Participation in activities of daily living after the Akwenda Intervention Program for children and young people with cerebral palsy in Uganda: A cluster-randomized trial.

The study was conducted in a specific low-resource, rural context in Uganda, so results may not generalize to high-income settings or urban areas with different social structures. The intervention was complex and multi-component, making it impossible to determine which specific element (e.g., assistive devices, caregiver training, or advocacy) was responsible for the improvements. Blinding of assessors may have been compromised due to the geographical clustering of participants and the visible provision of assistive devices. The PMP measure has moderate test-retest reliability, which could affect the precision of the outcome measurements.

The study was funded by several Swedish foundations and research councils (Stiftelsen Frimurare Barnhuset i Stockholm, Vetenskapsrådet, Stiftelsen Sunnerdahls Handikappfond, Stiftelsen Promobilia). No conflicts of interest were declared by the authors.

Do not attribute the improvement in participation to a single component like physical therapy or assistive devices alone. The intervention was a package including caregiver training, community advocacy, and device provision, and the study cannot separate the effect of any one part.