Determinants of satisfaction with motor rehabilitation in people with cerebral palsy: A national survey in France (ESPaCe) - 07/12/19

Doi : 10.1016/j.rehab.2019.09.002

G. Cornec ^a,^b,^c, G. Drewnowski ^d, I. Desguerre ^e, P. Toullet ^f, J. Boivin ^d, M. Bodoria ^g, J. De La Cruz ^h,^i,^j,⁎, ^{^{1
Co-last authors.}} , S. Brochard ^a,^b,^c,^k,^{^{1
Co-last authors.}}
on behalf of the
ESPaCe group
^a Physical and Rehabilitation Medicine Department, University Hospital of Brest, 29200 Brest, France
^b Western Brittany University, 29200 Brest, France
^c Pediatric Physical and Rehabilitation Medicine Department, Fondation Ildys, 29200 Brest, France
^d Expert patient, Lyon, France
^e Pediatrics-radiology-genetics, hôpital Necker–Enfants-malades, 75000 Paris, France
^f Institut Motricité Cérébrale – Cercle de Documentation et d’Information pour la rééducation des Infirmes Moteurs Cérébraux, 75000 Paris, France
^g Fondation Paralysie Cérébrale, 75000 Paris, France
^h University Hospital “12 Octubre”, Madrid, Spain
ⁱ Health Research Institute Imas12, Madrid, Spain
^j Development Research Network, ISCIII Red SAMID, Madrid, Spain
^k Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), 29200 Brest, France

^⁎Corresponding author. Hospital Universitario 12 de Octubre, Madrid, Spain.Hospital Universitario 12 de OctubreMadridSpain

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Saturday 07 December 2019
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Highlights

•	Satisfaction with motor rehabilitation for cerebral palsy was reported nationwide in France.
•	Satisfaction determinants were mainly organisation of care and practice features.
•	Pain management, therapeutic alliance and goal-setting were strong determinants.
•	Coordination of care and physical therapist training in cerebral palsy improved satisfaction.
•	More severe motor impairment and being an adolescent contributed to lower satisfaction.

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Abstract

Background

User satisfaction is a key indicator of healthcare quality.

Objective

We aimed to identify factors associated with satisfaction with motor rehabilitation (MR) in children and adults with cerebral palsy at a national level, using determinants related to patient characteristics, healthcare organisation and practice features.

Methods

This study was part of ESPaCe, a national survey aimed at documenting the views of individuals with cerebral palsy and their families regarding MR services via a questionnaire, developed by a multidisciplinary group. The ESPaCe questionnaire included the Client Satisfaction Questionnaire (CSQ-8), whose total score was the primary outcome of this study. Survey participation was promoted nation-wide. The questionnaire could be completed by the person with cerebral palsy or their main carer. Analysis included the description of determinants across CSQ-8 quartiles and generalised linear modelling of the CSQ-8 score.

Results

From June 2016 to June 2017, 1010 eligible participants (354 children, 145 adolescents and 511 adults) responded to the questionnaire, and 750 completed the CSQ-8. Univariate analysis suggested that multiple factors affected satisfaction with MR. On multivariate sequential adjustment, the factors that decreased satisfaction (all P<0.001) were being an adolescent, Gross Motor Function Classification System levels IV/V, frequent pain, receiving physiotherapy in private practice and poor access to a physiotherapist with specific CP training. Factors that increased satisfaction (all P<0.001) were presence of an MR coordinator, exchanges between healthcare professionals, provision of information regarding MR organisation, and goal setting and effective pain management by the physiotherapist. Organisation and practice features improved the predictive ability of patient characteristics (R²=0.40).

Conclusion

This study suggests that measures to improve the quality of healthcare for individuals with cerebral palsy should focus on improving pain management by the physiotherapist, establishing a therapeutic alliance, and greater provision of CP-specific practice education for healthcare professionals.

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Keywords : Cerebral palsy, User satisfaction, Rehabilitation, Survey, Patient preferences