Factors Contributing to the Default in Neuro-Rehabilitation Programmes for Children with Chronic Neuro-Disabilities in the Largest Tertiary Care Hospital for Children in Sri Lanka

Abstract

Background: Neurorehabilitation is essential for optimising functional independence in children with chronic neurodisabilities. However, clinic default remains a significant barrier to achieving long-term health outcomes, particularly in resource-limited settings like Sri Lanka.
Objective: This study aimed to identify the socio-demographic, clinical, and systemic factors contributing to default in neuro-rehabilitation programs at the Lady Ridgeway Hospital for Children (LRH), Colombo.
Methodology: A descriptive cross-sectional study was conducted among 71 children with chronic neuro-disabilities who had defaulted from therapy services for over one year. Data were collected through interviewer-administered questionnaires covering socio-economic status, clinical condition, and perceived barriers to attendance.
Results: Most children who defaulted had Cerebral Palsy (67.6%), out of which, 68% were mobility dependent. 56.6% of the children who defaulted were from rural areas of the country. The average distance to the clinic was 106 Km. Key reasons for default were multifactorial: 66.2% cited financial problems, 64.8% reported receiving inadequate information on the importance of therapy, and 60.6% turned to alternative or indigenous treatments. Systemic barriers included long waiting times (53.5%) and transport difficulties (47.9%). Interestingly, 84.5% of caregivers had never received a follow-up call after defaulting. 73% of participants highlighted the importance of awareness programmes regarding the disease condition for them. While 61% identified telehealth as an alternative, 59% highlighted the importance of local support groups.
Conclusion: Default is driven by a lack of caregiver awareness and substantial socio-economic burdens. Improving retention requires decentralised care, enhanced caregiver counselling, and the integration of digital health solutions.