Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.

<h4>Aim</h4>This study aimed to investigate whether children with cerebral palsy (CP) had equal access to timely physiotherapy. Additionally, to learn more about clinical characteristics of infants with CP, we explored differences in neonatal clinical history and CP profile between child...

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Autores principales:	Linnéa Hekne, Cecilia Montgomery, Kine Johansen
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/8c61001cfeb94d4593257571f203847e
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spelling	oai:doaj.org-article:8c61001cfeb94d4593257571f203847e2021-12-02T20:09:57ZEarly access to physiotherapy for infants with cerebral palsy: A retrospective chart review.1932-620310.1371/journal.pone.0253846https://doaj.org/article/8c61001cfeb94d4593257571f203847e2021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0253846https://doaj.org/toc/1932-6203<h4>Aim</h4>This study aimed to investigate whether children with cerebral palsy (CP) had equal access to timely physiotherapy. Additionally, to learn more about clinical characteristics of infants with CP, we explored differences in neonatal clinical history and CP profile between children referred by a neonatologist or enrolled in neonatal follow-up and those referred by other healthcare professionals as well as those referred before and after 5 months corrected age.<h4>Methods</h4>We conducted a retrospective chart review study including children born in Uppsala County, Sweden, from 2010 to 2016, who had received a CP diagnosis by July 2019. Entries by doctors and physiotherapists working at Uppsala University Children's Hospital were reviewed.<h4>Results</h4>Thirty-eight children were included (21 girls, 55.3%) in the study. Twenty-two (57.9%) were born at term. Twenty-five children (66%) had their first visit to a physiotherapist before 5 months corrected age, and this included all children (n = 22, 57.9%) referred by a neonatologist or enrolled in neonatal follow-up. The latter group had significantly earlier access to physiotherapy compared to children referred by other healthcare professionals, with a median of 1.9 (min-max: -1-4) and 7.6 (min-max: 1-24) months, respectively (p < 0.0001). Referral source explained unique variance in predicting time of referral to physiotherapist (R2 0.550, B 4.213, p < 0.0001) when controlling for both number of risk factors and severity of motor impairment. However, number of risk factor was vital for early access to physiotherapy for children referred by other health care professionals. Children referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age differed on all measured variables concerning neonatal clinical history and CP profile, compared to children referred by other healthcare professionals or after 5 months corrected age. The latter groups had milder forms of CP. In total, twenty-eight children (73.7%) were ambulatory at 2 years of age. Bilateral spastic CP was most common among those referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age, while unilateral spastic CP was most common among those referred by other healthcare professionals or after 5 months corrected age.<h4>Conclusion</h4>Infants with CP have unequal access to timely physiotherapy, and children considered at low risk for CP receive therapy later. Neonatal follow-up of infants considered at high risk for CP that involves an assessment of motor performance using an evidence-based method during the first months of life corrected age seems to be effective in identifying CP early. Conversely, measuring milestone attainment seems to be a less reliable method for early identification. To provide safe and equal care, all professionals performing developmental surveillance should receive proper training and use evidence-based assessment methods. Physiotherapy should be available prior to formal medical diagnosis.Linnéa HekneCecilia MontgomeryKine JohansenPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 6, p e0253846 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Linnéa Hekne Cecilia Montgomery Kine Johansen Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.
description	<h4>Aim</h4>This study aimed to investigate whether children with cerebral palsy (CP) had equal access to timely physiotherapy. Additionally, to learn more about clinical characteristics of infants with CP, we explored differences in neonatal clinical history and CP profile between children referred by a neonatologist or enrolled in neonatal follow-up and those referred by other healthcare professionals as well as those referred before and after 5 months corrected age.<h4>Methods</h4>We conducted a retrospective chart review study including children born in Uppsala County, Sweden, from 2010 to 2016, who had received a CP diagnosis by July 2019. Entries by doctors and physiotherapists working at Uppsala University Children's Hospital were reviewed.<h4>Results</h4>Thirty-eight children were included (21 girls, 55.3%) in the study. Twenty-two (57.9%) were born at term. Twenty-five children (66%) had their first visit to a physiotherapist before 5 months corrected age, and this included all children (n = 22, 57.9%) referred by a neonatologist or enrolled in neonatal follow-up. The latter group had significantly earlier access to physiotherapy compared to children referred by other healthcare professionals, with a median of 1.9 (min-max: -1-4) and 7.6 (min-max: 1-24) months, respectively (p < 0.0001). Referral source explained unique variance in predicting time of referral to physiotherapist (R2 0.550, B 4.213, p < 0.0001) when controlling for both number of risk factors and severity of motor impairment. However, number of risk factor was vital for early access to physiotherapy for children referred by other health care professionals. Children referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age differed on all measured variables concerning neonatal clinical history and CP profile, compared to children referred by other healthcare professionals or after 5 months corrected age. The latter groups had milder forms of CP. In total, twenty-eight children (73.7%) were ambulatory at 2 years of age. Bilateral spastic CP was most common among those referred by a neonatologist or enrolled in neonatal follow-up or referred before 5 months corrected age, while unilateral spastic CP was most common among those referred by other healthcare professionals or after 5 months corrected age.<h4>Conclusion</h4>Infants with CP have unequal access to timely physiotherapy, and children considered at low risk for CP receive therapy later. Neonatal follow-up of infants considered at high risk for CP that involves an assessment of motor performance using an evidence-based method during the first months of life corrected age seems to be effective in identifying CP early. Conversely, measuring milestone attainment seems to be a less reliable method for early identification. To provide safe and equal care, all professionals performing developmental surveillance should receive proper training and use evidence-based assessment methods. Physiotherapy should be available prior to formal medical diagnosis.
format	article
author	Linnéa Hekne Cecilia Montgomery Kine Johansen
author_facet	Linnéa Hekne Cecilia Montgomery Kine Johansen
author_sort	Linnéa Hekne
title	Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.
title_short	Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.
title_full	Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.
title_fullStr	Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.
title_full_unstemmed	Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.
title_sort	early access to physiotherapy for infants with cerebral palsy: a retrospective chart review.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/8c61001cfeb94d4593257571f203847e
work_keys_str_mv	AT linneahekne earlyaccesstophysiotherapyforinfantswithcerebralpalsyaretrospectivechartreview AT ceciliamontgomery earlyaccesstophysiotherapyforinfantswithcerebralpalsyaretrospectivechartreview AT kinejohansen earlyaccesstophysiotherapyforinfantswithcerebralpalsyaretrospectivechartreview
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Early access to physiotherapy for infants with cerebral palsy: A retrospective chart review.

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