Rehabilitation of cerebral palsy during 2010-2022 in Estonia

Abstract

Aim: The aim of this study was to investigate the use of rehabilitation services by children with cerebral palsy (CP) within one year of diagnosis, focusing on physiotherapy (PT), speech therapy (ST), psychological therapy (PS) and occupational therapy (OT) use, temporal trends and the cost of treatment. Methods: This population-based retrospective cohort study used population-wide health data acquired from the Estonian Health Insurance Fund. The study included patients aged 2-6 primarily diagnosed with CP between January 2010 and December 2021. Results: The study included 573 patients. The median age was 2 (lower-upper quartile: 2-3) years. A total of 79% of patients received rehabilitation by a median of 10 (5-25) hours. The proportion of patients who received different rehabilitative therapies ranged from 28% to 77%. The median hours of therapies received ranged from 5 (5-8) to 10 (5-30) hours. The median start day of therapies ranged from 17th (1-58) to 65th (7-196) day and the median end day of therapies ranged from 202nd (110-273) to 273rd day (194-325) day after the diagnosis. A total of 123 patients (21%) received care in an inpatient and 221 patients (39%) in an outpatient rehabilitation setting. There were temporal changes in the median end day of PT which ended later. Of the total combined cost of treatment for these patients 39.1% was spent on rehabilitation. The median cost of treatment for one patient was 1050.6 (396.2-2973) €. The average cost of treatment per patient increased during the study period. Conclusions: The study identified shortcomings in the rehabilitation of children with CP in Estonia. There was a considerable proportion of patients who did not receive rehabilitation and the amount of therapies received was relatively low. After the diagnosis rehabilitation started relatively late. There were no temporal changes in the rehabilitation use during the study period, apart from PT which ended later. Compared to other studies the expenditure on medical treatments was lower. Keywords: