Mostly Mothers, Many Others: Comparing Caregiver Attendance and Missed Treatment Hours in Pediatric Physical Therapy...

Cerebral palsy is a prevalent childhood motor disability which necessitates frequent outpatient physical therapy. Medical appointments can be time-consuming and burdensome for families and attendance rates for outpatient pediatric physical therapist visits are seldom reported.

This study investigates the number and types of caregivers that attend physical therapy sessions with the child and factors influencing attendance.

The study is a secondary analysis of a randomized controlled pragmatic clinical trial.

Intervention occurred in an outpatient hospital-based pediatric clinic.

The study included 90 children ages 2 to 8 years old with cerebral palsy enrolled in a randomized controlled pragmatic clinical trial (NCT02897024).

The study compared 2 physical therapy schedules, weekly and intensive, both with a total dose of 40 treatment hours. The weekly group received one 1-hour visit per week for 40 weeks. The intensive group repeated two bouts of 2-hour visits, 5 days per week for 2 weeks (20 hours, 4-month break, 20 hours). Both groups received 40 hours of physical therapy.

The primary outcomes were (1) number of caregivers accompanying the child to visits throughout the 40-week episode of care; and (2) number of missed treatment hours. Clinic location and accompanying caregiver(s) were collected from the electronic medical record. Prior to treatment, parents self-reported home zip code and income as part of the Hollingshead Four-Factor Socioeconomic Status as well as concurrent school-based therapy. Travel distance was calculated using home zip code and clinic location.

Forty combinations of caregivers accompanied n = 90 children to 1953 treatment sessions. The most common caregivers in attendance were the mother (70.5%) and father (15.0%). A non-parent attended 15.5% of sessions. The number of caregivers, travel distance, income, and concurrent school-based therapy were not significantly related to missed treatment hours. The intensive group missed significantly fewer treatment hours compared to the weekly group.

The findings highlight the heterogeneity of caregivers attending physical therapist visits and that responsibility primarily falls to mothers. Treatment schedule influenced attendance patterns while number of caregivers involved, distance traveled, household income, and concurrent therapies did not.

Attendance rates are an important metric for clinics and clinicians. Offering choices of treatment schedules may improve attendance rates. Future research could prospectively investigate caregiver scheduling preferences and their influence on attendance to outpatient pediatric physical therapy.