LOW BACK DISABILITY IN PRIMARY CAREGIVERS OF CHILDREN WITH CEREBRAL PALSY: COMPARISON WITH HEALTHY CAREGIVERS AND IDENTIFICATION OF PREDICTORS

Öz

Objective: This study aimed to compare pain, disability, spinal mobility, and quality of life between primary caregivers of children with Cerebral Palsy (CP) and primary caregivers of healthy children, and to identify predictors of low back disability in primary caregivers of children with CP. Method: This cross-sectional study was conducted at the Physical Therapy and Rehabilitation Clinic at Kırşehir Training and Research Hospital. It was conducted among primary caregivers of children with CP and primary caregivers of healthy children. A total of 162 caregivers (83 CP, 79 healthy) were assessed. Pain was measured using the Visual Analog Scale (VAS), disability with the Oswestry Disability Index (ODI), spinal mobility with the Spinal Mouse (sagittal plane and coronal plane), and quality of life with the Nottingham Health Profile (NHP). Group differences were analyzed using independent t-tests and chi-square tests. Pearson correlation and stepwise multiple linear regression identified predictors of low back disability in CP caregivers. The level of significance was set at p<0.05. Results: CP caregivers had higher ODI and VAS activity scores and lower NHP scores compared with healthy caregivers (p<0.05). ODI correlated negatively with sagittal plane spinal mobility (r=-0.485, p<0.001) and coronal plane spinal mobility (r=-0.351, p=0.001). Sagittal and coronal plane spinal mobility were independent predictors of low back disability, explaining 27% of the variance. Conclusion: Low back disability and reduced quality of life were significantly higher in primary caregivers of children with CP compared to healthy caregivers. Reduced spinal mobility independently predicts disability, underscoring the importance of spinal mobility interventions and caregiver support programs.

Anahtar Kelimeler

• Care Burden
• Musculoskeletal Disorders
• Quality of Life
• Spinal Mobility

SEREBRAL PALSİLİ ÇOCUKLARIN BİRİNCİL BAKIM VERENLERİNDE BEL DİSABİLİTESİ: SAĞLIKLI BAKIM VERENLERLE KARŞILAŞTIRMA VE BELİRLEYİCİ FAKTÖRLERİN İNCELENMESİ

Öz

Amaç: Bu çalışma, Serebral Palsili (SP) çocukların birincil bakım verenleri ile sağlıklı çocukların birincil bakım verenleri arasında ağrı, bel fonksiyon kısıtlılığı, omurga mobilitesi ve yaşam kalitesini karşılaştırmayı ve SP’li çocukların birincil bakım verenlerinde bel fonksiyon kısıtlılığının belirleyicilerini ortaya koymayı amaçladı. Yöntem: Bu kesitsel çalışma, Kırşehir Eğitim ve Araştırma Hastanesi Fizik Tedavi ve Rehabilitasyon Kliniği’nde gerçekleştirildi. Çalışma, SP’li çocukların birincil bakım verenleri ile sağlıklı çocukların birincil bakım verenleri arasında gerçekleştirildi. Toplam 162 bakım veren (83 SP, 79 sağlıklı) değerlendirildi. Ağrı Görsel Analog Skala (VAS) ile, bel fonksiyon kısıtlılığı Oswestry Disabilite İndeksi (ODİ) ile, omurga mobilitesi Spinal Mouse (sagittal düzlem ve koronal düzlem) ile ve yaşam kalitesi Nottingham Sağlık Profili (NSP) ile ölçüldü. Grup farkları bağımsız örneklem t-testi ve ki-kare testi ile analiz edildi. Pearson korelasyonu ve aşamalı çoklu doğrusal regresyon, SP bakım verenlerinde bel fonksiyon kısıtlılığının yordayıcılarını belirlemek için kullanıldı. Anlamlılık düzeyi p<0,05 olarak belirlendi. Bulgular: SP bakım verenleri, sağlıklı bakım verenlere kıyasla daha yüksek ODI ve VAS aktivite skorlarına ve daha düşük NHP skorlarına sahipti (p<0.05). ODI, sagittal düzlem omurga mobilitesi (r=-0.485, p<0.001) ve koronal düzlem omurga mobilitesi (r=-0.351, p=0.001) ile negatif korelasyon gösterdi. Sagittal ve koronal düzlem omurga mobilitesi, bel fonksiyon kısıtlılığının bağımsız yordayıcıları olup varyansın %27’sini açıkladı. Sonuç: SP'li çocukların birincil bakım verenlerinde bel fonksiyon kısıtlılığı ve yaşam kalitesi düşüklüğü, sağlıklı çocukların bakım verenlerine kıyasla anlamlı derecede daha yüksekti. Azalmış omurga mobilitesi, bel fonksiyon kısıtlılığını bağımsız olarak yordamakta, omurga mobilitesine yönelik müdahalelerin ve bakım veren destek programlarının önemini vurgulamaktadır.

Anahtar Kelimeler

• Bakım Yükü
• Kas-İskelet Sistemi Hastalıkları
• Yaşam Kalitesi
• Omurga Mobilitesi

Kaynakça

1. Patel DR, Neelakantan M, Pandher K, Merrick J. Cerebral palsy in children: a clinical overview. Transl Pediatr. 2020;9(Suppl 1):125-135.
2. Alhumaidi KA, Alshwameen MO, Alsayed MS, et al. Quality of life of primary caregivers of children with cerebral palsy from a family perspective. Cureus. 2023;15(11):e49378.
3. Eloreidi RMD, Kehyayan V, Kalu F, Thornton L. Needs of caregivers of children with cerebral palsy: a literature review. J Nurs Educ Pract. 2021;11(9):23.
4. Raina P, O'Donnell M, Rosenbaum P, et al. The health and well-being of caregivers of children with cerebral palsy. Pediatrics. 2005;115(6):626-636.
5. Choudhary N, Ojha S, Kumar Singh N. Linking work-family and family-work conflict to demographic determinants: a study on officers of a defence CPSE in Bangalore. J Inst Public Enterp. 2015;38:128-149.
6. Tong HC, Haig AJ, Nelson VS, et al. Low back pain in adult female caregivers of children with physical disabilities. Arch Pediatr Adolesc Med. 2003;157(11):1128-1133.
7. Shigetoh H, Abiko T, Ohyama M, Sakata E, Murata S. Associations of central sensitization-related symptoms with low back pain-related factors and work status in caregivers. Int J Environ Res Public Health. 2022;19(16):10135.
8. Ramezani M, Eghlidi J, Pourghayoomi E, Mohammadi S. Caring-related chronic low back pain and associated factors among mothers of children with cerebral palsy. Rehabil Res Pract. 2020;2020(1):8854435.

9. Abdullahi A, Thomson WW, Shamay SN. Prevalence and risks factors of caregiving-related low back pain among caregivers of stroke survivors: a systematic review and meta-analysis. Eur J Phys Rehabil Med. 2023;59(6):682-688.
10. Seroke S, Mkhize SW. Psychosocial experiences of mothers caring for children with cerebral palsy in the eThekwini district. Health SA Gesondheid. 2023;28(1):1-11.
11. Liu F, Zhang R, Cui C, Zhou H. Care burden and quality of life among family caregivers of children with cerebral palsy in China: the mediating roles of social support and coping styles. BMC Public Health. 2025;25(1):506.
12. Montero-Cuadrado F, Barrero-Santiago L, Llamas-Ramos R, Llamas-Ramos I. Musculoskeletal pain in family caregivers: does a therapeutic physical program in primary care work? a randomized controlled trial. Int J Environ Res Public Health. 2022;20(1):185.
13. Poitras S, Loisel P, Prince F, Lemaire J. Disability measurement in persons with back pain: a validity study of spinal range of motion and velocity. Arch Phys Med Rehabil. 2000;81(10):1394-1400.
14. Laird RA, Gilbert J, Kent P, Keating JL. Comparing lumbo-pelvic kinematics in people with and without back pain: a systematic review and meta-analysis. BMC Musculoskelet Disord. 2014;15(1):229.
15. Koitsiwe FA, Nkhata LA. Low back pain and risk factors among caregivers of children with disabilities in Zambia. Med J Zambia. 2025;52(1):46-54.
16. Bures RM. Migration and the life course: is there a retirement transition? Int J Popul Geogr. 1997;3(2):109-119.
17. Ying K, Rostenberghe HV, Kuan G, et al. Health-related quality of life and family functioning of primary caregivers of children with cerebral palsy in Malaysia. Int J Environ Res Public Health. 2021;18(5):2351.
18. Oskoui M, Coutinho F, Dykeman J, Jetté N, Pringsheim T. An update on the prevalence of cerebral palsy: a systematic review and meta-analysis. Dev Med Child Neurol. 2013;55(6):509-519.
19. Heller GZ, Manuguerra M, Chow R. How to analyze the visual analogue scale: myths, truths and clinical relevance. Scand J Pain. 2016;13(1):67-75.
20. Fritz JM, Irrgang JJ. A comparison of a modified Oswestry low back pain disability questionnaire and the Quebec back pain disability scale. Phys Ther. 2001;81(2):776-788.
21. Post R, Leferink V. Spinal mobility: sagittal range of motion measured with the spinal mouse, a new non-invasive device. Arch Orthop Trauma Surg. 2004;124(3):187-192.
22. Busija L, Ackerman IN, Haas R, et al. Adult measures of general health and health-related quality of life. Arthritis Care Res. 2020;72(S10):522-564.
23. Neves EB, Pietrovski EF, Claudino RF. Quality of life and low back pain in primary caregivers of children with cerebral palsy. Cad Saude Colet. 2015;23(1):50-56.
24. Kaya K, Unsal-Delialioglu S, Ordu-Gokkaya NK, et al. Musculoskeletal pain, quality of life and depression in mothers of children with cerebral palsy. Disabil Rehabil. 2010;32(20):1666-1672.
25. Owen BD. Intervention for musculoskeletal disorders among child-care workers. Pediatrics. 1994;94(6):1077-1079.
26. Brehaut JC, Kohen DE, Raina P, et al. The health of primary caregivers of children with cerebral palsy: how does it compare with that of other Canadian caregivers? Pediatrics. 2004;114(2):e182-e191.
27. Karthik S, Sirnaik F. Low back pain and its impact on activities of daily living and general health in primary caregivers of children with cerebral palsy. Int J Curr Res Mod Educ. 2017:48-52.
28. Rojas EMH, Álvarez SM, Bastos AS, Enríquez-Reyna MC. Risk for musculoskeletal disorders in informal caregivers of people with cerebral palsy. Rev Psicol Deporte. 2017;26(4):107-112.
29. Bella GP, Garcia MC, Spadari-Bratfisch RC. Salivary cortisol, stress, and health in primary caregivers (mothers) of children with cerebral palsy. Psychoneuroendocrinology. 2011;36(6):834-842.
30. Ones K, Yilmaz E, Cetinkaya B, Caglar N. Assessment of the quality of life of mothers of children with cerebral palsy (primary caregivers). Neurorehabil Neural Repair. 2005;19(3):232-237.
31. Byrne M, Hurley D, Daly L, Cunningham C. Health status of caregivers of children with cerebral palsy. Child Care Health Dev. 2010;36(5):696-702.
32. Davis E, Shelly A, Waters E, et al. The impact of caring for a child with cerebral palsy: quality of life for mothers and fathers. Child Care Health Dev. 2010;36(1):63-73.
33. Farajzadeh A, Maroufizadeh S, Amini M. Factors associated with quality of life among mothers of children with cerebral palsy. Int J Nurs Pract. 2020;26(3):e12811.
34. Battié MC, Cherkin DC, Dunn R, Ciol MA, Wheeler KJ. Managing low back pain: attitudes and treatment preferences of physical therapists. Phys Ther. 1994;74(3):219-226.
35. Taimela S, Härkäpää K. Strength, mobility, their changes, and pain reduction in active functional restoration for chronic low back disorders. Clin Spine Surg. 1996;9(4):306-312.