Association Between Physical, Social, and Attitudinal Environments and Quality of Life in Adolescents With Cerebral Palsy: Insights From the SPARCLE Cross-Sectional Study

Abstract

Objective

To 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) and to examine the magnitude of effects against personal and family factors.

Design

Cross-sectional study.

Setting

Nine administrative regions in Denmark, France, Germany, Ireland, Italy, Sweden, and the United Kingdom.

Participants

Adolescents with confirmed diagnosis of CP, born 1991-1997, aged 13-17 years at the time of data collection. Nonwalkers (GMFCS IV-V) were overrepresented.

Intervention

Not applicable.

Main Outcome Measures

Parent 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).

Results

Six hundred sixty-four adolescents with CP participated in the study: 57.2% boys, mean age 15.1 years, 45.1% with GMFCS IV-V, and 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, a supportive attitudinal environment from peers and psychological well-being, a supportive attitudinal environment from peers and teachers and satisfaction with school life, and 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 with the adequacy of the environment.

Conclusions

The adequacy of the environment relates to adolescent QoL. Personal and family factors correlated slightly higher with QoL than with environmental factors.