The effect of motor and functional independence of disabled children on musculoskeletal disorders in pediatric caregivers: A cross-sectional study

Care burden and musculoskeletal problems of caregivers of disabled children



Caregivers, Caregiver burden, Disabled child, Musculoskeletal pain


Background/Aim: There are conflicting results regarding the effect of motor and functional independence levels of disabled children on the burden of care. In addition, this burden, as well as musculoskeletal problems of pediatric caregivers, has not been examined in detail. The aim of this study is to examine the effects of motor and functional levels of the disabled child.

Methods: The study was planned as a single-blind, multicenter, cross-sectional study. Children between ages 1-12 with physical disabilities from various problems, and 65 caregivers over the age of 18 who cared for them for at least 6 months, were included. Caregivers were divided into two groups, as per the BAKAS Caregiver Impact Scale score as high care burden (n = 33) or low care burden (n = 32). The motor level of the disabled child was determined by the Gross Motor Function Classification System, and the functional level of the Pediatric Functional Independence Measurement. The Nordic Musculoskeletal Questionnaire was used to evaluate musculoskeletal problems in caregivers.

Results: There was no significant difference between the Gross Motor Function Classification System levels of children in groups (P > 0.05). The Pediatric Functional Independence Measurement scores of children in the high care burden group were significantly lower than those in the low care burden group (P < 0.05). According to a comparison of pain in parts of the body for 12 months, using the Nordic Musculoskeletal Questionnaire, the percentage of pain in the neck, shoulder, back, elbow, hand, hip, and foot regions of caregivers was significantly higher in the group with a high care burden (P < 0.05). There was no significant difference between percent of low back and knee pain in the last 12 months (P > 0.05). A weak positive correlation was found between the BAKAS Caregiver Impact scores and the Pediatric Functional Independence Measurement of children with disabilities (r = 0.26; P = 0.03).

Conclusion: The lower functional level of the disabled child may cause an increase in caregiver burden of both the caregivers and musculoskeletal disorders.


Download data is not yet available.


Girgin BA, Balci S. Fiziksel engelli çocuk ve ailesinin evde bakım gereksinimi. Gümüşhane Üniversitesi Sağlık Bilimleri Dergisi. 2015;4(2):305-17.

Dias BC, Ichisato SM, Marchetti MA, Neves ET, Higarashi IH, Marcon SS. Challenges of family caregivers of children with special needs of multiple, complex and continuing care at home. Escola Anna Nery. 2019;23(1). DOI:

World Health Organization & World Bank. (‎2011)‎. World report on disability 2011.

Hogan DP, Msall ME, Rogers ML, Avery RC. Improved disability population estimates of functional limitation among American children aged 5–17. Maternal child health journal. 1997;1(4):203-16. DOI:

Sen E, Yurtsever S. Difficulties experienced by families with disabled children. Journal for Specialists in Pediatric Nursing. 2007;12(4):238-52. DOI:

Kearney PM, Griffin T. Between joy and sorrow: Being a parent of a child with developmental disability. Journal of advanced nursing. 2001;34(5):582-92. DOI:

Etters L, Goodall D, Harrison BE. Caregiver burden among dementia patient caregivers: a review of the literature. Journal of the American Academy of Nurse Practitioners. 2008;20(8):423-8. DOI:

Raina P, O'Donnell M, Rosenbaum P, Brehaut J, Walter SD, Russell D, et al. The health and well-being of caregivers of children with cerebral palsy. Pediatrics. 2005;115(6):e626-e36. DOI:

Lee MH, Park C, Matthews AK, Hsieh K. Differences in physical health, and health behaviors between family caregivers of children with and without disabilities. Disability health journal. 2017;10(4):565-70. DOI:

Albayrak I, Biber A, Çalışkan A, Levendoglu F. Assessment of pain, care burden, depression level, sleep quality, fatigue and quality of life in the mothers of children with cerebral palsy. Journal of Child Health Care. 2019;23(3):483-94. DOI:

Sanford JT, Johnson AD, Townsend-Rocchiccioli J. The health status of rural caregivers. Journal of Gerontological Nursing. 2005;31(4):25-31. DOI:

Suriñach L. Quality of life, time commitment and burden perceived by the principal informal caregiver of Alzheimer's patients. Atención Primaria. 2004;34(4):170-7. DOI:

Balak ÖN. Serebral Palsili Çocukların Fonksiyonel Seviyelerinin Bakım Verenlerin Psikososyal Durumlarına Etkilerinin İncelenmesi. Doktora Tezi: Ankara Yıldırım Beyazıt Üniversitesi Sağlık Bilimleri Enstitüsü; 2019.

Snead K, Ackerson J, Bailey K, Schmitt MM, Madan-Swain A, Martin RC. Taking charge of epilepsy: the development of a structured psychoeducational group intervention for adolescents with epilepsy and their parents. Epilepsy Behavior. 2004;5(4):547-56. DOI:

Boyer F, Drame M, Morrone I, Novella J-L. Factors relating to carer burden for families of persons with muscular dystrophy. Journal of Rehabilitation Medicine. 2006;38(5):309-15. DOI:

Bakas T, Champion V, Perkins SM, Farran CJ, Williams LS. Psychometric testing of the revised 15-item Bakas Caregiving Outcomes Scale. Nursing research. 2006;55(5):346-55. DOI:

Can T. Bakas Caregiving Outcomes Scale'in (Bakas Bakım Verme Etki Ölçeği) Türkçe'ye uyarlanması, geçerlilik ve güvenirliliği. Doktora Tezi:Pamukkale Üniversitesi; 2010.

Palisano R, Rosenbaum P, Walter S, Russell D, Wood E, Galuppi B. Development and reliability of a system to classify gross motor function in children with cerebral palsy. Developmental medicine and child neurology. 1997;39(4):214-23. DOI:

El O, Baydar M, Berk H, Peker O, Koşay C, Demiral Y. Interobserver reliability of the Turkish version of the expanded and revised gross motor function classification system. Disability and rehabilitation. 2012;34(12):1030-3. DOI:

Msall ME, Ottenbacher K, Duffy L, Lyon N, Heyer N, Phillips L, et al. Reliability And Validity Of The Weefim In Children With Neurodevelopmental Disabilities. Pediatric Research. 1996;39(4):378. DOI:

Tur BS, Küçükdeveci AA, Kutlay S, Yavuzer G, Elhan AH, Tennant A. Psychometric properties of the WeeFIM in children with cerebral palsy in Turkey. Developmental medicine and child neurology. 2009;51(9):732-8. DOI:

Kahraman T, Genç A, Göz E. The Nordic Musculoskeletal Questionnaire: cross-cultural adaptation into Turkish assessing its psychometric properties. Disability rehabilitation. 2016;38(21):2153-60. DOI:

Tong HC, Kandala G, Haig AJ, Nelson VS, Yamakawa KSJ, Shin KY. Physical Functioning in Female Caregivers of Children With Physical Disabilities Compared With Female Caregivers of Children With a Chronic Medical Condition. Archives of Pediatrics & Adolescent Medicine. 2002;156(11):1138-42. DOI:

Rigby H, Gubitz G, Eskes G, Reidy Y, Christian C, Grover V, et al. Caring for stroke survivors: baseline and 1-year determinants of caregiver burden. International Journal of Stroke. 2009;4(3):152-8. DOI:

Lerthattasilp T, Charernboon T, Chunsuwan I, Siriumpunkul P. Depression and burden among caregivers of children with autistic spectrum disorder. J Med Assoc Thai. 2015;98(Suppl 2):S45-52.

Denno MS, Gillard PJ, Graham GD, DiBonaventura MD, Goren A, Varon SF, et al. Anxiety and depression associated with caregiver burden in caregivers of stroke survivors with spasticity. Archives of physical medicine rehabilitation. 2013;94(9):1731-6. DOI:

Alnazly EK, Abojedi A. Psychological distress and perceived burden in caregivers of persons with autism spectrum disorder. Perspectives in psychiatric care. 2019;55(3):501-8. DOI:

Özden F, Arık A, Özkeskin M, Bakırhan S. The Relationship Between Caregiver Workload and Stress Levels with Clinical Symptom Severity in Cerebral Palsy. International Journal of Disabilities Sports and Health Sciences. 2021;4(1):38-44. DOI:

Kavlak E, Kara G, Tekin F, Altuğ F, Ök N, Şenol H. Stress and depression levels of mothers who give care to children with cerebral palsy and mental retardation: a comparison study. Pamukkale Medical Journal. 2018;11(1):25–31. DOI:

Labaj A, Diesbourg T, Dumas G, Plamondon A, Mercheri H, Larue C. Posture and lifting exposures for daycare workers. International Journal of Industrial Ergonomics. 2016;54:83-92. DOI:

Labaj A, Diesbourg T, Dumas G, Plamondon A, Mecheri H. Comparison of lifting and bending demands of the various tasks performed by daycare workers. International Journal of Industrial Ergonomics. 2019;69:96-103. DOI:

World Medical Association Declaration of Helsinki. Ethical principles for medical research involving human subjects. Bulletin of the World Health Organization. 2001;79(4):373-4.

Habib MM, Khanam F, Hafez MA, Islam MS. Prevalence of low back pain (LBP) and its affect on everyday life among female caregivers of children with cerebral palsy (CP). Indian Journal of Physiotherapy Occupational Therapy. 2014;8(1):176. DOI:






Research Article

How to Cite

Candırı B, Ozaltın GE, Karaoba DD, Talu B. The effect of motor and functional independence of disabled children on musculoskeletal disorders in pediatric caregivers: A cross-sectional study: Care burden and musculoskeletal problems of caregivers of disabled children. J Surg Med [Internet]. 2022 Jun. 30 [cited 2024 Jul. 15];6(6):615-8. Available from: