1
|
Perret C, Alvarelhão JJM, Pennington L, Ehlinger V, Duffaut C, Arnaud C, Vidart d'Egurbide Bagazgoïtia N. Assessing the Adequacy of the Physical, Social, and Attitudinal Environment to the Specific Needs of Young Adults With Cerebral Palsy: The European Adult Environment Questionnaire. Arch Phys Med Rehabil 2024; 105:906-920. [PMID: 38206241 DOI: 10.1016/j.apmr.2023.11.012] [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: 03/30/2023] [Revised: 11/17/2023] [Accepted: 11/26/2023] [Indexed: 01/12/2024]
Abstract
OBJECTIVES To present the development of the European Adult Environment Questionnaire (EAEQ), to assess to what extent it covers the International Classification of Functioning, Disability and Health (ICF), and to describe the adequacy of the physical, social, and attitudinal environment to the specific needs of young adults with cerebral palsy (CP). DESIGN Cross-sectional. SETTING Administrative regions in France, Germany, Italy, Portugal, and Sweden. PARTICIPANTS Young adults with CP (N=357), with varying severity profiles, aged 19-28 years at time of interview (2018-20). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURE(S) Physical, social, and attitudinal environment unmet needs. RESULTS Relevant environmental factors (EFs) for young adults with CP were identified during focus groups in England and Portugal. EFs were mapped to the ICF environmental classification and the EAEQ analytical structure resulted from this linking procedure. It comprised 61 items, linked to 31 ICF environmental classification categories, and covered 4 of its 5 chapters. Content validity assessed with the bandwidth index (percentage coverage of ICF Core Sets for adults with CP) was satisfactory (79.3%). A descriptive analysis was carried out. Participants had a mean age of 24 years, 56% were men, 38% had severely limited mobility. Less than 16% reported unmet needs for EFs relating to home, college/work/day placement, and communication in the Products and technology chapter. Unmet needs were higher (>20%) for the other items in the Public use and Land development categories. Social support, attitudes, and understanding of relatives were often adequate to the participants' needs. The proportion of unmet needs varied by sex (women were more often concerned) and raised with increasing gross motor impairment. CONCLUSION The EAEQ describes in detail the adequacy of the environment to the specific needs of young adults with CP. Its ICF-based structure opens up possibilities for use in a universal conceptual framework.
Collapse
Affiliation(s)
- Célia Perret
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | | | - Lindsay Pennington
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Virginie Ehlinger
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Carine Duffaut
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France; Clinical Epidemiology Unit, University Hospital, Toulouse, France
| | | |
Collapse
|
2
|
Guyard A, Fauconnier J, Muehlan H, Cytera C, Markwart H, Himmelmann K, Schmidt S, Duffaut C, Arnaud C, Thyen U. Differences in participation between young adults with cerebral palsy and their peers: A cross-sectional multicentre European study. Disabil Health J 2024; 17:101554. [PMID: 38129262 DOI: 10.1016/j.dhjo.2023.101554] [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: 06/09/2023] [Revised: 11/08/2023] [Accepted: 11/13/2023] [Indexed: 12/23/2023]
Abstract
BACKGROUND Children and adolescents with disabilities are known to participate less in most areas of life than their non-disabled peers. OBJECTIVES (1) To estimate differences in participation between young adults with cerebral palsy (CP) and their non-disabled peers; (2) to test the mediating role of financial difficulties and student status; (3) to test the moderating role of personal factors on participation difference; and (4) to test the moderating role of impairment. METHODS A cross-sectional study was conducted in young adults [19-28 years] with CP (n = 228) and non-disabled peers (n = 2861) in France, Germany and Sweden. Participation was assessed using the Questionnaire of Young People's Participation adapted for young adults (QYPP-YA). Differences in five domains of participation were estimated using structural equation modeling with WLSMV method and bias-corrected bootstrap confidence intervals. RESULTS Young adults with CP showed lower participation than others in all domains, with the largest difference in the "intimate relationships" domain (β = 1.71 bcCI95[1.46; 1.95]). Student status mediated the difference in "intimate relationships", "interpersonal relationships" and "independence". Women showed greater differences than men on "independence". Impairments moderated difference in participation. The less severely impaired young adults showed no difference with their non-CP peers in "interpersonal relationships", "social life" and "independence", but made autonomous everyday decisions more often than their peers. CONCLUSIONS Young adults with CP do not have the same opportunities to attain the participation level of non-CP people of the same age. Continuance of education could help to reduce participation difference in "interpersonal relationships" and "independence".
Collapse
Affiliation(s)
- Audrey Guyard
- UMR 5525 CNRS / TIMC-IMAG Team MESP, Grenoble Alpes University, Pavillon Taillefer CHU Grenoble CS10217, F-38043, Grenoble, Cedex 9, France.
| | - Jérôme Fauconnier
- UMR 5525 CNRS / TIMC-IMAG Team MESP, Grenoble Alpes University, Pavillon Taillefer CHU Grenoble CS10217, F-38043, Grenoble, Cedex 9, France
| | - Holger Muehlan
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Chirine Cytera
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany; Hospital for Child and Adolescent Medicine, University of Lübeck, DE-23538, Lübeck, Germany
| | - Henriette Markwart
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Kate Himmelmann
- Institute of Clinical Sciences, University of Gothenburg, Medicinaregatan 3A Plan 500, 413 90, Göteborg, Sweden
| | - Silke Schmidt
- University of Greifswald, Institute of Psychology, Department Health & Prevention, Robert-Blum-Str. 13, 17489, Greifswald, Germany
| | - Carine Duffaut
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Hôpital Paule de Viguier, 330 Avenue de Grande Bretagne, TSA 70034, F-31059, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Hôpital Paule de Viguier, 330 Avenue de Grande Bretagne, TSA 70034, F-31059, Toulouse, France; Clinical Epidemiology Unit, University Hospital, F-31059, Toulouse, France
| | - Ute Thyen
- Hospital for Child and Adolescent Medicine, University of Lübeck, DE-23538, Lübeck, Germany
| |
Collapse
|
3
|
Rioual J, Perret C, Arnaud C, Vidart d’Egurbide Bagazgoïtia N. Unmet environmental needs and unmet healthcare needs in a population of young adults with cerebral palsy: what the SPARCLE study tells us. FRONTIERS IN REHABILITATION SCIENCES 2024; 5:1294999. [PMID: 38370854 PMCID: PMC10869570 DOI: 10.3389/fresc.2024.1294999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 01/22/2024] [Indexed: 02/20/2024]
Abstract
Introduction Optimizing care for young adults with cerebral palsy is crucial for their physical and psychological well-being. The inadequacy of proximal environment may play a role in the provision of health services. The aim of this study is to explore the association between unmet environmental needs in the physical, social and attitudinal domains and unmet healthcare needs in four interventions: physiotherapy, occupational therapy, speech therapy and psychological counselling. Methods Young adults with cerebral palsy were recruited in the SPARCLE3 European multicenter cross-sectional study. Healthcare needs and coverages were assessed using the Youth Health Care, Satisfaction, Utilization and Needs questionnaire. The need and availability of environmental factors in physical, social and attitudinal domains were collected using the European Adult Environment Questionnaire. Logistic regressions were conducted separately for each intervention to measure associations between unmet environmental needs and unmet healthcare needs. Results We studied 310 young adults with cerebral palsy, with a mean age of 24.3 years; 37.4% could not walk independently, 51.5% had an IQ below 70, 34.2% had severe communication difficulties. The most commonly expressed need was physiotherapy (81.6% of participants). Unmet healthcare needs were reported by 20.9%, 32.4%, 40.3% and 49.0% of participants requiring physiotherapy, occupational therapy, psychological counselling and speech therapy, respectively. The physical environment was never significantly associated with unmet healthcare needs. In contrast, the social environment was significantly associated with unmet healthcare needs across all interventions, with odds ratios over 2.5, depending on the number of unmet needs and the nature of intervention needed. With regard to the attitudinal environment, when at least one unmet attitudinal environmental need was reported, the odds of also reporting an unmet healthcare need were of 3.68 for speech therapy and 3.77 for physiotherapy. The latter association was significant only for individuals with severe motor impairment. Discussion Our results highlight the importance of the social and attitudinal environment in meeting healthcare needs in young adults with cerebral palsy. The lack of correlation between unmet healthcare needs and the physical environment suggests that it can be partly compensated for by social support.
Collapse
Affiliation(s)
- Jonathan Rioual
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
| | - Célia Perret
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
- Clinical Epidemiology Unit, University Hospital, Toulouse, France
| | | |
Collapse
|
4
|
Muehlan H, Alvarelhao J, Arnaud C, Cytera C, Fauconnier J, Himmelmann K, Marcelli M, Markwart H, Rapp M, Schmidt S, Thyen U. Satisfaction with health care services in young people with cerebral palsy in the transition period: results from a European multicenter study. Front Med (Lausanne) 2024; 11:1306504. [PMID: 38352143 PMCID: PMC10862483 DOI: 10.3389/fmed.2024.1306504] [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: 10/10/2023] [Accepted: 01/08/2024] [Indexed: 02/16/2024] Open
Abstract
Background Young people with chronic health conditions and disabilities rely on the healthcare system to maintain their best possible health. The appropriate delivery and utilization of healthcare services are key to improve their autonomy, self-efficacy and employment outcomes. The research question of our study is directed toward investigating if poor availability and accessibility of healthcare services in general, as identified by unmet needs in healthcare, are associated with dissatisfaction with healthcare. Methods Within a European multicenter observational study, 357 young adults with cerebral palsy aged 19-28 were included. We assessed special healthcare needs, utilization of healthcare services, and satisfaction with healthcare applying the short-form of the YHC-SUN-SF, environmental and social variables (EAEQ) as well as indicators for severity of condition and functionality (e.g., GMFCS) of these participants based on a self-, assisted self- or proxy-reports. We used correlation analyses to explore associations between satisfaction with healthcare and respective indicators related to availability and accessibility of healthcare services as well as severity of the condition. In addition, we included reference values for satisfaction with heath care from young adults with various chronic conditions assessed within population-based surveys from some of the European countries included in the study. Results We identified several unmet healthcare needs, especially for widely used and established services (e.g., physical therapy). Satisfaction with healthcare (YHC-SUN-SF general and subscale scores) was moderate to high and almost consistently better for the sample of young adults with cerebral palsy as compared to reference values for young adults with various chronic conditions assessed within general population surveys). Correlation coefficients between satisfaction with healthcare and utilization of services and (unmet) healthcare needs were low, also with different indicators for severity of the condition or functionality. Conclusion Young adults with cerebral palsy reports of unmet healthcare needs varied largely but showed substantial deficits in some aspects. This seems to have no impact on the satisfaction with healthcare those patients currently receive. We conclude that these are two different constructs and somewhat independent indicators to evaluate the quality of healthcare. Clinicians and other practitioners should consider this distinction when monitoring patient needs in their daily practice.
Collapse
Affiliation(s)
- Holger Muehlan
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | | | - Catherine Arnaud
- UMR 1295 CERPOP Centre for Epidemiology and Research in POPulation Health, Inserm, Université Toulouse III - Paul Sabatier, Team SPHERE, Toulouse, France
- Clinical Epidemiology Unit, University Hospital, Toulouse, France
| | - Chirine Cytera
- Hospital for Child and Adolescent Medicine, University of Luebeck, Luebeck, Germany
| | - Jerome Fauconnier
- Laboratoire TIMC-IMAG Equipe ThEMAS, Pavillon Taillefer, Université Joseph Fournier, Grenoble, France
| | - Kate Himmelmann
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marco Marcelli
- Azienda Sanitaria Locale Viterbo, Child and Adolescent Neuropsychiatric Unit—Adult Disability Unit, Viterbo, Italy
| | - Henriette Markwart
- Institute for Community Medicine, University Medicine Greifswald, Greifswald, Germany
| | - Marion Rapp
- Hospital for Child and Adolescent Medicine, University of Luebeck, Luebeck, Germany
| | - Silke Schmidt
- Department Health and Prevention, University of Greifswald, Greifswald, Germany
| | - Ute Thyen
- Hospital for Child and Adolescent Medicine, University of Luebeck, Luebeck, Germany
| |
Collapse
|
5
|
Lewis JA, Bear N, Smith N, Baker F, Lee OS, Wynter M, Paget SP. Goal setting, goal attainment and quality of life of children following selective dorsal rhizotomy. Child Care Health Dev 2022. [PMID: 36513964 DOI: 10.1111/cch.13090] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 11/10/2022] [Accepted: 12/03/2022] [Indexed: 12/15/2022]
Abstract
AIM The aim of this study is to describe the individualized occupational performance issues identified by parents/carers and children prior to selective dorsal rhizotomy (SDR) surgery and analyse change up to 2 years post surgery in goal attainment and quality of life (QoL). METHOD The Australian SDR Research Registry (trial registration: ACTRN12618000985280) was used to extract data for individualized goals, goal attainment and QoL based on the Canadian Occupational Performance Measure (COPM) and the Cerebral Palsy Quality of Life Questionnaire for Children (CP QOL-Child parent-proxy) at baseline and 1 and 2 years following SDR. Change in mean scores was analysed using linear mixed models. RESULTS Fifty-two children had COPM scores at baseline and 1 and/or 2 years post, of which 28 had two QoL scores. COPM problem areas included leisure (n = 39), productivity (n = 37) and self-care (n = 173). The most common goals were walking (26.1%), participation in physical activities (17.7%) and transitions (14.1%). Mean COPM scores improved significantly between baseline to 1 year and baseline to 2 years (P < 0.001). Mean QoL scores improved between baseline to 1 year for functional QoL domains: participation and physical health (P = 0.003) and pain and impact of disability (P = 0.011). CONCLUSIONS Collaborative goal setting is an integral part of family-centred rehabilitation practice. The COPM was an appropriate individualized outcome measure in identifying meaningful goals for our SDR cohort. Results demonstrate improved scores in goal attainment and improvement in functional QoL domains. This paper highlights the need to include outcomes that measure daily life experiences.
Collapse
Affiliation(s)
| | | | | | - Felicity Baker
- Women's and Children's Hospital, Adelaide, SA, Australia
| | - Olivia S Lee
- Royal Children's Hospital, Melbourne, Vic, Australia
| | | | - Simon P Paget
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | -
- The Children's Hospital at Westmead, Sydney, NSW, Australia.,Notre Dame University, Perth, WA, Australia.,Perth Children's Hospital, Perth, WA, Australia.,Women's and Children's Hospital, Adelaide, SA, Australia.,Royal Children's Hospital, Melbourne, Vic, Australia.,Queensland Children's Hospital, Brisbane, Qld, Australia
| |
Collapse
|
6
|
Schmidt S, Markwart H, Rapp M, Guyard A, Arnaud C, Fauconnier J, Thyen U, Hahm S, Vidart d’Egurbide Bagazgoïtia N, Muehlan H. Quality of life and mental health in emerging adults with cerebral palsy compared to the general population. Health Qual Life Outcomes 2022; 20:61. [PMID: 35366892 PMCID: PMC8976958 DOI: 10.1186/s12955-022-01961-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 03/21/2022] [Indexed: 11/17/2022] Open
Abstract
Background While evidence concerning Quality of Life (QoL) in youth with cerebral palsy (CP) in comparison to the general population has been accumulating, there is a lack of studies exploring differences on a wider range of positive and negative mental health outcomes in emerging adults.
Methods This binational case control study is part of the SPARCLE cohort study on QoL and participation of youth with CP. QoL (WHOQOL-BREF), depression (PHQ-9), anxiety (GAD-7) and self-efficacy (GSE) were assessed in 198 emerging adults with CP and 593 emerging adults from the general population, matched for country of residence, age and gender. ANCOVAs with impairment and pain as covariates were run.
Results Similar levels of QoL were found in both samples, except for the environmental domain, with better QoL for emerging adults with CP compared to the general population. There were significant descriptive differences regarding depression with worse levels in the CP sample, however, also worse levels of self-efficacy. Pain as a covariate had a significant negative impact on all measures, leading to poorer self-efficacy while worsening depression and anxiety; impairment had a significant worsening impact on physical QoL and self-efficacy only. Conclusion Similar expressions of mental health outcomes in emerging adults with CP and the general population indicate the high adaptive capability of emerging adults with CP.
Collapse
|
7
|
Vidart d'Egurbide Bagazgoïtia N, Ehlinger V, Duffaut C, Fauconnier J, Schmidt-Schuchert S, Thyen U, Himmelmann K, Marcelli M, Arnaud C. Quality of Life in Young Adults With Cerebral Palsy: A Longitudinal Analysis of the SPARCLE Study. Front Neurol 2021; 12:733978. [PMID: 34790161 PMCID: PMC8591289 DOI: 10.3389/fneur.2021.733978] [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] [Received: 06/30/2021] [Accepted: 09/10/2021] [Indexed: 11/13/2022] Open
Abstract
Introduction: While most people with cerebral palsy (CP) will have a life expectancy similar to that of the general population, international research has primarily focused on childhood and adolescence; and knowledge about the quality of life (QoL) of young adults with CP, its trajectories, and associated factors remains scarce. Methods: This longitudinal study included young adults with CP living in five European regions and who had previously participated in the SPARCLE cohort as children and/or adolescents. Their QoL in the psychological well-being and social relationships domains was estimated using age-appropriate validated instruments (KIDSCREEN-52 in childhood/adolescence and WHOQOL-Bref in young adulthood). We used generalized linear mixed-effect models with random intercept to estimate long-term trajectories of QoL in both domains and to investigate whether severity of impairment, pain, and seizure influenced these trajectories. We sought to identify potentially different trajectories of QoL from childhood to adulthood using a shape-based clustering method. Results: In total, 164 young adults with CP aged 22–27 years participated in the study. Psychological well-being linearly decreased by 0.78 points (scale 0–100) per year (95% confidence interval (CI) −0.99 to −0.56) from childhood to young adulthood, whereas QoL in the social relationships domain increased (β coefficient 1.24, 95% CI 0.92–1.55). Severity of impairment was associated with reduced QoL in all life periods of the study (childhood, adolescence, and young adulthood): motor impairment with social relationships, and more nuancedly intellectual disability with psychological well-being and social relationships. At all periods, frequent pain significantly reduced psychological well-being, and seizures were associated with lower QoL in the social relationships domain. In both domains, we identified a group of individuals with CP who presented a reverse trajectory compared with the general QoL trajectory. Conclusion: Identification of QoL trajectories and their associated factors yields improved knowledge about the experience of individuals with CP until young adulthood. Further studies are needed to better understand the determinants that have the greatest influence on the different shapes of long-term trajectories of QoL.
Collapse
Affiliation(s)
| | - Virginie Ehlinger
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
| | - Carine Duffaut
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France
| | - Jérôme Fauconnier
- Laboratory TIMC-IMAG, Grenoble Alpes University, Department UFR Medicine, Grenoble, France
| | - Silke Schmidt-Schuchert
- Department Health and Prevention, Institute of Psychology, University of Greifswald, Greifswald, Germany
| | - Ute Thyen
- Klinik für Kinder und Jugendmedizin, Universität zu Lübeck, Lübeck, Germany
| | - Kate Himmelmann
- Department of Pediatrics, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Marco Marcelli
- Azienda Sanitaria Locale Viterbo, Child and Adolescent Neuropsychiatric Unit-Adult Disability Unit, Viterbo, Italy
| | - Catherine Arnaud
- UMR 1295 CERPOP, Inserm, Toulouse University III Paul Sabatier, Team SPHERE, Toulouse, France.,Clinical Epidemiology Unit, University Hospital, Toulouse, France
| |
Collapse
|