Efficacy of early interventions with active parent implementation in low-and-Middle income countries for young children with cerebral palsy to improve child development and parent mental health outcomes: a systematic review

Abstract

Purpose

To determine the efficacy of interventions with active parent implementation for young children with cerebral palsy (CP) to improve child and parent outcomes in low-middle income countries (LMICs).

Methods

Five databases were systematically searched. Randomised or comparison studies evaluating interventions with the training of the parent and/or home practice components to implement with their child with CP (<60 months of age) were included. The modified Downs and Black scale assessed methodological quality. Data were pooled to calculate mean differences and 95% confidence intervals (95% CI).

Results

Searches yielded 189 unique articles. 11 studies from ten papers of moderate to high quality were included. Parent-implemented general developmental interventions had a small negative effect on gross motor function compared to interventionist-implemented therapy. Parent-implemented upper limb training compared to interventionist-implemented neurodevelopmental therapy had a small positive effect on bimanual hand function. Parent-implemented functional feeding training had a large significant effect on chewing function compared to parent-implemented oral motor exercises. Parent-implemented interventions targeting general child development and feeding had mixed effects on parent stress outcomes.

Conclusions

Parent-implemented interventions in LMICs are promising to improve child bimanual hand and chewing function. Further research evaluating the efficacy of parent-implemented interventions to improve parent mental health is needed.

Implications for Rehabilitation:

• Intensive motor training-based interventions with active parent implementation were effective to improve child gross motor, bimanual hand, and chewing function in young children with CP compared to passive, generic interventionist-implemented or health education interventions.

• Interventions with active parent implementation had mixed results to improve parent mental health, however, this was frequently not assessed. A consistent level of support and training provided to parents may be required to have a positive effect on parent stress.

• To further understand the feasibility of early interventions with active parent implementation in LMICs, data on adherence to home practice dose and session attendance and a qualitative understanding of contextual and child factors influencing parent implementation is needed.

Keywords:

• Systematic review
• cerebral palsy
• early intervention
• young children
• low-and-middle-income countries
• parent-implemented

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by Australian Government National Health and Medical Research Council (NHMRC) Centre for Research Excellence: Australasian Clinical Trials Network Top Up (N.B.); LSVT Global Student Small Grants for Occupational Therapy Behavioral Treatment Studies with Neurologically Impaired Patients (N.B.); Cerebral Palsy Alliance Project Grant (K.B. PG6916); Queen Elizabeth II Diamond Jubilee Postdoctoral Scholarship, Endeavour (K.B.), NHMRC Research Fellowship (R.B. 1116442, 1195602); NHMRC Career Development Fellowship (L.S.1160694), NHMRC Early Career Fellowship (K.B. 1145212). Children’s Hospital Foundation Mary McConnel Career Boost for Women (L.S, K.B), Research Training Provider Scholarship (N.B.); Occupational Therapy Australia Elspeth Pearson Award (N.B.)