Associations between Physical, Social and Attitudinal Environments and Quality of Life in Adolescents with Cerebral Palsy: Insights from the SPARCLE cross-sectional study

Abstract

ObjectiveTo assess the correlation between the adequacy of the environment (the quantity of met individual environmental needs) and quality of life (QoL) in adolescents with cerebral palsy (CP); to examine the magnitude of effects against personal and family factors. DesignCross-sectional study. SettingNine administrative regions in Denmark, France, Germany, Ireland, Italy, Sweden and the United Kingdom. ParticipantsAdolescents with confirmed diagnosis of CP, born 1991-1997, aged 13-17 years at time of data collection. Non-walkers (GMFCS IV-V) were over-represented. InterventionNot applicable. Main Outcome MeasuresParent reports of the adequacy of the environment (using the European Child Environment Questionnaire) and their adolescent's QoL (using the Kidscreen-52 generic instrument, focusing on 4 domains: physical well-being, psychological well-being, autonomy and school environment). Results664 adolescents with CP participated in the study: 57.2% boys, mean age 15.1 years, 45.1% with GMFCS IV-V, 45.7% attending mainstream schools. The adequacy of the environment was positively associated with QoL. More specifically, once adjusted for personal and family factors, positive correlations were observed between the adequacy of social support in the community and physical well-being, between a supportive attitudinal environment from peers and psychological well-being, between a supportive attitudinal environment from peers and teachers and satisfaction with school life, and between the adequacy of physical environment at home and QoL in the autonomy domain, the latter only in the subgroup of those with GMFCS IV-V. Among personal and family factors, impairments, pain, behavioral problems or parenting stress correlated slightly higher with QoL than the adequacy of the environment. ConclusionThe adequacy of the environment relates to adolescent QoL. Personal and family factors correlated slightly higher with QoL than environmental factors.