1. OCCUPATIONAL THERAPY PROGRAM, DEPARTMENT OF KINESIOLOGY, UNIVERSITY OF WISCONSIN-MADISON
Changes in Quality of Life for Caregivers of Children
with Cerebral Palsy Following ITB Treatment
Brenna Patterson, OTS and Ruth Benedict, DrPH, OTR/L
Acknowledgments
Results
Participants
• Caregivers of children or young adults with CP receiving ITB
treatment
• Recruited from the Spasticity and Movement Disorders Clinic
(SMDC) at the Waisman Center
• Hypothesis 1: N=15; Completed QOL questionnaire at baseline
and 6-months post-ITB implantation
• Hypothesis 2: N=11; Completed the QOL questionnaire at
baseline, 6-, 12-, and 24-months post-ITB implantation
Design & Intervention
• Longitudinal study with repeated measures design was used to
determine change in QOL levels from baseline to 6-months and
24-months following ITB treatment
Measures
• World Health Organization QOL-Bref (WHOQOL-Bref) is a self-
report questionnaire with Physical, Psychological, Social
Relationship, and Environmental QOL domains
Data Analysis
• Repeated Measures ANOVA
• Friedman nonparametric test
• Wilcoxon signed rank test as a post-hoc comparison
Research Design &
Methods
• Cerebral Palsy (CP) is characterized by motor impairment, often
driven by spasticity and dystonia1, 3
• An estimated 3.1 /1000 children are affected by CP and many
are dependent on caregivers3
• Intrathecal Baclofen (ITB), continuous infusion muscle relaxant,
is used to reduce spasticity for the child and may decrease
caregiver burden6
• Caregivers of children with CP are known to experience
symptoms of stress and decreased Quality of Life (QOL)1,2,4,5
• Effects of ITB treatment on caregiving, however, are not well
known
Purpose
• To determine the effects of ITB treatment among children with
cerebral palsy on their caregivers' quality of life.
Hypotheses
• #1: Caregiver physical, psychological, social relationship, and
environmental QOL will improve from baseline to 6 months
post-ITB intervention.
• #2: Increases in caregiver physical, psychological, social
relationship, and environmental QOL will be sustained or
further improved at 24-months post-ITB intervention.
Introduction
• ITB treatment did not significantly improve
caregiver physical, psychological, social
relationship, or environmental QOL over time
• In some cases, ITB appears to have made a
difference for individuals, but variability was too
great to find an effect for the group as a whole
• Caregiver quality of life is appears to be relatively
stable through the changes that occur in child
status following ITB treatment
• Global QOL measures may not be sensitive
enough to detect changes that occur in caregiving
for a child with CP
Conclusions
• When caregivers are considering ITB pump treatment,
understanding the effects on both their child and
themselves is an important consideration in order to
ensure continuity of care
• A caregiver of a child with GMFCS classification of III-V who
receives ITB may have stable, or similar, QOL levels as pre-
ITB implantation
• Therapists should inform families that outcomes of ITB for
caregiver QOL can be quite varied, and for most does not
change significantly.
Implications for Practice
No Mean Change Observed in Quality of Life
• Hypothesis 1 was not supported; no significant increase in physical, psychological,
social relationship, or environmental QOL observed from pre- to 6-months post-ITB
• The Friedman nonparametric test suggested a significant change in overall QOL from
baseline to 6-months ( χ2(7) = 15.729, p = 0.028), however, post-hoc comparison was
not significant
• Hypothesis 2 was not supported; there was no significant increase in mean QOL
observed from pre- to 24-months post-ITB treatment
References
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Physical QOL
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Psychological QOL
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Social Relationship QOL
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We would like to thank the Cerebral Palsy International
Research Foundation, the Pedal-with-Pete Foundation, the
Virginia Horne Henry Fund, the Wisconsin Alumni Research
Foundation, and the Spasticity and Movement Disorders
Clinic at the Waisman Center at the University of Wisconsin-
Madison. Thank you to my research mentor, Dr. Ruth
Benedict, for the support and guidance. I’d also like to thank
Dr. Travers, my research team, classmates, and family and
friends for their support of this project.
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Baseline to 6 Months
Baseline to 24 Months
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Baseline 24 Month
Physical QOL
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Psychological QOL
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Baseline 24 Months
Social Relationship QOL
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Environmental QOL