Abstract
Background In the Swedish population-based follow-up program and national quality registry for individuals with cerebral palsy (CPUP), physiotherapy (PT) and occupational therapy (OT) treatments are regularly recorded along with functional status. By Swedish law, all citizens irrespective of personal characteristics or socioeconomic status have the right to receive medical treatments as applicable. Previous studies have shown gender differences in terms of certain treatments and interventions received among children with CP. The purpose of this study was to examine differences in PT and OT treatments and interventions by gender and place of birth in children and adolescents participating in CPUP.
Methods This was a cross-sectional study. Data from the latest PT form (n = 2695) and OT form (n = 3480) measures were extracted for individuals aged 0-17 years in CPUP. Logistic regressions were used to assess the relationships between the outcome variables and gender and place of birth (including an interaction term gender x place of birth), adjusted for age, Gross Motor Function Classification System (GMFCS) levels and spasticity scores for PT interventions, and Manual Ability Classification System (MACS) for OT interventions.
Results are presented as odds ratios [95% confidence intervals] and p-values. Girls were more likely to have spinal braces than boys; 1.544 [1.073, 2.223] p<0.05, a significant interaction with place of birth indicated less spinal braces prescribed to children born outside Scandinavia; 0.204 [0.0792, 0.525] p<0.001. Boys were more likely to have undergone selective dorsal rhizotomy (SDR); 0.485 [0.251, 0.939] p<0.05. Individuals born outside Scandinavia, were less likely to have received intrathecal baclofen (ITB) 0.269 [0.0737, 0.980] p<0.05.
Conclusions Of the treatments prescribed, gender differences were observed for spinal braces and having undergone SDR. A statistically significant difference based on place of birth was seen for spinal brace and having received ITB treatment. Other PT and OT treatments were associated with age, levels of spasticity, and functional severity classified with the Gross Motor Function Classification System and the Manual Ability Classification System. Increased awareness of differences based on gender and where a child is born, could be obtained by inter- and intraprofessional discussions.