Prevalence and patterns of musculoskeletal deformities in children with cerebral palsy attending Mulago national referral hospital,Kampala,Uganda

Abstract

Introduction: Cerebral palsy (CP) is a major cause of motor disability among children. The prevalence of CP in Uganda is estimated to be 2.9 per 1000 children while the burden of musculoskeletal deformities (MSDs) among children with CP in one district in eastern Uganda was estimated at 6.9%. To improve the management and functional outcomes of children with CP-associated MSDs, there is a need for an extensive study on their prevalence, patterns, and associated factors which is currently lacking in our setting.Study Objective: To determine the prevalence of MSD, and factors associated with the development of MSD, and describe the patterns of MSD in children with CP at Mulago National Referral Hospital (MNRH). Methodology: This was a cross-sectional study that was carried out at MNRH among children with CP at the pediatric neurology clinic and CP physiotherapy clinic from March 2023 to May 2023. Eligible children with CP were consecutively sampled and enrolled in the study. A pre-tested questionnaire was used to capture data on social demographics, relevant history, and subsequent musculoskeletal and functional examination findings. Continuous data was summarized as mean and standard deviation while categorical data was summarized as frequencies and proportions. Bivariate and multivariate analysis was done to assess for associations. A p-value ≤ 0.05 was considered statistically significant. Results: A total of 171 participants were assessed, 855 body segments (upper limb, lower limbs and spine) were examined and 7,188 measurements were done. The mean age of the participants was 4.3 years (SD±3) and two-thirds 115 (67.3%) were males. The prevalence of MSD was 28.1%, 95% CI (21.8-35.3), approximately one-third (27.1%) of children with CP had mixed MSD. Two-thirds (66.7%) of these children had bilateral spastic CP. In the bivariate analysis, development of musculoskeletal deformities was significantly associated with severe gross motor function (GMF) impairment compared to mild-moderate GMF impairment (41.5% vs.58.5%, crude OR=2.6, p-value=0.006), severe MA (manual ability) impairment compared to mild-moderate MA impairment (53.2% vs. 46.8%, crude OR=2.2, p-value=0.029) and increased muscle tone/spasticity according to the modified Ashworth scale compared to no muscle tone or no spasticity (50.9% vs.49.1%, crude OR=6.8, p-value=<0.001). In the multivariate analysis, the development of musculoskeletal deformities was significantly associated with severe GMF impairment compared to mild-moderate GMF (adjusted OR = 2.8, p-value =0.043 (95%CI: 1.03-7.67) and increased muscle tone /spasticity compared to no spasticity (adjusted OR= 4.7, p-value =<0.021, (95%CI: 1.26-17.57). Conclusion: Musculoskeletal deformities are highly prevalent amongst children with cerebral palsy especially those with an increase in muscle tone/spasticity and severe GMF impairment, More than 1 in 4 of children with MSD have mixed contractures. These challenges call for a multidisciplinary management approach to map out the best treatment and preventative options to maximize these children’s functional outcomes in MNRH.