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Batista Freire E, Maia Peixoto H, Almeida Ayupe KM, Nunes da Silva E, Luiz Carregaro R, Martins de Toledo A. DIRECT HEALTHCARE COSTS for PEOPLE with CEREBRAL PALSY in the BRAZILIAN UNIFIED HEALTH SYSTEM BETWEEN 2015 and 2019. Expert Rev Pharmacoecon Outcomes Res 2024. [PMID: 39115979 DOI: 10.1080/14737167.2024.2390043] [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: 01/18/2024] [Revised: 06/28/2024] [Accepted: 07/29/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Estimate the costs of inpatient and outpatient care for people with Cerebral Palsy (CP) in Brazil. RESEARCH DESIGN AND METHODS Health records of people with CP in the Hospital and Outpatient Information's Systems of Brazil between 2015 to 2019 were analyzed. Variables analyzed were gender, age, ICD, Intensive Care Unit (ICU) use, total cost, and ICU cost. Costs were adjusted for inflation and converted to dollars. Linear regression analysis was performed to investigate the association between social and clinical variables and direct costs. RESULTS A total direct cost of approximately $166 million to the National Health System was identified, with $7.08 million/year and $26.1 million/year of inpatient and outpatient costs, respectively. The healthcare was primarily for children up to 14 years of age. The ICD 'spastic quadriplegic CP' received the most attendance. Rehabilitation was responsible for 75% of the outpatient care, with physiotherapy standing out. Increased age, use of ICU and the types of CP are related to increased cost. CONCLUSIONS Healthcare for people with CP produced expressive costs for the Brazilian public health system, mainly with outpatient procedures and rehabilitation, with children being the most attended. Estimating these costs assists in better resource allocation for more effective healthcare provision.
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Affiliation(s)
- Emilie Batista Freire
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Henry Maia Peixoto
- Núcleo em Medicina Tropical, Faculdade de Ciências da Saúde, Universidade de Brasília, Brasília, Brazil
| | | | - Everton Nunes da Silva
- Programa de Ciências e Tecnologias em Saúde, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Rodrigo Luiz Carregaro
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
| | - Aline Martins de Toledo
- Programa de Pós-Graduação em Ciências da Reabilitação, Faculdade de Ceilândia, Universidade de Brasília, Brasília, Brazil
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Feldner HA, Gaebler-Spira D, Awasthi V, Bjornson KK. Supportive mobility devices across the lifespan in Cerebral Palsy: a modified Delphi study to establish stakeholder research priorities. Disabil Rehabil Assist Technol 2024; 19:1739-1747. [PMID: 37452575 PMCID: PMC10883137 DOI: 10.1080/17483107.2023.2233564] [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: 01/04/2023] [Revised: 06/28/2023] [Accepted: 06/30/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE The aim of this study was to co-develop research priorities and identify meaningful research questions with a diverse group of stakeholders representing the CP community for implementation in subsequent research activities. The overarching aim of this research was to 1) Understand the mobility experiences, supported mobility device (SMD) use, and desired participation outcomes of people with cerebral palsy (CP) across the lifespan; and 2) Describe how perspectives of rehabilitation care and professional resources may influence mobility decision-making processes and outcomes. MATERIALS AND METHODS A three-round modified Delphi consensus study was conducted with a stakeholder advisory panel consisting of three adults with CP, two parents of children with CP, and four SMD providers. RESULTS The advisory panel identified 11 unique topical categories focused on SMD selection and use, stratified by age group and stakeholder role. Questions or statements within each category were ranked, and top consensus and concordance statements were retained, reviewed, and refined for use in a co-developed focus group guide. Priorities were identified in three main groupings: (1) Age/GMFCS level/Environment-related; (2) Individual with CP/Caregiver need-related; and (3) Clinician/provider partnership-related. DISCUSSION A modified Delphi process was a useful tool for stakeholders in co-developing research priorities related to SMD use across the lifespan. Drawing on the lived expertise of stakeholders is important in facilitating improved research translation in the CP community.
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Affiliation(s)
- Heather A Feldner
- Department of Rehabilitation Medicine, University of WA, Seattle, WA, USA
| | | | - Varun Awasthi
- Seattle Children's Research Institute, Seattle, WA, USA
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Sattoe JNT, Hilberink SR. Impairments and comorbidities in adults with cerebral palsy and spina bifida: a meta-analysis. Front Neurol 2023; 14:1122061. [PMID: 37533474 PMCID: PMC10390785 DOI: 10.3389/fneur.2023.1122061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 06/30/2023] [Indexed: 08/04/2023] Open
Abstract
Introduction Aging with a childhood-onset disability, such as cerebral palsy (CP), spina bifida (SB), and muscular diseases (MD), comes along with significant impairments and comorbidities. Despite the increasing evidence an overall picture is lacking. This study aimed to review the literature about adults with CP/SB/MD and impairments and comorbidities to perform a meta-analysis. Materials and methods Embase, PubMed, Cinahl, and Google Scholar were searched (2000-2020). Search terms included adults with one of the aforementioned disabilities combined with impairments and comorbidities. If specific impairments or comorbidities were reported by at least four studies, these were included in the study. Pooled prevalence (95% Confidence Interval) of impairments/comorbidities were calculated. Results The search yielded 7,054 studies of which 95 were included in the meta-analysis (64 CP, 31 SB, 0 MD). In total estimates were calculated for 26 (CP) and 11 (SB) outcomes. In adults with CP, pain [56.4% (95%CI 48.8-63.8)], deformities [44.2% (95%CI 12.9-78.4)], intellectual disability [37.2% (95%CI 26.7-48.3)], and fatigue [36.9% (95%CI 24.6-50.1)] were most prevalent; renal disease [3.0% (95%CI 2.1-4.2)] and stroke/rheumatic diseases {4.8% (95%CI 3.4-6.5; 4.8% (95%CI 1.5-9.9)] respectively} were least prevalent. For adults with SB, bladder incontinence [60.0% (95%CI 50.5-69.2)], bowel incontinence [49.2% (95%CI 34.5-64.0)], pain [44.1% (95%CI 27.4-61.5)], and sleeping problems [30.3% (95%CI 4.7-65.8)] were most prevalent; diabetes [4.8% (95%CI 2.8-7.3)] and renal disease [8.7% (95%CI 2.0-19.9)] were least prevalent. The included studies showed large heterogeneity. Conclusions More research is needed to study health issues in adults with MD. Adults with CP or SB deal with a variety of health issues. More attention for the mental health of these adults is needed. There also is a need for accessible and adequate screening, preventive measures and clinical follow-up.
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Manikandan M, Casey C, Doyle A, Kerr C, Walsh M, Walsh A, M Ryan J. Use of health services and unmet needs among adults with cerebral palsy in Ireland. Dev Med Child Neurol 2022; 64:1270-1280. [PMID: 35396701 PMCID: PMC9546397 DOI: 10.1111/dmcn.15233] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/08/2022] [Accepted: 03/11/2022] [Indexed: 11/27/2022]
Abstract
AIM To describe use of health services, unmet needs relating to health services, and identify factors associated with service use among adults with cerebral palsy (CP) in Ireland. METHOD Data relating to demographics, secondary diagnoses, current use of health services and assistive devices, and unmet needs for both were obtained on adults with CP from the National Physical and Sensory Disability Database. Logistic regression was used to identify factors associated with service use. RESULTS A total of 1268 adults with CP were included in this study. Over half were male (56%) and 78% lived with parents, siblings, or other family relatives. Physiotherapy, occupational therapy, and orthotics/prosthetic services were the most commonly used services, used by 57%, 48%, and 35% of the sample respectively. Unmet needs were highest for physiotherapy (23%) and occupational therapy services (13%). Age, sex, living arrangements, and wheelchair use were frequently associated with current service use. INTERPRETATION Adults with CP used a wide range of health services and unmet needs were reported for all services. The findings highlight a need for planning and development of services to meet their needs, regardless of their age, mobility level, or living arrangements. WHAT THIS PAPER ADDS Adults with cerebral palsy (CP) in Ireland used a wide range of therapeutic, respite, personal assistance, and support services. Unmet needs were highest for physiotherapy and occupational therapy services. Adults aged 25 years and above were less likely to use therapy services compared with younger adults. Adults living with parents, siblings, or family relatives were less likely to use personal assistance and physiotherapy services.
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Affiliation(s)
- Manjula Manikandan
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
| | - Claire Casey
- National Health Information SystemsHealth Research BoardIreland
| | - Anne Doyle
- Evidence CentreHealth Research BoardIreland
| | - Claire Kerr
- School of Nursing and MidwiferyQueen's University BelfastUnited Kingdom
| | - Michael Walsh
- National Clinical Programme for People with DisabilityClinical Design and Innovation Office, Health Service ExecutiveDublinIreland
| | - Aisling Walsh
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
| | - Jennifer M Ryan
- Department of Public Health and EpidemiologyRoyal College of Surgeons in IrelandIreland
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Pizzighello S, Uliana M, Michielotto M, Pellegri A, Vascello MGF, Piccoli S, Martinuzzi M, Martinuzzi A. Psychiatric symptoms in adult patients with cerebral palsy: A cohort study. Front Neurol 2022; 13:998922. [PMID: 36247792 PMCID: PMC9553524 DOI: 10.3389/fneur.2022.998922] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 09/07/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPatients with cerebral palsy (CP) have an increased risk of developing mental health disorders.AimsThis paper is aimed to investigate the occurrence of psychiatric symptoms in adults with CP and to explore the relation between clinical and psychosocial variables.Methods and proceduresWe included 199 adults with a diagnosis of CP. The chi-square and the Mann-Whitney U tests were used to compare clinical and psychosocial variables, the level of perceived disability, and the type of observed parental style in patients with and without psychiatric symptoms. Logistic regression analysis was used to identify variables that could predict the occurrence of mental health disorders.Outcome and resultsAnxiety and psychosis were the most represented disorders. Age, living status, assumption of drugs, motor, manual, and global impairment were significantly different between patients with and without psychiatric symptoms. Similarly, a different parental style was observed between the two groups. Logistic regression indicated that living status, prescribed drugs, parental style, and the perceived disability in getting along with others predicted the occurrence of psychiatric symptoms.Conclusions and implicationsResults suggest that patients with and without psychiatric symptoms have different clinical and psychosocial characteristics. Some variables should be considered as potentially affecting the mental health of patients with CP.
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Affiliation(s)
- Silvia Pizzighello
- Department of Conegliano, Scientific Institute IRCCS E. Medea, Treviso, Italy
- *Correspondence: Silvia Pizzighello
| | - Marianna Uliana
- Department of Conegliano, Scientific Institute IRCCS E. Medea, Treviso, Italy
| | - Martina Michielotto
- Department of Conegliano, Scientific Institute IRCCS E. Medea, Treviso, Italy
| | - Alda Pellegri
- Department of Bosisio Parini, Scientific Institute, IRCCS E. Medea, Lecco, Italy
| | | | - Sara Piccoli
- Department of Mental Health, AULSS 6 Euganea, Padua, Italy
| | - Michela Martinuzzi
- King's College London GKT School of Medical Education, London, United Kingdom
| | - Andrea Martinuzzi
- Department of Conegliano, Scientific Institute IRCCS E. Medea, Treviso, Italy
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Manikandan M, Kerr C, Lavelle G, Walsh M, Walsh A, Ryan JM. Health service use among adults with cerebral palsy: a mixed-methods systematic review. Dev Med Child Neurol 2022; 64:429-446. [PMID: 34705276 DOI: 10.1111/dmcn.15097] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 08/26/2021] [Accepted: 09/25/2021] [Indexed: 12/15/2022]
Abstract
AIM To determine the proportion of adults with cerebral palsy (CP) using health services and frequency of use, and to explore experiences and perceptions of health services for this population. METHOD A mixed-methods systematic review was conducted using the Joanna Briggs Institute methodology. Five databases were searched to September 2020. Observational and qualitative studies were included. Two reviewers screened titles, abstracts, and full texts; extracted data; and assessed the quality of included studies. Separate meta-analyses were used to pool the proportion of adults using each service and frequency of use. A meta-aggregation approach was used to synthesize qualitative data. Quantitative and qualitative findings were integrated using the Andersen and Newman Model of health care utilization. RESULTS Fifty-seven studies (31 quantitative, 26 qualitative) of 14 300 adults with CP were included. The proportion of adults using services ranged from 7% (95% confidence interval [CI]: 2-13%) for urologists to 84% (95% CI: 78-90%) for general practitioners. Incidence of visits ranged from 67 (95% CI: 37-123) hospital admissions to 404 (95% CI: 175-934) general practitioner visits per 100 person-years. Qualitative themes highlighted issues regarding accessibility, caregivers' involvement, health workers' expertise, unmet ageing needs, transition, and health system challenges. INTERPRETATION Adults with CP used a wide range of health services but faced context-specific challenges in accessing required care. Appropriate service delivery models for adults with CP are required. This review emphasizes a need to develop an appropriate service model for adults with CP to meet their needs.
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Affiliation(s)
- Manjula Manikandan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Claire Kerr
- School of Nursing and Midwifery, Queen's University Belfast, Belfast, UK
| | - Grace Lavelle
- Institute of Psychiatry, Psychology & Neuroscience, King's College London, London, UK
| | - Michael Walsh
- National Clinical Programme for People with Disability, Clinical Design and Innovation Office, Health Service Executive, Dublin, Ireland
| | - Aisling Walsh
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Jennifer M Ryan
- Department of Public Health and Epidemiology, Royal College of Surgeons in Ireland, Dublin, Ireland.,College of Health and Life Sciences, Brunel University, London, UK
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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.
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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
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Paget S, Ostojic K, Goldsmith S, Nassar N, McIntyre S. Determinants of hospital-based health service utilisation in cerebral palsy: a systematic review. Arch Phys Med Rehabil 2021; 103:1628-1637. [PMID: 34968439 DOI: 10.1016/j.apmr.2021.12.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/25/2021] [Accepted: 12/01/2021] [Indexed: 11/02/2022]
Abstract
OBJECTIVE To systematically review and synthesize evidence of determinants associated with hospital-based health service utilisation among individuals with cerebral palsy (CP). DATA SOURCES Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020. STUDY SELECTION Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilisation (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilisation. DATA EXTRACTION After initial screen, two reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle Ottawa scale. Determinants of health service utilisation were identified and categorised using the Andersen Behavioural Model. DATA SYNTHESIS Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across eight Andersen Model characteristics. Individual predisposing factors such as sex showed no difference in health service utilisation; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilisation was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants. CONCLUSIONS CP health service utilisation was associated with age, severity and comorbidities. Improved understanding of determinants of health service utilisation can support health service access for people with CP.
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Affiliation(s)
- Simon Paget
- The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia; Kids Rehab, the Children's Hospital at Westmead, Westmead NSW Australia.
| | - Katarina Ostojic
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Shona Goldsmith
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
| | - Natasha Nassar
- Child Population and Translational Health, The Children's Hospital at Westmead Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, Australia
| | - Sarah McIntyre
- Cerebral Palsy Alliance, Discipline of Child and Adolescent Health, The University of Sydney, Sydney, Australia
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van der Slot WMA, Benner JL, Brunton L, Engel JM, Gallien P, Hilberink SR, Månum G, Morgan P, Opheim A, Riquelme I, Rodby-Bousquet E, Şimşek TT, Thorpe DE, van den Berg-Emons RJG, Vogtle LK, Papageorgiou G, Roebroeck ME. Pain in adults with cerebral palsy: A systematic review and meta-analysis of individual participant data. Ann Phys Rehabil Med 2020; 64:101359. [PMID: 32061920 DOI: 10.1016/j.rehab.2019.12.011] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Revised: 12/29/2019] [Accepted: 12/31/2019] [Indexed: 12/16/2022]
Abstract
BACKGROUND There is little focus on adults with cerebral palsy (CP) in research and health care and insufficient knowledge on how to identify and manage pain in this population. OBJECTIVES This systematic review and meta-analysis aimed to determine whether pain prevalence in adults with CP is high and to explore variations in pain prevalence of subgroups, pain locations, pain severity and pain interference. METHODS Potential datasets were identified by experts in the field and literature searches in Embase, MEDLINE, and Cochrane, from January 2000 to October 2016. Included studies had a representative sample of ≥25 adults with CP and ≥1 pain outcomes. Methodological quality assessment, pain prevalence estimates and logistic regression models for subgroup effects on pain prevalence were conducted. RESULTS In total, 17 eligible studies were identified from 4584 publications. A meta-analysis was performed with individual participant data from 15 studies totalling 1243 participants (mean [SD] age 34.3 [12.6] years). Overall mean pain prevalence was 70% (95% CI 62-78). Women were more likely to have pain than men (P<0.001). The odds of pain was increased in adults with gross motor function level II (odds ratio [OR] 1.92, 95% CI 1.22-3.12) and IV (OR 1.77, 95% CI 1.03-4.29). Participants with pain reported pain predominantly in the legs (76%, 95% CI 66-84), and mean pain severity was 3.7/10 (95% CI 2.7-4.7) and pain interference 3.5/10 (95% CI 2.5-4.5). CONCLUSIONS This meta-analysis provides the first reliable pain prevalence estimate in a large international sample of adults with CP. The high prevalence of pain, 70%, suggests that adults with CP should be routinely screened for pain and treated accordingly. The range of measurement instruments used by the included studies emphasizes using common outcome measures specific to pain internationally.
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Affiliation(s)
- Wilma M A van der Slot
- Rijndam Rehabilitation and Department of Rehabilitation Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.
| | - Joyce L Benner
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Laura Brunton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Joyce M Engel
- Department of Occupational Science and Technology, University of Wisconsin-Milwaukee, Milwaukee, Wi, USA
| | - Philippe Gallien
- Breizh Paralysie Cérébrale Health Network, Pôle MPR Saint-Hélier, Rennes, France
| | - Sander R Hilberink
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Research Center Innovations in Care, Rotterdam University of Applied Sciences, Rotterdam, The Netherlands
| | - Grethe Månum
- Department of Research, Sunnaas Rehabilitation Hospital and Institute of Clinical Medicine, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Prue Morgan
- Department of Physiotherapy, Monash University, Frankston, Victoria, Australia
| | - Arve Opheim
- Department of Research, Sunnaas Rehabilitation Hospital, Nesoddtangen, Norway; Department of Research and Development, Habilitation & Health, Region Västra Götaland and Department of Rehabilitation Medicine, Sahlgrenska Academy, University of Gothenburg, Region Västra Götaland, Gothenburg, Sweden
| | - Inmaculada Riquelme
- Department of Nursing and Physiotherapy, University Institute of Health Sciences, University of the Balearic Islands, Palma de Mallorca, Mallorca, Spain
| | - Elisabet Rodby-Bousquet
- Center for Clinical Research, Uppsala University, Region Västmanland, Västerås and Department of Clinical Sciences, Orthopaedics, Lund University, Lund, Sweden
| | - Tülay Tarsuslu Şimşek
- School of Physical Therapy and Rehabilitation, Dokuz Eylül University, İzmir, Turkey
| | - Deborah E Thorpe
- Division of Physical Therapy, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Rita J G van den Berg-Emons
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
| | - Laura K Vogtle
- Department of Occupational Therapy, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Grigorios Papageorgiou
- Department of Biostatistics, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - Marij E Roebroeck
- Department of Rehabilitation Medicine, Erasmus University Medical Center and Rijndam Rehabilitation, Rotterdam, The Netherlands
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10
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Roquet M, Garlantezec R, Remy-Neris O, Sacaze E, Gallien P, Ropars J, Houx L, Pons C, Brochard S. From childhood to adulthood: health care use in individuals with cerebral palsy. Dev Med Child Neurol 2018; 60:1271-1277. [PMID: 30171608 DOI: 10.1111/dmcn.14003] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/12/2018] [Indexed: 11/29/2022]
Abstract
AIM To analyse the health care usage of individuals with cerebral palsy (CP) as a function of age and ambulatory status. METHOD In total, 970 self-administered questionnaires relating to health care usage were sent, via a clinical network of professionals and institutions, to children and adults with CP in Brittany, France. Frequency of use of different aspects of health care were analysed as a function of age and ambulatory status. Multivariate logistic regression evaluated differences in the frequency of each health care type with age; the transition from childhood to adulthood was specifically analysed. RESULTS The response rate was 53% (282 adults, 230 children). Use of medication (particularly psychotropic and analgesic) increased with age, while physical-types of health care (rehabilitation, physical medicine and rehabilitation follow-up, and equipment) decreased with age, independently of ambulatory status. Use of other treatments, such as botulinum toxin injections, was not influenced by age. The provision of rehabilitation was particularly affected by the period of transition. INTERPRETATION Although health care needs change naturally in adulthood, the large decrease in usage of specific types of rehabilitation after the transition to adulthood suggested individuals had difficulty accessing this type of health care after childhood. These results provide objectives for the development of patient-centred, transitional consultations, and longitudinal studies. WHAT THIS PAPER ADDS Use of medication, particularly psychotropic and analgesic drugs, increased with age in individuals with cerebral palsy. Use of orthoses, physical medicine and rehabilitation physician follow-up, and rehabilitation decreased with age. Transition from childhood to adulthood involved significant changes in health care usage.
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Affiliation(s)
- Marion Roquet
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France
| | | | - Olivier Remy-Neris
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | | | - Philippe Gallien
- Médecine Physique et de Réadaptation, CMPR Notre Dame De Lourde, Rennes, France
| | - Juliette Ropars
- Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France.,Service de Pédiatrie, CHRU Brest, Brest, France
| | - Laetitia Houx
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Christelle Pons
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
| | - Sylvain Brochard
- Médecine Physique et de Réadaptation, CHRU Brest, Brest, France.,Fondation Ildys, Brest, France.,Université de Bretagne Occidentale, Brest, France.,Laboratoire de Traitement de l'Information Médicale, INSERM, UMR 1101, Brest, France
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Origine, fondements rationnels et gouvernance de ESPaCe (Enquête Satisfaction Paralysie Cérébrale) : enquête nationale sur les besoins perçus et priorités d’amélioration en rééducation motrice rapportés par les personnes atteintes de paralysie cérébrale et leur famille. ACTA ACUST UNITED AC 2018. [DOI: 10.1016/j.motcer.2018.03.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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