1
|
Waiserberg N, Horev T, Feder-Bubis P. "When everyone is responsible, no one takes responsibility": exploring pediatric physiotherapy services in Israel. Isr J Health Policy Res 2024; 13:10. [PMID: 38414047 PMCID: PMC10900823 DOI: 10.1186/s13584-024-00597-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 02/21/2024] [Indexed: 02/29/2024] Open
Abstract
BACKGROUND According to Israel's National Health Insurance Law (1994), the Ministry of Health is responsible for the provision of health services in the country including physiotherapy services; moreover, the Special Education Law (1988), stipulates that physiotherapy services for children with motor disabilities, as well as other allied health services, are provided by the Ministry of Education in educational settings. Thus, children with motor disabilities are entitled PT services under two different laws by two different ministries. METHOD To describe the physiotherapy services for children with motor disabilities and examine how policymakers view these services, we conducted a qualitative study including in-depth semi-structured interviews with 10 policymakers from the Ministry of Health and the Ministry of Education, and the national directors of physiotherapy services from three of the four health maintenance organizations in Israel. RESULTS Study results indicate that there is an array of physiotherapy services and providers. Despite the regulation of these services for children with motor disabilities, uncertainty and lack of knowledge were found about various issues. Therefore, the thematic analysis was structured around four descriptive questions: Where do the children receive physiotherapy? Who is eligible for physiotherapy treatment and who receives treatment? What interventions do children with motor disabilities receive? Who provides therapy for children with motor disabilities? CONCLUSIONS Policymakers are dubious regarding the provision of these services, questioning whether children with motor disabilities receive physiotherapy services according to their needs. In addition, the abundance of suppliers does not necessarily improve the quality of services provided to children with motor disabilities, which may ultimately harm their developmental potential.
Collapse
Affiliation(s)
- Nilly Waiserberg
- Department of Health Policy and Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, David Ben Gurion Blvd 1, P.O.B. 653, Beer-Sheva, Israel.
- Department of Physical Therapy, School of Health Professions, Faculty of Medicine, Tel Aviv University, Chaim Levanon Street, P.O.B. 39040, Tel Aviv, Israel.
| | - Tuvia Horev
- Department of Health Policy and Management, Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, David Ben Gurion Blvd 1, P.O.B. 653, Beer-Sheva, Israel
| | - Paula Feder-Bubis
- Department of Health Policy and Management, Faculty of Health Sciences and Guilford Glazer Faculty of Business and Management, Ben-Gurion University of the Negev, David Ben Gurion Blvd 1, P.O.B. 653, Beer-Sheva, Israel
| |
Collapse
|
2
|
Chu SY, Rafi ABM, Lee J, Fierro V, Gan CH, Joginder Singh S, Hersh D, Lin LY. The relationship between affiliate stigma, stress, and quality of life for parents of individuals with cerebral palsy in Malaysia. Disabil Rehabil 2023; 45:4035-4047. [PMID: 36541160 DOI: 10.1080/09638288.2022.2153304] [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: 03/18/2022] [Accepted: 11/25/2022] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To examine the relationship between affiliate stigma, stress, and perceived quality of life among parents of children with cerebral palsy (CP). METHOD Surveys (Study 1) and semi-structured interviews (Study 2) were used to collect data. Thirty-eight respondents completed the Affiliate Stigma Scale (ASS), Caregiver Burden Inventory (CBI), and Care-related Quality of Life (CarerQol) scales (GMFCS). Eleven respondents took part in semi-structured interviews, which were then thematically evaluated. RESULTS Parents did not feel stigmatized because they had a child with CP. However, parents needed some form of short-term relief from caregiving. After controlling for demographics, high stress respondents experienced high affiliate stigma whereas low stress respondents had better quality of life. Although the respondents with less stigma had a better quality of life, this effect was moderate. Three major themes emerged from the interviews. CONCLUSION Counseling, support groups, and helper services should be offered to parents. Also, healthcare professionals participating in CP rehabilitation, community-based rehabilitation, and health institutions should be educated on how to better help parents of children with CP.
Collapse
Affiliation(s)
- Shin Ying Chu
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Adlina Binti Mohamed Rafi
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Healthy Ageing and Wellness (H-CARE), Speech Sciences Programme Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Jaehoon Lee
- Department of Educational Psychology, Leadership, and Counseling, Texas Tech University, Lubbock, TX, USA
| | - Veronica Fierro
- Department of Speech-Language Pathology, Delaware Valley University, Doylestown, PA, USA
| | - Chun Hong Gan
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Rehabilitation and Special Needs Studies (iCaRehab), Programme of Clinical Psychology and Behavioural Health, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Susheel Joginder Singh
- Universiti Kebangsaan Malaysia, Faculty of Health Sciences, Centre for Rehabilitation and Special Needs Studies (iCaRehab), Speech Sciences Programme, Jalan Raja Muda Abdul Aziz, Kuala Lumpur, Malaysia
| | - Deborah Hersh
- Speech Pathology, Curtin School of Allied Health, Curtin University, Perth, Australia
| | - Ling-Yi Lin
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| |
Collapse
|
3
|
Cornec G, Brochard S, Drewnowski G, Desguerre I, Toullet P, Fontaine A, Le Lay Y, Boivin J, Bérard E, Bodoria M, Gautheron V, De la Cruz J. The Use and Outcomes of Motor Rehabilitation Services Among People With Cerebral Palsy Change Across the Lifespan. Front Neurol 2022; 12:771348. [PMID: 35281990 PMCID: PMC8905679 DOI: 10.3389/fneur.2021.771348] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Accepted: 12/27/2021] [Indexed: 11/13/2022] Open
Abstract
Background and AimsThe provision of coordinated and multidisciplinary rehabilitation programs that adapt to the individual with cerebral palsy (CP) evolving rehabilitation needs throughout the different phases of life is highly challenging for healthcare systems. The aim of this study was to report the changes in motor rehabilitation (MR) environmental factors, service use and patient outcomes between children and adults with cerebral palsy and to identify if changes took place earlier or later than the standard division between pediatric and adult healthcare systems at 18 years.MethodsWe used data from the French ESPaCe survey to select a set of indicators for MR environmental factors, service use and patient outcomes, highlighted by patients and families in previous studies. We then compared the distribution of the indicator data between children and adults, as well as between four transition age groups: children under 12, adolescents up to 17 years, young adults, and adults over 25 years of age. We estimated odds ratios adjusted for motor involvement, associated impairments and informant type.ResultsA total of 997 respondents over 2 years of age were included in this study (484 children and 513 adults). Finding an available physiotherapist was very difficult for almost half of the children, and a greater proportion of adolescents and adults. Physiotherapy was provided in a private outpatient practice for twice as many adults over 25 years as children and adolescents. The weekly amount of physical therapy decreased as outpatient practice increased. Multidisciplinary rehabilitation decreased sharply from adolescence and was halved at adulthood. Satisfaction with the MR program decreased from childhood into adolescence and adulthood. Perceived impact of physiotherapy on people with CP and their main carers were less positive in adolescents.ConclusionsHealthcare policies should focus on accessibility issues at all ages, consider adolescents as a specific population, consider a wide transition phase (12–25 yo) and maintain a multidisciplinary approach at adulthood. There is a strong need for national rehabilitation strategies for individuals with CP.
Collapse
Affiliation(s)
- Gwenaël Cornec
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France
- Medical Research and Training Unit, Western Brittany University, Brest, France
- Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France
| | - Sylvain Brochard
- Physical and Rehabilitation Medicine Department, University Hospital of Brest, Brest, France
- Medical Research and Training Unit, Western Brittany University, Brest, France
- Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, Brest, France
- Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
| | | | - Isabelle Desguerre
- Hôpital Necker – Enfants malades, Pediatrics-Radiology-Genetics, Paris, France
| | - Philippe Toullet
- Institut Motricité Cérébrale – Cercle de Documentation et d'Information pour la rééducation des Infirmes Moteurs Cérébraux, Paris, France
| | - Audrey Fontaine
- “A Pas de Géants”, Paris, France
- ISIR, UMR 7222 CNRS, Agathe Group INSERM U 1150, Sorbonne University, Paris, France
| | - Yann Le Lay
- Private Practice, Nantes, France
- IFM3R Institut Régional de Formation aux Métiers de la Rééducation et de la Réadaptation des Pays de la Loire, Nantes, France
| | | | | | | | - Vincent Gautheron
- Department of Pediatric Physical and Rehabilitation Medecine, CHU Bellevue - Saint-Etienne, LIBM, Université Jean Monnet Saint Etienne et Université de Lyon, Saint-Étienne, France
| | - Javier De la Cruz
- Hospital Universitario 12 Octubre, Madrid, Spain
- Health Research Institute Imas12, Madrid, Spain
- Mother & Child Health and Development Network (SAMID Network), National Health Institute (ISCIII), Madrid, Spain
- *Correspondence: Javier De la Cruz
| |
Collapse
|
4
|
Predictors of Rehabilitation Service Utilisation among Children with Cerebral Palsy (CP) in Low- and Middle-Income Countries (LMIC): Findings from the Global LMIC CP Register. Brain Sci 2021; 11:brainsci11070848. [PMID: 34202162 PMCID: PMC8301915 DOI: 10.3390/brainsci11070848] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 12/05/2022] Open
Abstract
Background: We assessed the rehabilitation status and predictors of rehabilitation service utilisation among children with cerebral palsy (CP) in selected low- and middle-income countries (LMICs). Methods: Data from the Global LMIC CP Register (GLM-CPR), a multi-country register of children with CP aged <18 years in selected countries, were used. Descriptive and inferential statistics (e.g., adjusted odds ratios) were reported. Results: Between January 2015 and December 2019, 3441 children were registered from Bangladesh (n = 2852), Indonesia (n = 130), Nepal (n = 182), and Ghana (n = 277). The proportion of children who never received rehabilitation was 49.8% (n = 1411) in Bangladesh, 45.8% (n = 82) in Nepal, 66.2% (n = 86) in Indonesia, and 26.7% (n = 74) in Ghana. The mean (Standard Deviation) age of commencing rehabilitation services was relatively delayed in Nepal (3.9 (3.1) year). Lack of awareness was the most frequently reported reason for not receiving rehabilitation in all four countries. Common predictors of not receiving rehabilitation were older age at assessment (i.e., age of children at the time of the data collection), low parental education and family income, mild functional limitation, and associated impairments (i.e., hearing and/or intellectual impairments). Additionally, gender of the children significantly influenced rehabilitation service utilisation in Bangladesh. Conclusions: Child’s age, functional limitation and associated impairments, and parental education and economic status influenced the rehabilitation utilisation among children with CP in LMICs. Policymakers and service providers could use these findings to increase access to rehabilitation and improve equity in rehabilitation service utilisation for better functional outcome of children with CP.
Collapse
|
5
|
Al Imam MH, Jahan I, Das MC, Muhit M, Smithers-Sheedy H, McIntyre S, Badawi N, Khandaker G. Rehabilitation status of children with cerebral palsy in Bangladesh: Findings from the Bangladesh Cerebral Palsy Register. PLoS One 2021; 16:e0250640. [PMID: 33939721 PMCID: PMC8092763 DOI: 10.1371/journal.pone.0250640] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/08/2021] [Indexed: 12/31/2022] Open
Abstract
OBJECTIVE The objective of this study was to assess the rehabilitation status and factors associated with rehabilitation service utilisation among children with cerebral palsy (CP) in Bangladesh. MATERIALS AND METHODS This is a population-based surveillance study conducted among children with CP registered in the Bangladesh CP Register (BCPR), the first population-based register of children with CP aged <18 years (y) in Bangladesh. Children with CP were identified from the community using the key informant method and underwent a detailed neurodevelopmental assessment. Socio-demographic, clinical and rehabilitation status were documented. Unadjusted and adjusted analyses with a 95% confidence interval (CI) were used to identify potential predictors of rehabilitation service uptake. RESULTS Between January 2015 and December 2019, 2852 children with CP were registered in the BCPR (mean (standard deviation, SD) age: 7 y 8 months (mo) (4 y 7 mo), 38.5% female). Of these, 50.2% had received rehabilitation services; physiotherapy was the most common type of service (90.0%). The mean (SD) age at commencement of rehabilitation services was 3 y 10 mo (3 y 1 mo). The odds of not receiving rehabilitation was significantly higher among female children (adjusted odds ratio (aOR) 1.3 [95% CI: 1.0-1.7], children whose mothers were illiterate and primary level completed (aOR 2.1 [95% CI: 1.4-3.1] and aOR 1.5 [95% CI: 1.1-2.1], respectively), fathers were illiterate (aOR 1.9 [95% CI: 1.3-2.8]), had a monthly family income ~US$ 59-118 (aOR: 1.8 [95% CI: 1.2-2.6]), had hearing impairment (aOR: 2.3 [95% CI: 1.5-3.5]) and motor severity (i.e. Gross Motor Function Classification System level III (aOR: 0.6 [95% CI: 0.3-0.9]) and level V (aOR: 0.4 [95% CI: 0.2-0.7])). CONCLUSIONS Rehabilitation status was poor among the majority of the children with CP in the BCPR cohort, limiting their opportunities for functional improvement. A community-based rehabilitation model focusing on socio-demographic and clinical characteristics should be a public health priority in Bangladesh.
Collapse
Affiliation(s)
- Mahmudul Hassan Al Imam
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Israt Jahan
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- School of Health, Medical and Applied Sciences, Central Queensland University, Rockhampton, Queensland, Australia
| | - Manik Chandra Das
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Mohammad Muhit
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
| | - Hayley Smithers-Sheedy
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
| | - Nadia Badawi
- Cerebral Palsy Alliance, Sydney Medical School, The University of Sydney, Camperdown, New South Wales, Australia
- Grace Centre for Newborn Intensive Care, Sydney Children’s Hospital Network, Westmead, New South Wales, Australia
| | - Gulam Khandaker
- CSF Global, Dhaka, Bangladesh
- Asian Institute of Disability and Development (AIDD), University of South Asia, Dhaka, Bangladesh
- Discipline of Child and Adolescent Health, Sydney Medical School, The University of Sydney, Sydney, New South Wales, Australia
- Central Queensland Public Health Unit, Central Queensland Hospital and Health Service, Rockhampton, Queensland, Australia
- * E-mail:
| |
Collapse
|
6
|
Travlos V, Patman S, Wilson A, Simcock G, Downs J. Quality of Life and Psychosocial Well-Being in Youth With Neuromuscular Disorders Who Are Wheelchair Users: A Systematic Review. Arch Phys Med Rehabil 2017; 98:1004-1017.e1. [DOI: 10.1016/j.apmr.2016.10.011] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2016] [Revised: 08/21/2016] [Accepted: 10/05/2016] [Indexed: 12/14/2022]
|