The effects of perceived therapist guidance and advice on adherence to home-based exercise programs in mothers of children with cerebral palsy in Rwanda

The alarming prevalence of non- or poor adherence to Home-based Exercise Programs (34–79.2 %, HEP) in parents of Children with Cerebral Palsy (C-CP) is a global health concern due to its detrimental effect on treatment outcomes. To examine whether Perceived Therapist Guidance and Advice (TGA) or social support moderate the effects of PTSD, depression, parenting stress, low self-efficacy, the burden of care, or the effects of perceived family stigma on adherence to HEP. A stratified random sample of 301 mothers of C-CP attending the largest seven physical rehabilitation hospitals or centres in Rwanda participated in this study. Data were collected using validated measures of all investigated constructs. We conducted hierarchical multiple linear regressions, and the nature of moderation was scrutinized using the process macro 4.1 model number 1 within SPSS version 28. The prevalence of adherence to HEP in the present sample was 32.9 %. Mothers' TGA and social support were positively associated with adherence to HEP; whereas mothers' stressors, including PTSD, parenting stress, depression symptoms, low self-efficacy, burden of care, and family stigma were negatively associated with adherence to HEP. In addition, TGA significantly moderated the associations of the different mothers' stressors with adherence to HEP, leading to increased HEP adherence for mothers with high stressor levels. Social support did not moderate any of these associations. Our respondents often reported poor family and friends’ social support due to family stigma-related to caring C-CP. Therapists play a vital role by providing education, support, and counselling to parents, emphasizing the importance of adherence, and addressing any stigma-related concerns, especially for mothers who experience high levels of stress. Therapists should be aware that mothers of C-CP frequently relied solely on their support to improve adherence to HEP. What does this study add to the literature? According to the recent review of the factors of the adherence to HEP among parents of C-CP, there are no prior available data in Rwanda and in Africa in general. This study for the first time demonstrates that:•The prevalence of adherence to HEP in mothers of C-CP was 32.9 % in Rwanda.•Mothers' PTSD, depression symptoms, parenting stress, caregiver burden, and perceived family stigma were moderately and negatively associated with adherence to HEP.•Therapist guidance and advice, and social support were moderately