are presented under the following six major themes: child safety restraints, wheelchairs, vehicles, travel habits, parental and professional knowledge. The results are mapped onto two groups of children, those with behavioral problems and those with physical disabilities.Conclusion: The literature reflected little change across the six major themes since the previous review. Children with disabilities continue to be inappropriately restrained in vehicles, constituting an ongoing road safety problem. There is a strong need to increase parent knowledge, upskill health professionals and provide families with financial assistance to enable them to ensure the safe transportation of children with disabilities to minimize the risk of injury and fatalities on the road, and enhance their participation in the community.
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Affiliation(s)
- Angela Downie
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Angela Chamberlain
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia
| | - Rebecca Kuzminski
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Sharmila Vaz
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Belinda Cuomo
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia
| | - Torbjörn Falkmer
- School of Occupational Therapy, Social Work and Speech Pathology, Curtin University, Perth, Australia.,Faculty of Health Sciences, Curtin University, Perth, Australia.,Long Pocket Brisbane, Cooperative Research Centre for Living with Autism (Autism CRC), Queensland, Australia.,Pain and Rehabilitation Centre, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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23
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Lindsay S. Accessible and inclusive transportation for youth with disabilities: exploring innovative solutions. Disabil Rehabil 2019; 42:1131-1140. [PMID: 30636464 DOI: 10.1080/09638288.2018.1517194] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Background: Although access to reliable transportation is an essential component of quality of life, young people with disabilities encounter many transportation-related obstacles.Objective: To explore solutions to the challenges that youth with disabilities encounter in accessing and navigating transportation.Methods: A nominal group technique was used in two consultation workshops (one involving rehabilitation clinicians and accessible transportation stakeholders; and one with youth with disabilities and parents). Fifteen participants across two workshops took part and prioritized their solutions and we used a comparative analysis within and between groups to explore overarching themes.Results: The workshops resulted in 122 solutions (76 from youth/parents; 46 from stakeholders). Although there was considerable overlap within the ideas generated between the groups, they each prioritized them differently. The following themes emerged across the two group's prioritized solutions: training, funding, enhancing access, and improved efficiency.Conclusions: Our findings highlight that youth with disabilities, parents and key stakeholders offered many practical solutions for enhancing accessible transportation for youth with disabilities.Implications for RehabilitationClinicians and educators should explore different apps and transportation training programs that could help support youth with disabilities to enhance their independence and participation in the communityClinicians and educators should be involved in the development of disability awareness training programs for public transit and school bus drivers to enhance youth's inclusion and participation in society.Clinicians, educators, youth and parents should continue to advocate for inclusive, accessible, affordable and efficient transportation for people with disabilities.
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Affiliation(s)
- Sally Lindsay
- Bloorview Research Institute, Holland Bloorview Kids Rehabilitaiton Hospital, Toronto, Canada.,Department of Occupational Science and Occupational Therapy, University of Toronto, Toronto, Canada.,Rehabilitation Sciences Institute, University of Toronto, Toronto, Canada
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24
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Tonmukayakul U, Shih STF, Bourke-Taylor H, Imms C, Reddihough D, Cox L, Carter R. Systematic review of the economic impact of cerebral palsy. RESEARCH IN DEVELOPMENTAL DISABILITIES 2018; 80:93-101. [PMID: 29981952 DOI: 10.1016/j.ridd.2018.06.012] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 03/08/2018] [Accepted: 06/19/2018] [Indexed: 06/08/2023]
Abstract
BACKGROUND Cerebral palsy (CP) and its associated conditions can pose a significant economic burden on families, the health care system and the general economy. The boundary for inclusion of costs in research can vary substantially across studies. AIMS To summarize the evidence for burden of disease for CP including the impacts on the health system, the community and carers. METHODS Literature was identified from Ovid Medline, Embase, CINHAL, PsyInfo, Econlit, Health Economic Evaluation Database (HEED) and NHS Economic Evaluation Database (NHS EED) in the Cochrane Library. The search was restricted to articles published in English between 1970 and April 2016. All costs were converted to $USD 2016 price. RESULTS Twenty-two articles were included. Studies varied from snapshot cost descriptions to more complex lifetime estimates, from prevalence-based to incidence-based studies, and from inclusion to exclusion of non-medical costs. There was a strong positive relationship between CP severity and expenditure. Significant costs were incurred by families and the welfare system to facilitate school and community engagement. CONCLUSION Facilitating participation for people with CP involves substantial expense. The size, nature and distribution of the economic burden emphasises the importance of finding effective strategies to reduce the risk and severity of CP, together with how it is financed.
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Affiliation(s)
- Utsana Tonmukayakul
- Deakin University, Geelong, Centre for Population Health Research, Locked Bag 20000, Geelong, Victoria, 3220, Australia.
| | - Sophy T F Shih
- Deakin University, Geelong, Centre for Population Health Research, Locked Bag 20000, Geelong, Victoria, 3220, Australia
| | - Helen Bourke-Taylor
- School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Building G, McMahons Road, Frankston, Victoria, 3199, Australia
| | - Christine Imms
- Centre for Disability and Development Research, Australian Catholic University, Level 2, Daniel Mannix Building, 11 Young Street, Fitzroy, Victoria, 3065, Australia
| | - Dinah Reddihough
- Murdoch Children's Research Institute, The University of Melbourne, Royal Children's Hospital, Flemington Road, Parkville, Victoria, 3052, Australia
| | - Liz Cox
- Victoria Managed Insurance Authority, Level 10 South, 161 Collins Street, Melbourne, Victoria, 3000, Australia
| | - Rob Carter
- Deakin University, Geelong, Centre for Population Health Research, Locked Bag 20000, Geelong, Victoria, 3220, Australia
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25
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Beauchamp F, Bourke-Taylor H, Brown T. Therapists’ perspectives: supporting children to use switches and technology for accessing their environment, leisure, and communication. JOURNAL OF OCCUPATIONAL THERAPY SCHOOLS AND EARLY INTERVENTION 2018. [DOI: 10.1080/19411243.2018.1432443] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Fiona Beauchamp
- Occupational Therapist, Cerebral Palsy Education Centre, Glen Waverley, Australia
| | - Helen Bourke-Taylor
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia
| | - Ted Brown
- Department of Occupational Therapy, School of Primary and Allied Health Care, Faculty of Medicine Nursing and Health Sciences, Monash University, Peninsula Campus, Frankston, Victoria, Australia
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Joyce K, Bourke-Taylor H, Wilkes-Gillan S. Validity of the Assistance to Participate Scale with Parents of typically developing Australian children aged three to eight years. Aust Occup Ther J 2017; 64:381-390. [DOI: 10.1111/1440-1630.12409] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/05/2017] [Indexed: 11/28/2022]
Affiliation(s)
- Kahli Joyce
- School of Allied Health; Australian Catholic University; Melbourne Victoria Australia
| | - Helen Bourke-Taylor
- Department of Occupational Therapy; School of Primary and Allied Health Care; Faculty of Medicine, Nursing and Health Sciences; Monash University; Frankston Victoria Australia
| | - Sarah Wilkes-Gillan
- School of Allied Health; Australian Catholic University; Sydney New South Wales Australia
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Meehan EM, Reid SM, Williams KJ, Freed GL, Sewell JR, Reddihough DS. Medical service use in children with cerebral palsy: The role of child and family factors characteristics. J Paediatr Child Health 2016; 52:621-7. [PMID: 27088437 DOI: 10.1111/jpc.13163] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/29/2016] [Indexed: 10/21/2022]
Abstract
AIM The aim of the study was to investigate the patterns of medical service use in children with cerebral palsy (CP), taking into account child and family characteristics. METHODS Nine hundred and one parents and carers of children registered with the Victorian CP Register were invited to complete a survey. Participants were asked about their child's appointments with general practitioners and public and private paediatric medical specialists over the preceding 12 months. Information on family characteristics and finances was also collected. Data on CP severity and complexity were extracted from the CP Register. RESULTS Three hundred and fifty parents and carers (39%) participated. Of these, 83% reported that their child had ≥1 appointment with a general practitioner over the preceding 12 months, while 84% had ≥1 appointment with a public or private paediatric medical specialist. Overall, 58% of children saw 2-5 different paediatric medical specialists, while 9% had appointments with ≥6 clinicians. Children with severe and complex CP were more likely to have had ≥1 appointment with a publically funded paediatric medical specialist and had seen a greater number of different clinicians over the study period. Family characteristics were not associated with service use. CONCLUSIONS Children with CP are managed by a number of paediatric medical specialists, and they continue to see a range of specialists throughout adolescence. In Victoria, differences in service use are not based on family characteristics; instead the highest service users are those with severe and complex CP. For this group, care co-ordination and information sharing between treating clinicians are important, if gaps in care are to be avoided.
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Affiliation(s)
- Elaine M Meehan
- Department of Paediatrics.,Developmental Disability and Rehabilitation Research, Clinical Sciences
| | - Susan M Reid
- Department of Paediatrics.,Developmental Disability and Rehabilitation Research, Clinical Sciences
| | - Katrina J Williams
- Department of Paediatrics.,Developmental Disability and Rehabilitation Research, Clinical Sciences.,Developmental Medicine.,Deakin Child Study Centre, School of Psychology, Deakin University, Melbourne, Victoria, Australia
| | - Gary L Freed
- Health Systems and Workforce Unit, Centre for Health Policy, School of Population and Global Health, University of Melbourne
| | - Jillian R Sewell
- Department of Paediatrics.,Community Health Services Research, Population Health, Murdoch Childrens Research Institute.,Centre for Community Child Health, Royal Children's Hospital, Australia
| | - Dinah S Reddihough
- Department of Paediatrics.,Developmental Disability and Rehabilitation Research, Clinical Sciences.,Developmental Medicine
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Effectiveness of Stretch Interventions for Children With Neuromuscular Disabilities: Evidence-Based Recommendations. Pediatr Phys Ther 2016; 28:262-75. [PMID: 27341572 DOI: 10.1097/pep.0000000000000269] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
PURPOSE To determine whether casting, orthoses, stretching, or supported standing programs are effective in improving or maintaining body functions and structures, activity, or participation in children with neuromuscular disabilities. METHODS A systematic review was conducted using 6 electronic databases to identify Level 1 and 2 studies investigating stretch interventions for children aged 0 to 19 years with neuromuscular disabilities. Interventions were coded using the International Classification of Function and rated with Grading of Recommendation Assessment, Development and Evaluation, the Oxford Levels of Evidence, and the Evidence Alert Traffic Light System. RESULTS Sixteen studies evaluated the effectiveness of stretch interventions. Low-grade evidence supports casting temporarily increasing ankle range of motion, orthoses improving gait parameters while they are worn, and supported standing programs improving bone mineral density. CONCLUSION There is limited evidence suggesting stretch interventions benefit body functions and structures. There is inconclusive evidence to support or refute stretching interventions for preventing contractures or impacting a child's activity or participation. TRIAL REGISTRATION Prospero CRD42014013807.
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29
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Woodgate RL, Edwards M, Ripat JD, Borton B, Rempel G. Intense parenting: a qualitative study detailing the experiences of parenting children with complex care needs. BMC Pediatr 2015; 15:197. [PMID: 26611116 PMCID: PMC4660805 DOI: 10.1186/s12887-015-0514-5] [Citation(s) in RCA: 100] [Impact Index Per Article: 11.1] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 11/24/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Increased numbers of children with chronic illnesses and/or disabilities who have complex care needs are living at home. Along with the transfer of care to the home setting, parents assume the primary responsibility of their child's complex care needs. Accordingly, it becomes even more important to understand the evolving roles and challenges faced by parents of children with complex care needs in order to better support them. The aim of this paper is to present research findings that add to our understanding of the roles parents assume in parenting their children with complex care needs. METHODS To arrive at a detailed and accurate understanding of families' perspectives and experiences, the qualitative research design of ethnography was used. In total, 68 parents from 40 families were recruited. Data collection strategies included ethnographic methods of interviewing and photovoice. Several levels of analysis generated a sociocultural theme with subthemes representing how parents experienced raising children with complex care needs within the context of their life situations. RESULTS Intense parenting as the overarching theme refers to the extra efforts parents had to commit to in raising their children with complex care needs. Parenting was described as labour-intensive, requiring a readiness to provide care at any time. This left parents with minimal time for addressing any needs and tasks not associated with caring for their child. The main theme is supported by four sub-themes: 1) the good parent; 2) more than a nurse; 3) there's just not enough; 4) it takes a toll on the health of parents. CONCLUSIONS Overall, parents of children with complex care needs take on more roles as well as work more intensely at these roles than parents of healthy children. This, in turn, has led to the need for additional supports and resources for parents. However, to date, parents of children with complex care needs are still lacking adequate services and supports necessary to help them in their role of intense parenting. The findings sensitize professionals to the issues confronted by parents caring for children with complex care needs. Implications for further research and clinical practice are discussed.
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Affiliation(s)
- Roberta L Woodgate
- College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
| | - Marie Edwards
- College of Nursing, Faculty of Health Sciences, University of Manitoba, 89 Curry Place, Winnipeg, MB, R3T 2N2, Canada.
| | - Jacquie D Ripat
- College of Rehabilitation Sciences, Faculty of Health Sciences, University of Manitoba, R106 - 771 McDermot Avenue, Winnipeg, MB, R3E 0T6, Canada.
| | - Barbara Borton
- Rehabilitation Centre for Children, 633 Wellington Crescent, Winnipeg, MB, R3M 0A8, Canada.
| | - Gina Rempel
- College of Medicine, Faculty of Health Sciences, University of Manitoba, 260 Brodie Centre - 727 McDermot Avenue, Winnipeg, MB, R3E 3P5, Canada.
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Bourke-Taylor H, Cotter C, Stephan R. Complementary, Alternative, and Mainstream Service use Among Families with Young Children with Multiple Disabilities: Family Costs to Access Choices. Phys Occup Ther Pediatr 2014; 35:311-325. [PMID: 25365470 DOI: 10.3109/01942638.2014.975312] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
ABSTRACT Families raising a young child with multiple disabilities are charged with significant responsibilities such as learning about their child's condition and navigating mainstream and alternative services. Aim: Describe service choices, costs, out of pocket expenses, and the impact on families. Methods: Survey design using a custom questionnaire was used to collect extensive retrospective and current data. Purposive sampling (N = 29) occurred from one early intervention facility specialized in servicing children with cerebral palsy (CP) and, or multiple disabilities in Australia. Descriptive statistics were used for analysis of data. Results: Twenty-three (79%) families reported caring for a child with CP. Twenty-three families reported using at least one complementary/alternative intervention. Out-of-pocket amounts were reported including: chiropractic services (10 families); naturopathy (9 families); point percussion therapy (7 families), and Chinese medicine (6 families). Expenses resulted in families reporting forgoing clothing items, family entertainment, recreation/hobbies for parents (55%); family holidays (59%); time for parents alone (66%); and health services for parents (38%). Conclusions: Families of young children with multiple disabilities select a wide range of services for their child, with consequential out of pocket expenses. Early intervention professionals can be an important resource for families as they evaluate their choices and select interventions for their child.
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Affiliation(s)
- Helen Bourke-Taylor
- 1Faculty of Health Sciences, School of Allied Health, Australian Catholic University, Fitzroy, Australia
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