title: Transparency and tuning of rehabilitation care for children with cerebral palsy: a multiple case study in five children with complex needs.
abstract: OBJECTIVE
  Generally, there is a lack of knowledge whether and how parent-identified problems, treatment goals and treatment activities are tuned in the treatment of children with cerebral palsy. This study aimed to observe whether parent-identified problems and treatment goals were documented ('transparency' of the rehabilitation process), and to examine the relationship ('tuning') of parent-identified problems to treatment goals and to treatment activities of children with cerebral palsy in pediatric rehabilitation in the Netherlands.
  
  
  METHODS
  Five school-aged subjects with cerebral palsy were observed in detail during physical, occupational, and speech therapy, and their written reports were studied. Parent-identified problems, treatment goals, and treatment activities were linked to the ICF components, domains and categories and the amount of agreement was determined by code comparison.
  
  
  RESULTS
  Only two children with a total of six parent-identified problems could be documented. Forty-five treatment goals were identified and 72 treatment activities were observed. The analyses indicated some tuning of parent-identified problems, goals and activities in all subjects, but only four of the treatment activities were perfectly tuned to treatment goals as well as to parent-identified problems.
  
  
  CONCLUSIONS
  We conclude that transparency and tuning of the pediatric treatment process described in the present study could be improved substantially. Several suggestions for improving the transparency and tuning of the treatment process are discussed.
authors.affiliation: Langeveld Institute for the Study of Education and Development in Childhood and Adolescence, Utrecht University, TC Utrecht, the Netherlands.
authors.forename: R C
authors.initials: RC
authors.lastname: Siebes
authors.forename: M
authors.initials: M
authors.lastname: Ketelaar
authors.forename: J W
authors.initials: JW
authors.lastname: Gorter
authors.forename: L
authors.initials: L
authors.lastname: Wijnroks
authors.forename: A C E
authors.initials: AC
authors.lastname: De Blécourt
authors.forename: H A
authors.initials: HA
authors.lastname: Reinders-Messelink
authors.forename: P E M
authors.initials: PE
authors.lastname: Van Schie
authors.forename: A
authors.initials: A
authors.lastname: Vermeer
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003256:Community Participation; D003191:Comprehensive Health Care; D006040:Goals; D006801:Humans; D020380:Needs Assessment; D009788:Occupational Therapy; D017063:Outcome Assessment, Health Care; D010290:Parents; D010347:Patient Care Planning; D010348:Patient Care Team; D026741:Physical Therapy Modalities; D011368:Professional-Family Relations; D013070:Speech Therapy; D016896:Treatment Outcome