Unequal access to timely physiotherapy for children with cerebral palsy
in one Swedish county: a retrospective chart review
Abstract
Rational and aims: Early intervention is considered best practice for
children with Cerebral Palsy (CP). Given that access to such
intervention is known to vary, we aimed to investigate whether children
with CP in Uppsala County, Sweden, have equal access to timely
physiotherapy. Furthermore, we describe their birth history and CP
profile to learn more about typical features that might enable earlier
identification. Method: We conducted a retrospective chart review study
including children born in the county from 2010 to 2016, who received a
CP diagnosis by December 2018. Entries by doctors and physiotherapists
working at Uppsala University Children’s Hospital were reviewed.
Results: Thirty-eight children were included (21 girls). Twenty-two
(58%) were term born. Age at first visit to physiotherapy varied
greatly and depended on referral source (p<0.000) and number
of risk factors for CP (p<0.000). Children considered at low
risk for CP received therapy later. Severity of motor impairment
(p=0.001) and number of risk factors (p=0.014) influenced age at
referral to habilitation services. Twenty-eight (74%) children were
ambulatory at 2 years of age. Unilateral (n=16) and bilateral (n=17)
spastic CP was most common. Children referred from the child health
services (CHS) had milder forms of CP. Conclusion: Children with CP have
unequal access to timely physiotherapy, and children referred from the
CHS have the most delayed access. All professionals performing
developmental surveillance and health monitoring should receive proper
training and use evidence-based assessment methods when available to
provide safe and equal care. Physiotherapy should be available prior to
formal medical diagnosis.