Participation in activities of daily living after the Akwenda Intervention Program for children and young people with cerebral palsy in Uganda: A cluster-randomized trial.

Abstract

Aim: To evaluate the efficacy of the Akwenda Intervention Program on participation attendance and involvement of children and young people with cerebral palsy (CP) in rural Uganda.

Method: This was a cluster-randomized, controlled, single-blind, interventional study of 100 participants with CP (aged 2-23 years; 48 females; allocated to the intervention or waiting list control group). Picture My Participation interviews assessed participation attendance and involvement in 20 home and community activities. Group differences were analysed using a Mann-Whitney U test and effect sizes were calculated. Change in attendance was related to age and functional level, and to improvements in child functioning, which was published in a previous report from the same study.

Results: Attendance increased more in the intervention compared to the control group (p < 0.001; r = 0.48; z = -4.62) and across both Gross Motor Function Classification System (GMFCS) subgroups and two age subgroups (2-5 years and 13-23 years). Positive correlations were found between increases in attendance and higher GMFCS levels (ρ = 0.25, p = 0.03) and with all three caregiver assistance scales and the social function child scale of the Ugandan version of the Pediatric Evaluation of Disability Inventory. The intervention group had larger increases in involvement than the controls (p < 0.001; r = 0.41; z = -3.95), although positive changes were seen in both groups.

Interpretation: The Akwenda Intervention Program, which intervened at the level of the child, family, and community, was successful in enhancing participation for children with CP.