Türkiye’de Pediatrik Fizyoterapi ve Rehabilitasyon Alanında Fizyoterapistlerin Serebral Palsi Yönetiminin İncelenmesi

Year 2025, Volume: 12 Issue: 1, 146 - 163, 30.04.2025

Kübra Seyhan Bıyık , Cemil Özal , Şadiye Sezin Şimşek Aybar , Fuat Sönmez , Kıvanç Delioğlu , Mintaze Kerem Günel

https://doi.org/10.21020/husbfd.1530175

Abstract

Amaç: Türkiye’de Pediatrik Fizyoterapi ve Rehabilitasyon alanında çalışan fizyoterapistlerin serebral palsi (SP) yönetimi ile ilgili görüşlerini incelemekti.
Gereç ve Yöntem: Çalışmaya yaş ortalaması 32.48+8.16 (22-57) yıl olan Türkiye’de pediatrik fizyoterapi ve rehabilitasyon alanında çalışan 172 fizyoterapist (%66 kadın) dahil edildi. Fizyoterapistlere Google form ile hazırlanan “SP yönetimi anketi” uygulandı. Eğitim düzeyleri ve çalıştıkları kuruma göre fizyoterapistlerin uyguladıkları değerlendirme ve müdahale yöntemleri ile çalışma şartlarına göre SP yönetimi deneyimleri Ki-kare testi ile karşılaştırıldı.
Bulgular: SP’li çocuklarda değerlendirme kapsamında lisansüstü mezunu fizyoterapistler daha çok günlük yaşam aktiviteleri (p=0.006), sosyal katılım (p=0.028) düzeylerine odaklanırken lisans mezunu olanlar vücut yapı ve fonksiyonlarına odaklandı (p<0.035). Akademide ve özel kliniklerde çalışanlar günlük yaşam aktivitelerini diğer kurumlarda çalışanlara göre daha çok tercih etti (p=0.025). Müdahale yöntemleri kapsamında lisansüstü mezunlar yenilikçi teknolojileri (p<0.037) daha çok tercih ederken lisans mezunları kuvvetlendirme (p=0.009) ve germe eğitimlerini (p=0.012) tercih etti. Kamu/özel hastanelerde çalışanlar kuvvetlendirme (0.041) ve germe eğitimini (p=0.002), akademik çalışanlar teknolojik müdahaleleri (p<0.05), özel kliniklerde çalışanlar bantlama/osteopati/masaj gibi bölgesel uygulamaları diğer gruplara göre daha çok tercih etti (p<0.05). Çevresel koşullar düşünüldüğünde çocuğa özel hedefler seçme, çocuğu çok boyutlu değerlendirme, güncel bilgileri takip etme ve invaziv bir uygulama sonrası bireyselleştirilmiş program belirlemede zorluk kurumlara göre farklılık gösterdi (p>0.05).
Sonuç: Türkiye'de pediatrik fizyoterapi ve rehabilitasyon alanında çalışan fizyoterapistler, eğitim düzeylerine ve kurumlarına göre farklı değerlendirme ve müdahale yöntemleri kullanmaktadır. Lisansüstü eğitim ve geniş zaman aralıklı bireysel çalışma ortamı (akademi ve özel kliniklerde) SP’li çocukları çok boyutlu değerlendirme ve kanıta dayalı fizyoterapi ve rehabilitasyon müdahalelerini uygulamayı kolaylaştırabilir.

Keywords

çocuk, serebral palsi, fizyoterapist, rehabilitasyon

Investigating of Cerebral Palsy Management of Physiotherapists in the Field of Pediatric Physiotherapy and Rehabilitation in Turkey

Abstract

Objectives: To investigate the opinions of physiotherapists about the management of cerebral palsy (CP) in the field of Pediatric Physiotherapy and Rehabilitation in Turkey.
Materials and Methods:172 physiotherapists (66% female) with a mean age of 32.48+8.16 (22-57) years in the field of pediatric physiotherapy and rehabilitation in Turkey were included. “A survey on CP management” prepared with a Google Form was sent to physiotherapists. A Chi-square test was used to compare the evaluation and intervention methods used by physiotherapists according to their education levels and institutions as well as their CP management experiences according to their working conditions.
Results: Physiotherapists with postgraduate degrees focused more on daily living activities (p=0.006) and social participation (p=0.028) when evaluating children with CP, whereas those with undergraduate degrees focused more on body structure and function (p<0.035). Academic and private clinic physiotherapists preferred daily living activities more than others (p=0.025). In intervention methods, postgraduate physiotherapists preferred innovative technologies (p<0.037), while undergraduate physiotherapists preferred strengthening (p=0.009) and stretching training (p=0.012). Those working in public/private hospitals preferred strengthening (0.041) and stretching training (p=0.002), academic ones preferred technological interventions (p<0.05), and private clinic physiotherapists preferred regional applications such as taping/osteopathy/massage more than others (p<0.05). The difficulties in choosing child-specific goals, multidimensional evaluation, following up-to-date information, and determining an individualized program after an invasive procedure varied according to the institutions (p<0.05).
Conclusion: In Turkey, physiotherapists working in pediatric physiotherapy and rehabilitation use different evaluation and intervention methods depending on their education levels and institutions. The implementation of multidimensional assessment and evidence-based physiotherapy and rehabilitation interventions for children with CP can be facilitated by postgraduate education and an expanded working environment.

Keywords

child, cerebral palsy, physical therapist, rehabilitation

References

• Alshehri, M. A., Alhasan, H., Alayat, M., Al-Subahi, M., Yaseen, K. ve Ismail, A. (2018). Factors affecting the extent of utilization of physiotherapy services by physicians in Saudi Arabia. Journal Of Physical Therapy Science, 30(2), 216-222. https://doi.org/10.1589/jpts.30.216
• Camden, C., Mulligan, H., Cinar, E., Gauvin, C., Berbari, J. ve Nugraha, B. (2023). Perceived strengths and weaknesses of paediatric physiotherapy services: Results from an international survey. Physiotherapy Research International, 28(1), e1974. https://doi.org/10.1002/pri.1974
• Camden, C., Mulligan, H., Nugraha, B., Berbari, J., Gauvin, C. ve Cinar, E. (2021). Scope and practices of physical therapists working with children: results from an international online survey. Pediatric Physical Therapy, 33(4), 251-258. https://doi.org/10.1097/PEP.0000000000000816
• Coşkunsu, D. K., Toprak, M., Duman, Ç., ve İnal, H. S. (2018). Türkiye’de fizyoterapistlerin iş bulma sürelerinin ve istihdam durumlarinin değerlendirilmesi [An Assessment Of Physıotherapısts’ Employment Tıme And Status In Turkey]. Fizyoterapi Rehabilitasyon, 29(2), 44-52. https://doi.org/10.21653/tjpr.365475
• Dannemiller, L., Mueller, M., Leitner, A., Iverson, E., ve Kaplan, S. L. (2020). Physical therapy management of children with developmental coordination disorder: an evidence-based clinical practice guideline from the Academy of Pediatric Physical Therapy of the American Physical Therapy Association. Pediatric Physical Therapy, 32(4), 278-313. https://doi.org/10.1097/PEP.0000000000000753
• de Meyrick, J. (2003). The Delphi method and health research. Health Education, 103(1), 7-16. https://doi.org/10.1108/09654280310459112
• Günel, M. K. (2011). Physiotherapy for children with cerebral palsy. Ž Petelin Gadže (Ed.) Epilepsy in Children-Clinical and Social Aspects içinde(pp 213-234). InTechOpen.
• Han, H., ve Kim, J. H. (2022). Development of a wearable orthotic device pattern to prevent hip dislocation in children with cerebral palsy. International Journal of Clothing Science and Technology, 34(3), 418-433. https://doi.org/10.1108/IJCST-09-2020-0142
• Hareb, F., Bertoncelli, C. M., Rosello, O., Rampal, V., ve Solla, F. (2020). Botulinum toxin in children with cerebral palsy: an update. Neuropediatrics, 51(01), 001-005. https://doi.org/10.1055/s-0039-1694988
• Jackman, M., Sakzewski, L., Morgan, C., Boyd, R. N., Brennan, S. E. ve Langdon, K. (2022). Interventions to improve physical function for children and young people with cerebral palsy: international clinical practice guideline. Developmental Medicine and Child Neuroogyl, 64(5), 536-549. https://doi.org/10.1111/dmcn.15055
• Jemes-Campaña, I. C., Romero-Galisteo, R. P., Gálvez-Ruiz, P., Labajos-Manzanares, M. T., ve Moreno-Morales, N. (2021). Service Quality in Early Intervention Centres: An Analysis of Its Influence on Satisfaction and Family Quality of Life. Children (Basel), 8(8). https://doi.org/10.3390/children8080716
• Larsson, I., Miller, M., Liljedahl, K., ve Gard, G. (2012). Physiotherapists’ experiences of physiotherapy interventions in scientific physiotherapy publications focusing on interventions for children with cerebral palsy: a qualitative phenomenographic approach. BMC Pediatrics, 12, 1-12. https://doi.org/10.1186/1471-2431-12-90
• Mayston, M. J., Saloojee, G. M., ve Foley, S. E. (2024). The Bobath Clinical Reasoning Framework: A systems science approach to the complexity of neurodevelopmental conditions, including cerebral palsy. Developmental Medicine and Child Neurology, 66(5), 564–572. https://doi.org/10.1111/dmcn.15748
• Mazer, B., Feldman, D., Majnemer, A., Gosselin, J., ve Kehayia, E. (2006). Rehabilitation services for children: therapists' perceptions. Pediatric Rehabilitation, 9(4), 340-350. https://doi.org/10.1080/13638490600668087
• Mokkink, L. B., Terwee, C. B., Patrick, D. L., Alonso, J., Stratford, P. W. ve Knol, D. L. (2010). The COSMIN checklist for assessing the methodological quality of studies on measurement properties of health status measurement instruments: an international Delphi study. Quality of Life Research, 19, 539-549. https://doi.org/10.1007/s11136-010-9606-8
• Morgan, C., Fetters, L., Adde, L., Badawi, N., Bancale, A. ve Boyd, R. N. (2021). Early intervention for children aged 0 to 2 years with or at high risk of cerebral palsy: international clinical practice guideline based on systematic reviews. JAMA Pediatrics, 175(8), 846-858. https://doi.org/10.1001/jamapediatrics.2021.0878
• Niederberger, M., ve Spranger, J. (2020). Delphi Technique in Health Sciences: A Map. Frontier Public Health, 8, 457. https://doi.org/10.3389/fpubh.2020.00457
• Novak, I., Morgan, C., Fahey, M., Finch-Edmondson, M., Galea, C. ve Hines, A. (2020). State of the Evidence Traffic Lights 2019: Systematic Review of Interventions for Preventing and Treating Children with Cerebral Palsy. Current Neurology Neuroscience Reports, 20(2), 3. https://doi.org/10.1007/s11910-020-1022-z
• Olaleye, O. A., Hamzat, T. K., ve Oloso, M. O. (2015). Perceived quality of physiotherapy services among informal caregivers of children with cerebral palsy in Ibadan, Nigeria. Journal of Pediatric Rehabilitation Medicine, 8(3), 227-234. https://doi.org/10.3233/prm-150339
• Oskoui, M., Coutinho, F., Dykeman, J., Jetté, N. ve Pringsheim, T. (2013). An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Developmental Medicine and Child Neurology, 55(6), 509-519. https://doi.org/10.1111/dmcn.12080
• Rana, R., ve Singhal, R. (2015). Chi-square test and its application in hypothesis testing. Journal of Primary Care Specialties, 1(1), 69-71. https://doi.org/10.4103/2395-5414.157577
• Reyes, P., Puelle, F., ve Barría, R. M. (2020). Perception of the Quality of Physiotherapy Care Provided to Outpatients from Primary Health Care in Chile. Evaluation and the Health Professions, 43(1), 16-22. https://doi.org/10.1177/0163278718770711
• Rosenbaum, P., Paneth, N., Leviton, A., Goldstein, M., Bax, M. ve Damiano, D. (2007). A report: the definition and classification of cerebral palsy April 2006. Developmental Meicine and Child Neurology Supplement, 109, 8-14. https://doi.org/10.1111/j.1469-8749.2007.tb12610.x
• Serdaroǧlu, A., Cansu, A., Özkan, S., ve Tezcan, S. (2006). Prevalence of cerebral palsy in Turkish children between the ages of 2 and 16 years. Developmental Medicine and Child Neurology, 48(6), 413-416. https://doi.org/10.1017/S0012162206000910
• Strobl, W., Theologis, T., Brunner, R., Kocer, S., Viehweger, E. ve Pascual-Pascual, I.(2015). Best clinical practice in botulinum toxin treatment for children with cerebral palsy. Toxins, 7(5), 1629-1648. https://doi.org/10.3390/toxins7051629
• T.C. Milli Eğitim Bakanlığı [MEB].(2012). Milli Eğitim Bakanlığı Özel Eğitim Kurumları Yönetmeliği. https://ookgm.meb.gov.tr/meb_iys_dosyalar/2024_06/24175722_ozelegitimkurumlariyonetmeligi.pdf
• T.C. Milli Eğitim Bakanlığı [MEB]. (2019). Engelli Hakları Rehberi. https://orgm.meb.gov.tr/icdep/content/upload/attached-files/engeli-haklari-rehberi-20211219203142.pdf
• T.C. Sağlık Bakanlığı [SB]. (2019). Çocuklar için Özel Gereksinim Değerlendirmesi Hakkında Yönetmelik. T.C. Cumhurbaşkanlığı İdari İşler Başkanlığı Hukuk ve Mevzuat Genel Müdürlüğü.T.C. Resmi Gazete,(30692), 20 Şubat 2019, 1-412. https://www.resmigazete.gov.tr/eskiler/2019/02/20190220.pdf
• T.C. Sosyal Güvenlik Kurumu (2013). Sosyal Güvenlik Kurumu Sağlık Uygulama Tebliğ (SUT). T.C. Cumhurbaşkanlığı Mevzuat Bilgi Sistemi. https://www.mevzuat.gov.tr/File/GeneratePdf?mevzuatNo=17229&mevzuatTur=Teblig&mevzuatTertip=5
• Zischke, C., Pope, R., Hing, W., Milne, N., ve Spittle, A. (2019, 17-19, October). Paediatric physiotherapy services across Australia, New Zealand and the United Kingdom.[Oral presentation]. Australian Physiotherapy Association Transform 2019 Physiotherapy Conference, Adelaide, Australia