Physiotherapeutic interventions and physical activity for children in Northern Sweden with cerebral palsy: a register study from equity and gender perspectives

ABSTRACT

Background: Young people with disabilities, especially physical disabilities, report worse health than others. This may be because of the disability, lower levels of physical activity, and discrimination. For children with cerebral palsy, access to physiotherapy and physical activity is a crucial prerequisite for good health and function. To date, there is limited knowledge regarding potential gender bias and inequity in habilitation services.

Objectives: To map how physiotherapeutic interventions (PTI), physical leisure activity, and physical education are allocated for children with cerebral palsy regarding sex, age, level of gross motor function, and county council affiliation. This was done from a gender and equity perspective.

Methods: A register study using data from the Cerebral Palsy follow-Up Program (CPUP). Data included 313 children ≤18 years with cerebral palsy from the five northern counties in Sweden during 2013. Motor impairment of the children was classified according to the expanded and revised Gross Motor Function Classification System (GMFCS).

Results: In three county councils, boys received more physiotherapy interventions and received them more frequently than girls did. Differences between county councils were seen for frequency and reasons for physiotherapy interventions (p < 0.001). The physiotherapist was involved more often with children who had lower motor function and with children who had low physical leisure activity. Children with lower motor function level participated in physical leisure activity less often than children with less motor impairment (p < 0.001). Boys participated more frequently in physical education than did girls (p = 0.028).

Conclusion: Gender and county council affiliation affect the distribution of physiotherapy interventions for children with cerebral palsy, and there are associations between gender and physical activity. Thus, the intervention is not always determined by the needs of the child or the degree of impairment. A gender-bias is indicated. Further studies are needed to ensure fair interventions.

KEYWORDS:

• Disability
• habilitation
• physiotherapy
• gender bias
• CPUP registry

RESPONSIBLE EDITOR

Carmen Vives-Cases, Alicante University, Spain

SPECIAL ISSUE Gender and Health Inequalities: Intersections with other relevant axes of oppression

RESPONSIBLE EDITOR

Carmen Vives-Cases, Alicante University, Spain

SPECIAL ISSUE Gender and Health Inequalities: Intersections with other relevant axes of oppression

Acknowledgments

None.

Author contributions

FD, MW and BE were responsible for study planning. FD conducted the analyses together with BE. FD drafted the initial manuscript. All authors contributed to the writing process and revisions. Each author read and approved the final manuscript.

Disclosure statement

The authors report no conflict of interest. The authors alone are responsible for the content and writing of this article.

Ethics and consent

None.

Paper context

Cerebral palsy is the most common cause of physical disability in children. These children have poorer health and less participation in society than others, e.g. because of the disability, lower levels of physical activity, and discrimination. From equity and gender perspectives, we map how physiotherapeutic interventions, physical leisure activity and physical education are allocated for children in northern Sweden with cerebral palsy. Our main results indicate a gender-bias in access to habilitation service.

Additional information

Funding

This work was partly supported by the Swedish Research Council (Grant 344-2011-5478), and the Ume̊ Centre for Gender Studies (UCGS).

Notes on contributors

Frida Degerstedt

FD, MW and BE were responsible for study planning. FD conducted the analyses together with BE. FD drafted the initial manuscript. All authors contributed to the writing process and revisions. Each author read and approved the final manuscript.