The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study
| dc.contributor.author | Dambi, Jermaine M | |
| dc.contributor.author | Jelsma, Jennifer | |
| dc.coverage.spatial | Zimbabwe | en_ZA |
| dc.date.accessioned | 2015-01-21T09:47:40Z | |
| dc.date.available | 2015-01-21T09:47:40Z | |
| dc.date.issued | 2014-12-05 | |
| dc.date.updated | 2015-01-15T17:54:57Z | |
| dc.description.abstract | Background: Cerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based. Method: Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments. Results: Children receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services. There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain. Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (pā<ā.001) as compared to recipients of institution-based services. Conclusion: Long term caregiving leads to strain in caregivers and there is a need to design interventions to alleviate the burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findings from this study suggest that the provision of care within a community setting as part of a well-structured outreach programme may be preferable method of service delivery within a resource-constrained context. It was associated with a greater improvement in functioning, greater satisfaction with services and better compliance. | en_ZA |
| dc.identifier.apacitation | Dambi, J. M., & Jelsma, J. (2014). The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study. <i>BMC Pediatrics</i>, http://hdl.handle.net/11427/12284 | en_ZA |
| dc.identifier.chicagocitation | Dambi, Jermaine M, and Jennifer Jelsma "The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study." <i>BMC Pediatrics</i> (2014) http://hdl.handle.net/11427/12284 | en_ZA |
| dc.identifier.citation | Dambi, Jermaine M. and Jelsma, Jennifer. (2014). The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study. BMC Pediatrics. 14(1):301-311. | en_ZA |
| dc.identifier.issn | 1471-2431 | en_ZA |
| dc.identifier.ris | TY - Journal Article AU - Dambi, Jermaine M AU - Jelsma, Jennifer AB - Background: Cerebral palsy requires appropriate on-going rehabilitation intervention which should effectively meet the needs of both children and parents/care-givers. The provision of effective support is a challenge, particularly in resource constrained settings. A quasi-experimental pragmatic research design was used to compare the impact of two models of rehabilitation service delivery currently offered in Harare, Zimbabwe, an outreach-based programme and the other institution-based. Method: Questionnaires were distributed to 46 caregivers of children with cerebral palsy at baseline and after three months. Twenty children received rehabilitation services in a community setting and 26 received services as outpatients at a central hospital. The Gross Motor Function Measurement was used to assess functional change. The burden of care was measured using the Caregiver Strain Index, satisfaction with physiotherapy was assessed using the modified Medrisk satisfaction with physiotherapy services questionnaire and compliance was measured as the proportion met of the scheduled appointments. Results: Children receiving outreach-based treatment were significantly older than children in the institution-based group. Regression analysis revealed that, once age and level of severity were controlled for, children in the outreach-based treatment group improved their motor function 6% more than children receiving institution-based services. There were no differences detected between the groups with regard to caregiver well-being and 51% of the caregivers reported signs consistent with clinical distress/depression. Most caregivers (83%) expressed that they were overwhelmed by the caregiving role and this increased with the chronicity of care. The financial burden of caregiver was predictive of caregiver strain. Caregivers in the outreach-based group reported greater satisfaction with services and were more compliant (pā<ā.001) as compared to recipients of institution-based services. Conclusion: Long term caregiving leads to strain in caregivers and there is a need to design interventions to alleviate the burden. The study was a pragmatic, quasi-experimental study thus causality cannot be inferred. However findings from this study suggest that the provision of care within a community setting as part of a well-structured outreach programme may be preferable method of service delivery within a resource-constrained context. It was associated with a greater improvement in functioning, greater satisfaction with services and better compliance. DA - 2014-12-05 DB - OpenUCT DO - 10.1186/s12887-014-0301-8 DP - University of Cape Town J1 - BMC Pediatrics LK - https://open.uct.ac.za PB - University of Cape Town PY - 2014 SM - 1471-2431 T1 - The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study TI - The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study UR - http://hdl.handle.net/11427/12284 ER - | en_ZA |
| dc.identifier.uri | http://hdl.handle.net/11427/12284 | |
| dc.identifier.uri | http://dx.doi.org/10.1186/s12887-014-0301-8 | |
| dc.identifier.vancouvercitation | Dambi JM, Jelsma J. The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study. BMC Pediatrics. 2014; http://hdl.handle.net/11427/12284. | en_ZA |
| dc.language | eng | en_ZA |
| dc.language.rfc3066 | en | |
| dc.publisher | BioMed Central | en_ZA |
| dc.publisher.department | Division of Physiotherapy | en_ZA |
| dc.publisher.faculty | Faculty of Health Sciences | en_ZA |
| dc.publisher.institution | University of Cape Town | |
| dc.rights | Creative Commons Attribution 4.0 International (CC BY 4.0) | * |
| dc.rights.holder | Dambi and Jelsma; licensee BioMed Central Ltd. | |
| dc.rights.uri | http://creativecommons.org/licenses/by/4.0/ | en_ZA |
| dc.source | BMC Pediatrics | en_ZA |
| dc.source.uri | http://www.biomedcentral.com/bmcpediatr/ | |
| dc.subject.other | Cerebral palsy | en_ZA |
| dc.subject.other | Community based rehabilitation | en_ZA |
| dc.subject.other | Institution based intervention | en_ZA |
| dc.subject.other | Cerebral palsy | en_ZA |
| dc.subject.other | Community based rehabilitation | en_ZA |
| dc.subject.other | Institution based intervention | en_ZA |
| dc.subject.other | Rehabilitation | en_ZA |
| dc.title | The impact of hospital-based and community based models of cerebral palsy rehabilitation: a quasi-experimental study | en_ZA |
| dc.type | Journal Article | en_ZA |
| uct.type.filetype | ||
| uct.type.filetype | Text | |
| uct.type.filetype | Image | |
| uct.type.publication | Research | en_ZA |
| uct.type.resource | Article | en_ZA |