The psychosocial determinants of adherence to home-based rehabilitation strategies in parents of children with cerebral palsy: A systematic review

Abstract

Abstract Background Involving parents of children with cerebral palsy (C-CP) in home exercise programmes (HEP) is globally practised and closely linked to improved treatment outcomes for physical performance and function. Nevertheless, non-adherence to HEP is increasing at an alarming rate, and little is known about the factors of adherence to HEP (AHEP) especially in parents of C-CP. Objective This systematic review was aimed to identify the factors enhancing AHEP among parents of C-CP to reinforce the efficacy of rehabilitation practices proposed by health professionals, researchers, and educators. Method We searched PubMed, Scopus, CINHAL, PsycINFO, and Embase for articles published up to March 2023, that investigated the factors of AHEP among parents of C-CP. We conducted a narrative synthesis using the search results and pertinent material from other sources. Results Overall non-adherence rates to HEP were moderate to high (34%-79.2%). There was strong evidence that factors enhancing AHEP are in three categories: child-related (low age and gross motor function (GMF), caregiver-related (high self-efficacy and knowledge, high social support, low depression, anxiety and stress symptoms, and low perception of barriers), and the physiotherapist-related. For the last category, parents’ perception of a supportive and collaborative relationship with the therapists is one of the conditions mostly favour AHEP. Conclusions Our findings highlight that factors influencing AHEP are multifactorial. Some of them are conditions that are difficult to change such as FGM or the economic and social conditions of the family. Instead, the relationship between therapist and parent is a dimension that can be strengthened. These results suggest the importance of substantial training and psychosocial support for the therapists to make them more aware of and competent in the need to build a supportive relationship with parents.