Health service use among adults with cerebral palsy: a mixed methods systematic review

Introduction: Cerebral palsy (CP) is a childhood neurodisability that primarily results in motor impairments and activity limitations. Most children with CP survive well into adulthood. As adults, people with CP experience secondary conditions in addition to ongoing health issues from childhood. However, health service use among adults with CP remains unclear. This mixed methods review aims to identify, appraise and synthesize the available literature on health service use among adults with CP.
Methods: The mixed methods systematic review was conducted in accordance with the Joanna Briggs Institute (JBI) methodology. A systematic search of Medline (Ovid), CINAHL, EMBASE, PsychINFO and the Cochrane library was conducted. Quantitative observational studies, qualitative studies, and mixed methods studies examining health service use among adults with CP (≥ 18 years) were included. Outcomes of interest were the proportion and frequency of adults using health services, and the experiences and perceptions of health services for adults with CP. Two reviewers independently screened titles, abstracts and full texts, extracted data, and assessed the quality of included studies using JBI instruments. Quantitative and qualitative findings were integrated using Anderson and Newman model (1995). Ethical approval was not required for this review.
Results: Fifty-seven studies (n=31 quantitative, and n=26 qualitative) were included. Studies included 14,300 adults with CP, mean reported age 18-48 years. Overall, there were large variation in pooled analysis ranging from 11% neurologist to 84% GP services; incidence rate of 67 hospital admissions to 503 GP visits per 100PY. The qualitative themes highlighted challenges in accessibility, caregivers involvement, health workers expertise, unmet ageing needs, transition and health system challenges.
Conclusion: Overall, adults used wide- range of medical and rehabilitation services. The findings highlights the context specific challenges faced in accessing their needed services. Thus, emphasizing the need to develop an appropriate service delivery model and educate service providers in order to meet the needs of adults with CP.