Gender differences in treatments and interventions received by children and adolescents with cerebral palsy

Abstract

Background: In the Swedish population-based follow-up program and national quality registry for individuals with cerebral palsy (CPUP), physiotherapy (PT) and occupational therapy (OT) treatments are regularly recorded along with functional status. By Swedish law, all citizens irrespective of personal characteristics or socioeconomic status, have the right to receive healthcare and medical treatments as applicable. Previous research has shown gender differences in treatments and interventions received by children with cerebral palsy (CP). The purpose of this study was to examine differences in treatments and interventions by gender and place of birth in children and adolescents participating in CPUP. Methods: This was a cross-sectional registry study. Data from the latest PT (n = 2635) and OT assessment forms (n = 3480) in CPUP were extracted for individuals aged 0-17 years. Logistic regressions were used to assess the relationships between the outcome variables and gender and place of birth (including an interaction term gender X place of birth), adjusted for age, Gross Motor Function Classification System (GMFCS) levels and spasticity scores for PT interventions and Manual Ability Classification System (MACS) for OT interventions. Results: Results are presented as odds ratios [95% confidence intervals] and p-values. Girls were significantly more likely to have spinal braces than boys; 1.54 [1.07, 2.22] p < 0.05, a significant interaction with place of birth indicated fewer spinal braces prescribed to children born outside of the Nordic countries; 0.20 [0.079, 0.53] p < 0.001. Girls were less likely to have undergone selective dorsal rhizotomy (SDR); 0.49 [0.25, 0.94] p < 0.05. Individuals born outside of the Nordic countries, were significantly less likely to have received intrathecal baclofen (ITB) 0.27 [0.074, 0.98] p < 0.05. Conclusions: Of the treatments prescribed, gender differences were observed for spinal braces and having undergone SDR. A statistically significant difference based on place of birth was noted for spinal bracing and having received ITB treatment. Other PT and OT treatments were associated with age, level of spasticity, and functional severity as classified using the GMFCS and the MACS. Increased awareness of differences based on gender, and where a child is born, could be obtained by inter-and intraprofessional discussions.

Cerebral palsy and sex differences in children: A narrative review of the literature

“…Girls were less likely to have undergone surgery (selective dorsal rhizotomy) or intrathecal baclofen and they were more likely to have spinal braces (Josenby, 2020) maybe because female sex is more associated with the risk of scoliosis (Pettersson et al, 2020).…”

“…Eleven articles related sex to the different kind of interventions or outcomes in a rehabilitation program (Brunton & Bartlett, 2010; Degerstedt et al, 2017; Engel‐Yeger et al, 2009; Feitosa et al, 2017; Franzén et al, 2017; Gough et al, 2008; Himmelmann et al, 2020; Josenby, 2020; Mitchell et al, 2015; Wolter et al, 2020; Zwick et al, 2012).…”

“…A recent study (Josenby, 2020) reported that girls were less likely to have undergone selective dorsal rhizotomy and to have intrathecal baclofen (ITB), and more likely to have spinal braces (if they were not born outside of the Nordic countries), even though it did not reach statistical significance.…”

Treatment of spasticity in children and adolescents with cerebral palsy in Northern Europe: a CP-North registry study

“…Previous research on spasticity reducing methods in Sweden have reported sex differences. A Swedish population-based study showed that significantly more boys than girls were treated with SDR [ 18 ]. In another Swedish population-based study based on treatments reported 2014–2015, significantly more boys received BTX-A [ 18 ].…”

“…A Swedish population-based study showed that significantly more boys than girls were treated with SDR [ 18 ]. In another Swedish population-based study based on treatments reported 2014–2015, significantly more boys received BTX-A [ 18 ]. However, this difference was not found in reports from 2016–2017 [ 19 ], or in the present study.…”