Parental engagement in early intervention for infants with cerebral palsy-A realist synthesis
Phillip Antony Harniess1,2, Deanna Gibbs3, Jeff Bezemer2
1Physiotherapy Department, Great Ormond Street Hospital, London, UK.
Insights
Parental engagement in early intervention (EI) for infants at high risk of cerebral palsy (CP) is crucial. Effective strategies focus on relationships, education, and co-design, enhancing parental self-efficacy and outcomes.
Area of Science:
- Pediatrics
- Occupational Therapy
- Physiotherapy
Background:
- Parental engagement in early intervention (EI) for infants at high risk of cerebral palsy (CP) is increasingly emphasized.
- While family-centered care is applied, theoretical evaluations of parental engagement strategies in EI are lacking.
- This study addresses the gap by identifying theories behind EI strategies and evaluating their practical application.
Purpose of the Study:
- To identify component theories underlying early intervention strategies for parental engagement.
- To evaluate how these strategies work in practice using empirical findings.
- To inform the development of more effective EI programs for infants with CP.
Main Methods:
- A realist synthesis approach was employed.
- Searches were conducted across multiple databases (Medline, Embase, Amed, CINAHL, PsychInfo) from February 1985 to February 2020.
- Study rigor was assessed using the Critical Appraisal Skills Programme tool.
Main Results:
- Twenty-six articles were included, identifying quality of relationships, parent education, and intervention co-design as key themes.
- Parental reasoning mechanisms (trust, belief, control, feasibility, motivation) are linked to intervention resources and strategies.
- Engagement outcomes include increased parental self-efficacy, adherence, confidence, and reduced anxiety.
Conclusions:
- Relational quality between parent, infant, and therapist is fundamental for effective parental engagement in EI for infants with CP.
- Sensitively designed strategies are essential for parent connection, involvement, and investment.
- This highlights the importance of a therapeutic alliance in improving outcomes.
Background:
Emphasis on parental engagement strategies within occupational therapy and physiotherapy early intervention (EI) programmes for infants at high risk of cerebral palsy (CP) has increased. This reflects consensus that increasing parent participation enhances treatment efficacy, potentially improving infant and parent outcomes. However, evaluation of parental engagement in EI is complex. Despite the growing application of parental engagement strategies, aligned with family-centred care practice, theoretical evaluation is currently lacking within the literature. This realist synthesis aimed to identify component theories underlying EI strategies to support parental engagement and to use empirical findings to evaluate how these work in practice.
Methods:
Realist synthesis: Databases Medline, Embase, Amed, CINAHL and PsychInfo were searched (from February 1985 - February 2020); further articles were sourced from reference lists. A data extraction form was used, and a Critical Appraisal Skills Programme tool was used to assess study rigour.
Results:
Twenty-six articles were included. Quality of relationships, parent education and intervention co-design were the key themes related to parental engagement strategies. Findings indicate that constructive parent reasoning mechanisms of trust, belief, sense of control, perceived feasibility of home programme delivery and ultimately motivation are linked to the underlying intervention resources afforded by specific strategies (e.g., coaching pedagogy). These responses are precursors to engagement outcomes that include increased parental self-efficacy and adherence. Importantly, parental self-efficacy can initiate a process of change leading to improved parental confidence and anxiety.
Conclusions:
Sensitively designed programme strategies, centred on relational quality between parent, infant and therapist, are fundamental for effective parent connection, involvement and investment within EI for infants with CP.
