Determinants of Hospital-Based Health Service Utilization in Cerebral Palsy: a Systematic Review

Arch Phys Med Rehabil. 2022 Aug;103(8):1628-1637. doi: 10.1016/j.apmr.2021.12.003. Epub 2021 Dec 28.


Objective: To systematically review and synthesize evidence of determinants associated with hospital-based health service utilization among individuals with cerebral palsy (CP).

Data sources: Electronic databases MEDLINE, Embase, APA Psycinfo were searched from January 2000 to April 2020.

Study selection: Observational studies were included that described people with CP, reported quantitative measures of hospital-based health service utilization (inpatient, outpatient, emergency department), and based in high-income countries. We excluded studies that included only subsets of people with CP, or those that only reported therapy service utilization.

Data extraction: After initial screen, 2 reviewers reviewed full texts for inclusion and performed data extraction and risk of bias assessment using the Newcastle-Ottawa scale. Determinants of health service utilization were identified and categorized using the Andersen behavioral model.

Data synthesis: Seventeen studies met inclusion criteria. Study quality was high. Twenty-six determinants were reported across 8 Andersen model characteristics. Individual predisposing factors such as sex showed no difference in health service utilization; inpatient admissions decreased with increasing age during childhood and was lower in adults. Increased health service utilization was associated with "individual need" including severe gross motor disability, epilepsy, developmental/ intellectual disability and gastrostomy-use across inpatient, outpatient and emergency department settings. There was little information reported on socio-demographic and health system contextual determinants.

Conclusions: CP health service utilization is associated with age, severity and comorbidities. Improved understanding of determinants of health service utilization can support health service access for people with CP.

Keywords: Cerebral palsy; Health services; Health services accessibility; Rehabilitation.

Publication types

  • Review
  • Systematic Review
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Cerebral Palsy*
  • Disabled Persons*
  • Hospitalization
  • Hospitals
  • Humans
  • Motor Disorders*