Effectiveness of a Nursing-Led Self-Management Intervention on Self-Care Skills and Quality of Life in Adults with Cerebral Palsy at a Public Level Hospital

Abstract

Background/Objectives: Adults with cerebral palsy (CP) experience pain, declining function and limited access to adult-oriented services, yet few self-management programs have been evaluated in this population, and none, to the best of current knowledge, in Pakistan. This study evaluated the effect of a nursing-led self-management intervention on self-care skills, self-management practices and quality of life (QoL) in adults with CP attending a public tertiary-care hospital. Methods: A quasi-experimental, one-group pretest–posttest study was conducted in the Department of Physical Medicine and Rehabilitation, Mayo Hospital, Lahore. The sample size, calculated for a paired-samples t test (two-sided α = 0.05, power 80%, dz = 0.47), required a minimum of 38 participants; allowing for 15% attrition, 45 adults aged ≥18 years with confirmed CP were recruited consecutively. A complementary pre–post survey of 80 nurses was also conducted. In addition to routine rehabilitation, participants received individualized nursing education and skills reinforcement comprising demonstration, teach-back, action planning and caregiver involvement. Self-care skills, self-management practices, QoL and perception of nursing care were assessed using a structured five-point Likert-type questionnaire. Pre–post differences were analyzed using paired t tests (or Wilcoxon signed-rank tests where assumptions were violated) and reported with 95% confidence intervals and Cohen’s dz. Results: All 45 participants completed both assessments. Self-care skills increased from 39.3 to 48.2 (mean difference 8.9; 95% CI 7.3–10.4; dz = 1.73), self-management practices from 25.1 to 32.7 (dz = 2.03) and QoL from 27.9 to 34.0 (dz = 1.51); all p < 0.001. Post-intervention QoL was significantly associated with baseline QoL (β = 0.67) and post-intervention self-care skills (β = 0.27). Among the 80 nurses, assessment and care practice scores improved and perceived barriers decreased significantly (all p < 0.001). Conclusions: The nursing-led self-management intervention was associated with substantial improvements in self-care skills, self-management practices and QoL among adults with CP. In the absence of a control group, these findings should be confirmed through randomized controlled trials with longer follow-up.