Published 24 April 2009, doi:10.1136/bmj.b1458
Cite this as: BMJ 2009;338:b1458

Research

Participation in life situations of 8-12 year old children with cerebral palsy: cross sectional European study

¹ Université Joseph Fournier, DIM-Pôle Santé Publique Equipe ThEMAS, CHU de Grenoble BP 217, 38043 Grenoble Cedex 9, France, ² Institute of Health and Society, Newcastle University, Newcastle upon Tyne NE1 7RU, ³ Göteborg University, Queen Silvia Children’s Hospital, S-41685 Gothenburg, Sweden, ⁴ Azienda Sanitaria Locale Viterbo, Viale Trento 18 H, 01100 Viterbo, Italy, ⁵ Enable Ireland, Lavanagh Centre, Ballintemple, Cork, Republic of Ireland, ⁶ National Institute of Public Health, University of Southern Denmark, Oster Farimagsgade 5A, 1399 Copenhagen, Denmark, ⁷ School of Nursing and Midwifery, Queen’s University Belfast, Belfast BT9 5BN, ⁸ Klinik für Kinder und Jugendmedizin, Universitätsklinikum Schleswig-Holstein, Ratzeburger Allee 160, 23538 Lübeck, Germany, ⁹ Institut National de la Santé et de la Recherche Médicale, Université Paul Sabatier, Faculté de Médecine, 37 allées J Guesde, 31073 Toulouse, France

Objectives To evaluate how involvement in life situations (participation) in children with cerebral palsy varies with type and severity of impairment and to investigate geographical variation in participation.

Design Cross sectional study. Trained interviewers visited parents of children with cerebral palsy; multilevel multivariable regression related participation to impairments, pain, and sociodemographic characteristics.

Setting Eight European regions with population registers of children with cerebral palsy; one further region recruited children from multiple sources.

Participants 1174 children aged 8-12 with cerebral palsy randomly selected from the population registers, 743 (63%) joined in the study; the further region recruited 75 children.

Main outcome measure Children’s participation assessed by the Life-H questionnaire covering 10 main areas of daily life. Scoring ignored adaptations or assistance required for participation.

Results Children with pain and those with more severely impaired walking, fine motor skills, communication, and intellectual abilities had lower participation across most domains. Type of cerebral palsy and problems with feeding and vision were associated with lower participation for specific domains, but the sociodemographic factors examined were not. Impairment and pain accounted for up to a sixth of the variation in participation. Participation on all domains varied substantially between regions: children in east Denmark had consistently higher participation than children in other regions. For most participation domains, about a third of the unexplained variation could be ascribed to variation between regions and about two thirds to variation between individuals.

Conclusions Participation in children with cerebral palsy should be assessed in clinical practice to guide intervention and assess its effect. Pain should be carefully assessed. Some European countries facilitate participation better than others, implying some countries could make better provision. Legislation and regulation should be directed to ensuring this happens.

© Fauconnier et al 2009
This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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