Factors affecting tunisian’s caregivers compliance to home:Exercise programs designed for their children with cerebral palsy

Introduction: Cerebral palsy (CP) is the leading cause of motor disability in children, often accompanied by cognitive and behavioral impairments that reduce quality of life. In Tunisia, early intervention is challenged by limited resources and fragmented care. Home Exercise Programs, implemented by caregivers, are crucial for improving function, but their success largely depends on caregiver adherence—a poorly studied factor in this context. Objectives: This study aimed to assess the adherence levels of Tunisian caregivers to HEPs for children with CP and to identify the key determinants influencing this adherence. Methods: A cross-sectional study was conducted from September to December 2024 at the Department of Physical Medicine and Rehabilitation, Sahloul University Hospital. Ninety three caregivers were interviewed by phone using a structured questionnaire combining sociodemographic, clinical, and contextual data. Four validated tools were included: IMI, SF 12, HADS, and MCSI. Adherence was measured using a composite score based on frequency, consistency, and quality of exercise implementation. Results: Only 26.88% of caregivers showed good adherence. Factors associated with better adherence included higher education, moderate SES, school attendance, fewer child impairments, stronger family support, lower anxiety, integration into routines, clear professional communication, and digital tool use. Conclusion: Caregiver adherence to HEPs is shaped by interconnected clinical, psychological, and contextual factors. Supporting caregiver well-being, adapting exercises to daily routines, enhancing professional communication, and promoting low-tech digital tools are key to improving adherence in low-resource settings like Tunisia.