Correlation of Gross Motor Functional Classification System (GMFCS) Level and Encountering Barriers to Access Healthcare

Research Objectives: To evaluate the relationship of cerebral palsy (CP) motor severity, as measured by the Gross Motor Functional Classification System (GMFCS), on healthcare access

Design: A prospective, cross-sectional cohort study

Setting: Accredited clinical motion analysis laboratory at a regional children’s hospital

Participants: 72 ambulatory, adult patients with CP who had previously received care at the children’s hospital participated. Ages ranged from 18-48 years (mean = 24.5).

Interventions: Not Applicable

Main Outcome Measures: Patient interviews evaluated access to healthcare services and insurance status. A physical therapist determined each participant’s GMFCS level, and higher GMFCS levels correspond with higher levels of mobility impairment. Fisher’s exact tests were used to identify associations between GMFCS level and access to care.

Results: GMFCS level varied with 28 GMFCS 1 patients, 29 GMFCS 2 patients, 13 GMFCS 3 patients, and 2 GMFCS 4 patients. With increasing GMFCS level, patients were more likely to report they encountered barriers accessing healthcare (p = 0.025). Patients with a higher GMFCS level were also more likely to report that their health insurance did not offer benefits or cover services that met their needs (p=0.018). Similarly, the patients with a higher GMFCS level were more likely to report that their health insurance did not allow them to see the healthcare providers they need, with a correlation that approached statistical significance (p=0.084). In this patient population, patients categorized as GMFCS 3 or 4 were also more likely to have Medicaid or Medicare than those categorized as GMFCS 1 or 2 (p=0.018).

Conclusions: This data suggests that patients with higher GMFCS levels have less access to adequate healthcare services. Further research is warranted to identify specific barriers to healthcare access, better understand the needs of this unique population, and ensure healthcare systems are adequately providing care for patients with more severe CP.

Author(s) Disclosures: There are no conflicts of interest.