Barriers and facilitators of home-based physiotherapy programs for children with cerebral palsy as perceived by primary caregivers and physiotherapists

Abstract

Cerebral Palsy (CP) is a disorder of movement and posture, which causes activity limitations due to non-progressive disturbances of the immature brain. For children with CP, the participation of their families in home activity programs is key for successful therapy interventions. However, primary caregivers (PCs) in Sri Lanka often have difficulties accomplishing proper home-based physiotherapy programs (HBPP). This study explored barriers and facilitators of HBPP for children with CP as perceived by PCs and physiotherapists (PTs). Adopting a grounded theory approach, a qualitative descriptive study was conducted using individual interviews. Forty PCs of children with CP and ten PTs participated. The data generated were thematically analyzed using constant comparative analysis. Four major themes were identified based on the perceived barriers and facilitators of HBPP. PCG's confidence on HBPP, child's interest to do HBPP, proper PT guidance, availability of resources identified as themes under facilitators and PCG's workload, nature of the child, unsuccessful therapy sessions and lack of social support were identified as themes under barriers. The findings of this study will help reinforce the caregivers or to support them to overcome their barriers. Sharing knowledge among family members could facilitate active participation of the caregiver. Physiotherapists should develop effective teaching techniques and create PC-PT confidence. In addition, economically sustainable and accessible rehabilitation services are needed. This study contributes to the existing literature on HBPP for children with CP in Sri Lanka. The findings of this study can be used to develop interventions to improve the effectiveness of HBPP and to support caregivers in their role in providing home-based therapy.