Czynniki przyczyniające się do przerywania rehabilitacji neurologicznej u dzieci z porażeniem mózgowym: Badanie kliniczno-kontrolne ze zmatchowaną populacją
Determinants of default from pediatric neuro-rehabilitation services in Cerebral Palsy: A matched case-control study
W skrócie
[Preprint - wstępne wyniki] Badanie wykazało, że dzieci z porażeniem mózgowym w Sri Lance najczęściej przerywają terapię rehabilitacyjną z powodu poważnych trudności ruchowych (niemożność chodzenia), uzależnienia od transportu publicznego, niskich dochodów rodziny, słabo kontrolowanej epilepsji oraz braku wsparcia finansowego państwa. Okazało się, że główną przeszkodą nie jest sama odległość do ośrodka, ale strata zarobków podczas każdej wizyty, zmęczenie podróżami oraz brak wiedzy rodzin o znaczeniu rehabilitacji.
Oryginalny abstract (angielski)
Abstract Background Long-term neurorehabilitation is essential to optimize functional outcomes and prevent secondary complications in children with cerebral palsy (CP). However, premature service default represents a critical barrier to care, particularly in low- and middle-income countries (LMICs). This study aimed to isolate independent risk factors associated with default from paediatric neuro-rehabilitation services in Sri Lanka. Methods An analytical matched case-control study was conducted at Lady Ridgeway Hospital for Children, Colombo. The post-COVID-19 indexing cohort (July 2022–June 2023) comprised 279 eligible children relying exclusively on institutional primary rehabilitation. Default was operationally defined as continuous absence for > 1 calendar year. Active cases (n = 72) were compared with frequency-matched adherent controls (n = 144, 2:1 ratio). Data collection integrated medical record reviews and structured interviews evaluating clinical severity, transport logistics, out-of-pocket costs, and household-level barriers. Univariate and forward-stepwise multivariable logistic regression models were constructed. Results Multivariable analysis identified five powerful independent predictors of rehabilitation default: non-ambulatory status – Gross motor Functional Classification System IV-V (GMFCS IV–V: adjusted odds ratio [aOR ] = 4.12, 95% CI: 2.05–8.28, p reliance on public transport (aOR = 3.84, 95% CI: 1.88–7.85, p primary breadwinner engaging in daily wage labour (aOR = 3.25, 95% CI: 1.62–6.52, p = 0.001), poorly controlled epilepsy (aOR = 3.10, 95% CI: 1.48–6.48, p = 0.003), and absence of state disability allowance (aOR = 2.41, 95% CI: 1.12–5.18, p = 0.024). Physical travel distance (p = 0.082) and direct out-of-pocket transit expenses (p = 0.115) were statistically comparable between groups, confirming that indirect daily wage loss (3.00-4.50 USD /visit) and public transit fatigue drive attrition rather than geographic proximity. Comparative household analysis (N = 69 vs. N = 144) demonstrated that defaulted families had significantly higher information deficits regarding rehabilitation importance (66.7% vs. 21.5%), alternative medicine reliance (62.3% vs. 18.1%), apprehension of staff reprimands (30.4% vs. 6.3%), and spousal isolation (42.0% vs. 11.8%; all p