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Unequal access to timely physiotherapy for children with cerebral palsy in one Swedish county: a retrospective chart review
  • Linnéa Hekne,
  • Cecilia Montgomery,
  • Kine Johansen
Linnéa Hekne
Västerås Central Hospital
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Cecilia Montgomery
Uppsala University
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Kine Johansen
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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.

Peer review status:Published

25 Jun 2021Published in PLOS ONE volume 16 issue 6 on pages e0253846. 10.1371/journal.pone.0253846