A systematic review and meta-analysis of the effectiveness of interventions to improve psychological wellbeing in the parents of children with cerebral palsy

Interventions to address parenting stress among caregivers of children with chronic diseases: An umbrella review

BACKGROUND

Caregivers of children with chronic diseases suffer from great parenting pressure, which directly affects the treatment and rehabilitation of children, reduces the quality of life of caregivers and damages family functioning. Existing reviews have not systematically summarized and evaluated interventions for parenting stress in caregivers of children with chronic diseases.

DATA SOURCES

Embase, PubMed, Web of Science, OVID, CNKI, CBM, Wan Fang and Cochrane Library were searched for eligible reviews in November 2021 and October 2022.

METHODS

Two reviewers independently screened titles and abstracts, reviewed full texts of articles for eligibility, and appraised the quality of reviews using JBI. The quality of the evidence was assessed using GRADE. Findings are reported in accordance with PRISMA checklist. Narrative summaries grouped findings by intervention types.

RESULTS

Out of 2632 records, we included 21 systematic reviews for a synthesis. Interventions for parenting stress in children with chronic diseases were divided into seven categories. Cognitive behavioural interventions, psychosocial interventions, child behavioural and/or developmental parent interventions and synthesized interventions have shown high-level evidence in reducing parenting stress for caregivers of children with chronic diseases. Furthermore, outcome measures and intervention protocols were highly heterogeneous across interventions.

CONCLUSIONS

This umbrella review suggest that reducing the parenting stress of caregivers of children with chronic diseases can directly target caregivers' parenting stress through cognitive behavioural interventions/psychosocial interventions and/or provide guidance to parents on the behavioural and developmental problems of children with chronic diseases. A more standardized approach to outcome measures is essential to assess efficacy and compare interventions across studies.

RELEVANCE TO CLINICAL PRACTICE

The findings provide information and evidence for reducing parenting stress among caregivers of children with chronic diseases to guide the development of comprehensive intervention strategies.

PATIENT OR PUBLIC CONTRIBUTION

Patient or public contribution does not apply to this study.

Dental caries and developmental defects of enamel in cerebral palsy: A meta-analysis

OBJECTIVE

This systematic review and meta-analysis aimed to compare the occurrence of dental caries and developmental defects of enamel (DDE) in individuals with and without cerebral palsy (CP).

MATERIALS AND METHODS

We conducted searches across five databases and the grey literature. Data were organized using EndNote 20. Reporting followed the MOOSE checklist. A random-effects model meta-analyses were conducted using RStudio, presenting results as mean difference (MD), odds ratio (OR), and 95% confidence interval (CI). The risk of bias of studies was analyzed using the Newcastle-Ottawa Scale, and the certainty of evidence was assessed using GRADE.

RESULTS

Among 1336 identified records, 25 studies involving 59,997 participants (mean age: 11.1 years) were included. Data of 12 were pooled into meta-analyses. No significant differences were found between CP and non-CP individuals across indices: DMFT (k = 7) (MD = 0.31; 95% CI [-0.42-1.05]), dmft (k = 4) (MD = 0.31; 95% CI [-0.50-1.14]), DMFS (k = 2) (MD = -0.61; 95% CI [-20.56-19.33]), dmfs (k = 3) (MD = 0.54; 95% CI [-1.09-2.17]), and DDE (k = 3) (OR = 0.80, 95% CI [0.09-7.31]). The certainty of evidence was very low.

CONCLUSION

Individuals with CP do not appear to differ significantly from those without CP in terms of dental caries experience and DDE.

Psychological aspects of being a parent of an individual with Rett syndrome: A scoping review

BACKGROUND

Rett syndrome (RTT) causes multiple disabilities with a lifelong need for substantial care, placing a tremendous lifelong responsibility on the parents. Parenting an individual with RTT can therefore be challenging. Research on the psychological aspects of parenting individuals with RTT is limited and unclear. We aimed to identify and map the existing literature on this subject.

METHOD

A scoping review was conducted with systematic searches in PubMed, PsycINFO and CINAHL.

RESULTS

Eighteen studies were included. Negative and positive psychological aspects were described with the majority focusing on the negative. Three factors seemed to especially affect the parents: severity of the diagnosis, time (increasing age of parents or individual with RTT; years of caretaking), work-status of the mother.

CONCLUSIONS

Seemingly, parents are highly affected; however, the literature is scarce and has several gaps. Future research should include older parents, fathers, parents of individuals living in group homes, and positive aspects.

Factors affecting the health-related quality of life of children with cerebral palsy in Indonesia: a cross-sectional study

PURPOSE

Children with cerebral palsy (CP) and their parents experience various problems that can affect their quality of life. This study examined factors affecting the quality of life of children with CP.

METHODS

A cross-sectional study was conducted in Yogyakarta, Indonesia, from January to August 2019. The participants were consecutively recruited children with CP aged 2 to 18 years and their parents. Ninety-eight children with CP and their parents, specifically their mothers, were recruited. Children's health-related quality of life (HRQoL) was measured using the Pediatrics Quality of Life Cerebral Palsy. Parental HRQoL and stress were measured using the WHOQOL-BREF and Parenting Stress Index (PSI).

RESULTS

Functional level V was the most common category for both Gross Motor Function Classification System (GMFCS) and Bimanual Fine Motor Function (BFMF) (35% and 28%, respectively). Children's mean HRQoL was medium (49.81±20.35). The mean total PSI score was high (94.93±17.02), and 64% of parents experienced severe stress. Bivariate analysis showed that GMFCS, BFMF, number of comorbidities, presence of pain, and parental stress were significantly correlated with the total score for children's HRQoL (p<.05). Multiple linear regression analysis (p<.05) demonstrated that more severe GMFCS and parental stress were associated with lower mean HRQoL scores in children.

CONCLUSION

Factors including the level of GMFCS and parental stress affected the HRQoL of children with CP. Parental stress management should be included in the comprehensive management of these children.

Fathers' experiences of caring for children living with cerebral palsy: A qualitative study in a low resourced socioeconomic context, Ghana

BACKGROUND

In Ghana, little is known about fathers' experiences caring for children with cerebral palsy.

PURPOSE

The purpose of this study is to explore a. the caregiving demand and burden on fathers of children with cerebral palsy and b. describe the caregiving consequences and coping strategies of fathers of children with cerebral palsy.

DESIGN AND METHODS

The study utilized an exploratory, descriptive qualitative approach with a sample size of fifteen fathers purposively selected. The study used a semi-structured interview guide to conduct a one-on-one interview with participants. The analysis performed was thematic and content analysis.

RESULTS

The results revealed complexities of care demand and burden; thus, meeting the child's needs resulted in physical and mental exhaustion, frequent hospital visits, and substantial financial implications for fathers.

CONCLUSIONS

We conclude that the family, particularly fathers, need support to embrace the challenging care roles as parents to children with cerebral palsy. It is evident that caring for children is mainly reserved for mothers in the African context. However, the demanding nature of care for a child with a developmental disability requires the involvement of both parents to meet the child's care needs and reduce the caregiver's care burden.

PRACTICE IMPLICATIONS

Health professionals, particularly nurses must initiate and advocate for fathers' active participation in daily childcare. Tailored supportive care for families with children with disabilities in sub-Saharan Africa is required.

Factors associated with caregiver burden among family caregivers of children with cerebral palsy: a systematic review

OBJECTIVES

To identify caregiver and children factors associated with caregiver burden on primary caregivers of children with cerebral palsy (CP).

DESIGN

Systematic review DATA SOURCES: Seven electronic databases, including PubMed, Cochrane Library, Scopus, PsycINFO, Web of Science, CINAHL and Embase, were systematically searched up to 1 February 2023.

ELIGIBILITY CRITERIA

Original observational studies reporting caregiver burden and related factors among caregivers of children with CP.

DATA ABSTRACTION AND SYNTHESIS

Two reviewers independently screened results and assessed the quality of studies. Title, abstract, full-text screening and data abstraction were done independently by two reviewers. Risk of bias was assessed using the JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies. The quality of evidence for factors was rated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

RESULTS

16 articles were included in the review. All studies were cross-sectional and examined caregiver-reported burden measures. The Zarit Burden Interview was the most commonly used questionnaire. Depression of caregiver and severity of illness in children with CP were moderate quality of evidence for factors contributing to caregiver burden.

CONCLUSIONS

Higher caregiver burden is associated with more depressive feelings and worse life quality of the caregiver, and with more severe physical disability of the children. Future studies should focus on high-quality longitudinal research and appropriate assistance to reduce caregiver burden and improve the quality of caregiving for children with CP.

PROSPERO REGISTRATION NUMBER

CRD42021268284.

Play-based groups for children with cerebral palsy and their parents: A qualitative interview study about the impact on mothers' well-being

BACKGROUND

Cerebral palsy (CP) is the most common childhood physical disability in developed countries. Parents of children with CP experience difficulties that can result in reduced well-being. Health professionals supporting children with CP have been encouraged to focus on parental well-being as this forms part of the child's essential environment. There is a lack of evidence about interventions that holistically support the whole family by providing therapeutic input for the child and support for parents. This study aimed to explore parents' experiences of play-based groups for children with CP and their parents, with a focus on the groups' impact on parents' well-being.

METHODS

Parents of children with CP who had attended play-based groups in the year prior were recruited for this qualitative study. Semi-structured interviews were conducted, audio-recorded and transcribed verbatim. Participants' demographic characteristics were collected as contextual information. Data were analysed using an inductive thematic approach.

RESULTS

Ten mothers were interviewed. Overall, mothers had positive experiences of the groups and perceived them as an important influence on their well-being. Four themes described mothers' experiences of the groups and the subsequent impact on their well-being: (1) practical support, (2) connecting with others, (3) transitioning journeys and (4) different motivators, different experiences. Numerous factors influenced mothers' experiences of attending the groups and the subsequent impact on their well-being. This included mothers' individual experiences of having a child with CP.

CONCLUSIONS

Interventions combining practical and social support for the whole family can have a positive impact on the well-being of mothers of children with CP. Care should be taken to provide individualised support for each family. There is no 'one-size-fits-all' approach, and a package of care can provide multiple services that meet the varying needs of mothers and their children with CP.

Grappling with uncertainty - Experiences of parents of infants following perinatal stroke

BACKGROUND

The term perinatal stroke describes focal damage to the developing brain due to cerebrovascular disease and occurring either before or shortly after birth. Aetiology, presentation and evolution differ from stroke in adults.

AIMS

We aimed to explore early parental experiences related to having a child with perinatal stroke, including how parental psychological wellbeing had been impacted, to consider how support for families could be improved.

METHODS AND PROCEDURES

We undertook a qualitative research study, using in-depth interviews of parents of infants with perinatal stroke when the infants were 5-6 months corrected gestational age. Sixteen parents (11 female, 5 male) of 11 infants with perinatal stroke took part. Thematic analysis was used in data interpretation.

OUTCOMES AND RESULTS

Parents described distress related to the lack of information regarding likely outcome following perinatal stroke, as well as confusion around the term 'stroke'. Guilt and self-blame were expressed, with increased emotional sensitivity. Seeking information about stroke to reduce uncertainty was a useful strategy for some, but overwhelming for others.

CONCLUSIONS AND IMPLICATIONS

The diagnosis of perinatal stroke led to psychological distress in parents. Uncertainty following diagnosis produced significant emotional difficulties. Recommendations for practice include providing timely, paced information and psychological support.

Caregiver burden in cerebral palsy: Validity and reliability of the Turkish version of caregiver difficulties scale

BACKGROUND

This study aims to translate the caregiver difficulties scale (CDS) into Turkish language and to reveal its reliability and validity in Turkish informal family caregivers of children with cerebral palsy (CP).

METHODS

This study included 130 participants (39.9 ± 7.8 years; range 24-58 years; 106 females and 24 males). Demographic properties of participants, relationship with the care recipient, income, caregiving time, CP type and diseases of the child (e.g., epilepsy, hydrocephalus and congenital heart disease) and the caregiver were recorded. The CDS, caregiver well-being scale (CWBS), World Health Organization Quality of Life (WHOQOL-BREF) and Beck depression inventory (BDI) were used for data collection. The internal consistency of the CDS was assessed using the calculation of Cronbach's alpha coefficient. A test-retest interval of 2 weeks was used to assess the reliability. The intercorrelation of variables was evaluated using the Spearman correlation coefficient. The receiver operating characteristic (ROC) analysis was performed to find the predictive power of CDS scores for depression.

RESULTS

A total of 130 family caregivers of children with CP completed the test/retest procedures. The Cronbach alpha coefficients were found as 0.878 for the test and 0.852 for the retest. Intraclass correlation coefficient (ICC) value was found between 0.83 and 0.90 for test-retest reliability of the CDS. In addition, the CDS showed a significantly strong correlation with CWBS-activities of living subscale and WHOQOL-BREF psychological, physical and environment domains, as well as a significantly moderate correlation with CWBS basic needs subscale, BDI and WHOQOL-BREF general health and social domains. CDS scores that are >46 resulted in a sensitivity of 81.48% and a specificity of 73.79% for moderate-severe depression.

CONCLUSION

The Turkish version of the CDS is a valid and reliable measure for caregiver burden of family caregivers of children with CP.

Parental engagement in early intervention for infants with cerebral palsy-A realist synthesis

BACKGROUND

Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex. Despite the growing application of parental engagement strategies, aligned with family-centred care practice, theoretical evaluation is currently lacking within the literature. This realist synthesis aimed to identify component theories underlying EI strategies to support parental engagement and to use empirical findings to evaluate how these work in practice.

METHODS

Realist synthesis: Databases Medline, Embase, Amed, CINAHL and PsychInfo were searched (from February 1985 - February 2020); further articles were sourced from reference lists. A data extraction form was used, and a Critical Appraisal Skills Programme tool was used to assess study rigour.

RESULTS

Twenty-six articles were included. Quality of relationships, parent education and intervention co-design were the key themes related to parental engagement strategies. Findings indicate that constructive parent reasoning mechanisms of trust, belief, sense of control, perceived feasibility of home programme delivery and ultimately motivation are linked to the underlying intervention resources afforded by specific strategies (e.g., coaching pedagogy). These responses are precursors to engagement outcomes that include increased parental self-efficacy and adherence. Importantly, parental self-efficacy can initiate a process of change leading to improved parental confidence and anxiety.

CONCLUSIONS

Sensitively designed programme strategies, centred on relational quality between parent, infant and therapist, are fundamental for effective parent connection, involvement and investment within EI for infants with CP.

Outcome of Community-Based Early Intervention and Rehabilitation for Children with Cerebral Palsy in Rural Bangladesh: A Quasi-Experimental Study

We evaluated the outcome of a community-based early intervention and habilitation for children with cerebral palsy (CP) in Bangladesh. Children registered on the Bangladesh CP Register (BCPR) were recruited in two groups for this study: Group A received a comprehensive six-month long community-based caregiver-led intervention program at the “Shishu Shorgo” (Bengali title, which translates to ‘Children’s Heaven’) Early Intervention and Rehabilitation Centres developed to support participants from the BCPR. Group B received standard care. A quasi-experimental study was conducted. Data were obtained at baseline, at the end of the program (i.e., 6 months), and at a 12-month follow-up. Outcome measures for children included gross motor functional measure (GMFM-66), Communication Function Classification System (CFCS), and Viking Speech Scale (VSS) and, for adult caregivers, the depression, anxiety, and stress scale (DASS 21). Between October 2016 and March 2017, 156 children with CP were recruited (77 in Group A and 79 in Group B). The total score of GMFM-66, CFCS level, and VSS level significantly improved statistically in Group A (p < 0.05 for all) and deteriorated in Group B (p < 0.001, p = 0.095, p = 0.232). The intervention showed promising outcomes particularly for children with CP under five years of age. There is a need for caregiver-led community-based programs for children with CP in LMICs.

Relationship among Gross Motor Function, Parenting Stress, Sense of Control, and Depression in Mothers of Children with Cerebral Palsy

The purpose of this study was to investigate the relationship among the gross motor function of children with cerebral palsy and parenting stress, sense of control, and depression in their mothers. Data were collected from 247 children with cerebral palsy and their mothers. To verify the relationship among variables, path analysis was performed. The control variables included the sex and age of the children. The proposed model showed good fit indices. Gross motor function had an indirect effect on parenting stress and depression and a direct effect on parenting stress and self-control (as parenting sense of control). Parenting stress had an indirect effect on depression and a direct effect on self-control and depression. This result suggests the importance of improving the gross motor function in children with cerebral palsy and self-control in the mothers, as well as decreasing parenting stress to reduce the level of the mothers’ depression. Considering the mediating effect of self-control on depression, programs designed to enhance self-control could be effective in decreasing depression in mothers of children with cerebral palsy.

Systematic Review of Acceptance and Commitment Therapy in Individuals with Neurodevelopmental Disorders, Caregivers, and Staff

The purpose of this review was to quantitatively synthesize studies using acceptance and commitment therapy (ACT) with individuals with neurodevelopmental disorders (NNDs), their parents, and staff members that support them. Thirty studies published in peer-reviewed journals between 2006 and 2020 met inclusion criteria. They were reviewed and coded on variables associated with participants' characteristics, settings, dropouts, design type, ACT procedures and measures, social validity, treatment integrity, and main findings. The What Works Clearinghouse (WWC), the revised Cochrane risk-of-bias tool for randomized trials (RoB2) and the Risk of Bias in Nonrandomized Studies of Interventions (ROBINS-I) were applied to evaluate the quality of the studies. Results indicated that 20 studies used group designs and 10 studies used single-case designs. Participants with NNDs consisted predominantly of those with autism spectrum disorder, attention deficit hyperactivity disorder, and learning disabilities. Group studies reported process and outcome measures exclusively; whereas, single-case studies also incorporated behavioral/direct measures. Overall, results showed mixed improvements across studies using indirect and direct measures. Lastly, quality assessment for group studies presented moderate or serious risk of bias and two single-case studies did not meet WWC evidence of effectiveness. Directions for future research and practice are discussed.

Psychological Distress among Caregivers of Children with Neurodevelopmental Disorders in Nepal

Parenting a child with neurodevelopmental disorder (NDD) is related to a higher rate of anxiety and depression, increased stress, and reduced quality of life. Although there is reason to believe that parenting children with NDD in low- and middle-income countries (LMIC) can be challenging, there is a lack of knowledge on the psychological distress among these caregivers, especially in rural areas. The aim of the study was to examine the psychological distress among caregivers having children with NDD in rural Nepal. Sixty-three caregivers were visited in their homes and interviewed by experienced mental health professionals. This study examined demographic information, severity of disability, perceived caregiver burden, and psychological distress, measured by the General Health Questionnaire-12 (GHQ-12). The study found a high level of psychological distress in the caregivers (M = 5.38, SD = 2.8). A majority (90.5%) scored two or higher, indicating the presence of a common mental disorder (CMD). Almost half (46%) scored six or higher, indicating a high level of distress. A majority of the caregivers reported that caring for their disabled child had a negative effect on the caregiver’s economy (70%), physical health (65%), social life (64%), and dreams and expectations for the future (81%). There was a significant relationship between the caregiver’s psychological distress (GHQ-12) and degree of disability in the child (Gross Motor Function Classification System), degree of caregiver burden, feeding problems, having health workers as a possible source of help, receiving incentive from the government, having somebody to confide in, and caregiver illiteracy. A forward regression analysis entering the significant factors indicated that caregiver burden, having someone to confide in, and having health workers as a possible source of help were significant related to psychological distress. The final step of the model explained 42.4% of the variance in psychological distress among the caregivers. The study indicates a high level of psychological distress and high overall burden in caregivers of children with NDD in rural Nepal. Further implications for research and service development are discussed.

Pain and Communication in Children with Cerebral Palsy: Influence on Parents' Perception of Family Impact and Healthcare Satisfaction

Cerebral palsy (CP) is an impacting chronic condition. Concomitant comorbidities such as pain and speech inability may further affect parents’ perception of the pathology impact in the family quality of life and the provided care. The objective of this cross-sectional descriptive correlational study was to compare parental reports on family impact and healthcare satisfaction in children with CP with and without chronic pain and with and without speech ability. Parents of 59 children with CP (age range = 4–18 years) completed several questions about pain and speech ability and two modules of the Pediatric Quality of Life Measurement Model: The PedsQLTM 2.0 Family Impact Module and the PedsQLTM Healthcare Satisfaction Generic Module. Our findings revealed that children’s pain slightly impacted family physical health, social health and worry. In children without pain, speech inability increased the perceived health impact. Parents’ healthcare satisfaction was barely affected by pain or speech inability, both increasing parents’ satisfaction in the professional technical skills and inclusion of family domains on the care plan. In conclusion, pain and speech inability in children with CP can impact family health but not healthcare satisfaction. Regular assessment and intervention in family health is essential for the design of family-centred programs for children with CP.

Family functioning and strengths in families raising a child with cerebral palsy

Cerebral palsy (CP) is a serious disorder that has serious consequences on the functioning of children and their families. This study explores family functioning (adaptation, cohesion and family type) and strengths (pride, accord and whole) in Greek and Italian families raising a child with CP and their interaction. Participants were 120 parents of a biological child with CP. Data collection used a self-report questionnaire, the Family Adaptability and Cohesion Evaluation Scale (FACES-III) and the Family Strengths Inventory. According to the findings, parents (in both countries) estimate and wish their family to be in the balanced range which represents healthy family functioning according to the revised edition of the Olson Circumplex Model. Finally, they share a high sense of family strengths, which is mainly displayed in the high sense of pride and accord.

Role of child neurologists and neurodevelopmentalists in the diagnosis of cerebral palsy: A survey study

OBJECTIVE

To contextualize the role of child neurologists and neurodevelopmentalists (CNs/NDDs) in cerebral palsy (CP) care, we review the changing landscape of CP diagnosis and survey stakeholder CNs/NDDs regarding their roles in CP care.

METHODS

The optimal roles of the multiple specialties involved in CP care are currently unclear, particularly regarding CP diagnosis. We developed recommendations regarding the role of CNs/NDDs noting (1) increasing complexity of CP diagnosis given a growing number of genetic etiologies and treatable motor disorders that can be misdiagnosed as CP and (2) the views of a group of physician stakeholders (CNs/NDDs from the Child Neurology Society Cerebral Palsy Special Interest Group).

RESULTS

CNs/NDDs felt that they were optimally suited to diagnose CP. Many (76%) felt that CNs/NDDs should always be involved in CP diagnosis. However, 42% said that their patients with CP were typically not diagnosed by CNs/NDDs, and 18% did not receive referrals to establish the diagnosis of CP at all. CNs/NDDs identified areas of their expertise critical for CP diagnosis including knowledge of the neurologic examination across development and early identification of features atypical for CP. This contrasts with their views on CP management, where CNs/NDDs felt that they could contribute to the medical team, but were necessary primarily when neurologic coexisting conditions were present.

DISCUSSION

Given its increasing complexity, we recommend early referral for CP diagnosis to a CN/NDD or specialist with comparable expertise. This contrasts with current consensus guidelines, which either do not address or do not recommend specific specialist referral for CP diagnosis.

First Things First: Parent Psychological Flexibility and Self-Compassion During COVID-19

The COVID-19 pandemic has brought about significant stress and anxiety for many parents around the world. Psychological flexibility and self-care are fundamental aspects of psychological health. For parents, shaping these processes may help promote family nurturance, support children's prosocial behavior, and provide effective and consistent use of evidence-based parenting "kernels." The goal of this article is to provide practitioners with evidence-based tools that will support psychological flexibility, self-care, and positive parenting behaviors in caregivers during COVID-19 and beyond.

Children with cerebral palsy: Family and parent demographic characteristics and family strengths in Greece and Italy

The study focuses on families raising a child with cerebral palsy to investigate family strengths and their association with family and parent demographic characteristics in Greece and Italy. Participants were 120 parents raising a biological child with cerebral palsy. Data collection used a self-report questionnaire and the Family Strengths Inventory. According to the findings, families share a high sense of family strengths, which is mainly represented in the high sense of 'pride' and 'accord'. In addition, demographic characteristics seem to be important predictors of well-being and strengthen parents and families raising a child with cerebral palsy.