Family-centered physiotherapy services for children with cerebral palsy in Syria: an observational study

BACKGROUND: Children with cerebral palsy (CP) require long-term physiotherapy, and optimal pediatric rehabilitation should follow a family-centered framework that emphasizes respectful communication, shared decision-making, and comprehensive information. In Syria, healthcare disruptions and resource limitations may affect these elements, yet little is known about mothers' perceptions of family-centered physiotherapy services. This study assessed Syrian mothers' perceptions of physiotherapy services for children with CP and examined whether these perceptions varied by selected maternal, child, and service-related characteristics. METHODS: A cross-sectional survey was conducted at the Syrian Cerebral Palsy Center. Mothers of children aged 1-18 years who had received at least 3 months of physiotherapy were invited to participate, and 93 mothers were included in the final analysis. The Arabic version of the Measure of Processes of Care-20 (MPOC-20) was used to evaluate family-centered service behaviours on a 7-point Likert scale. Data were analyzed using SPSS version 23 with descriptive statistics, independent-samples t-tests, and one-way ANOVA. Statistical significance was set at p < 0.05. RESULTS: Overall, mothers rated Coordinated and Comprehensive Care most highly, whereas Providing General Information received the lowest ratings. Lower scores were also observed in domains related to information-sharing and partnership, indicating unmet needs in communication and shared decision-making. Mothers living in rural areas reported significantly higher scores for Providing General Information than mothers living in urban areas. Maternal age was significantly associated with Providing Specific Information, with younger mothers reporting lower scores than mothers aged 35-45 years. No significant differences were observed across child age groups. Treatment intensity was significantly associated with several MPOC-20 domains: mothers of children receiving physiotherapy more than twice per week reported higher scores in Enabling and Partnership, Coordinated and Comprehensive Care, and Respectful and Supportive Care, whereas Providing General Information was lower in this group. CONCLUSIONS: Syrian mothers generally perceived physiotherapy services positively in domains related to coordination and supportive care; however, important deficiencies were identified in the provision of general and child-specific information and in parent-therapist partnership. Differences by maternal age, residence, and treatment intensity suggest that family-centered care may vary across subgroups. Efforts to strengthen caregiver education, structured information-sharing, and collaborative care planning may improve the family-centeredness of physiotherapy services for children with CP in this setting.