A Systematic Review of Caregiver-focused Interventions for Children With Cerebral Palsy in Low- and Middle-income Countries

Vollständiger Abstract

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ABSTRACT Objective: In many global settings, children with cerebral palsy (CP) and their families face challenges in routinely accessing specialist-delivered care. This systematic review aimed to summarize caregiver-focused interventions for children with CP in low- and middle-income countries (LMIC). Method: Following Preferred Reporting Items for Systematic review and Meta-Analysis guidelines, we searched 8 electronic databases, most recently in February 2024. Eligible studies described caregiver-focused interventions for children aged 18 years or older with CP, performed in LMICs (by World Bank criteria), reported outcomes in children or caregivers, and met standards for observational research design. Two reviewers independently extracted data, assessed risk of bias using the NIH Study Quality Assessment Tool, and qualitatively synthesized findings. Results: From 16,485 titles screened, 293 full texts were reviewed, and 16 studies met inclusion criteria. These studies were conducted in 10 LMICs, primarily in South Asia. Most interventions (n = 8) were group-based, with 8 interventions lasting longer than 12 weeks, considered long term. Outcomes focused on caregivers (n = 4), children (n = 4), or both (n = 8). Child motor function (n = 5) and caregiver mental health or well-being (n = 6) were the most common measures, with mostly positive impacts on motor function and little or negative effects on caregiver mental health. Caregivers reported benefits such as improved adaptability and knowledge, alongside enhanced child physical function and communication. Study quality was rated fair (n = 9) or good (n = 7). Conclusion: Caregiver-focused interventions in LMICs can positively impact caregiver well-being and child outcomes. Group-based delivery appears feasible and effective. Future work should explore sustainable implementation strategies to broaden reach and impact.