Current Practice of Physiotherapists in the Management of Children With Cerebral Palsy in Benin Country: A Cross‐Sectional Online Survey

ABSTRACT

Background

In low‐ and middle‐income countries, physiotherapy is often the only available rehabilitative care, making the quality of physiotherapy care particularly important. However, how well physiotherapy practice in managing children with cerebral palsy (CP) is supported by evidence‐based guidelines remains unclear. This study aims to describe the current practice of physiotherapists in managing children with CP in Benin, a French‐speaking country in Sub‐Saharan Africa.

Methods

This study used a cross‐sectional online survey, addressed to physiotherapists working in Benin.

Results

A total of 91 physiotherapists participated in the study, 52 of whom worked with children with CP. One‐third of the children with CP treated were under 2 years old. Physiotherapy sessions were delivered twice or thrice weekly and lasted 30–45 min. Most of the physiotherapists working with children with CP (63.5%) received no certified paediatric neurorehabilitation training. About 54% rarely or never used a standardized outcome measure, and 36.5% used such measures occasionally. CP‐specific common classification systems were mostly unused and unknown. The most common intervention modalities were handling techniques (muscle stretching, joint mobilization and Bobath therapy [for movement normalization]), but functional exercises (milestones) were also commonly used. About 58% felt confident in the management of children with CP, and the need for training on modern approaches was stressed.

Conclusion

The management of children with CP in Benin does not meet the standards of evidence‐based practice. The results of this study will help develop strategies to improve the physiotherapy quality of care provided to children with CP in Benin and beyond.

Summary

• The extent to which research‐based guidelines are implemented in physiotherapy practice for children with cerebral palsy remains unclear

• Physiotherapy practices in Benin are currently predominantly passive, with children receiving treatment rather than being actively engaged in.

• The study highlights the need to train physiotherapists in modern, activity‐based approaches for managing children with cerebral palsy, as well as in strategies to engage parents in applying developmental concepts in daily home life.

• It also emphasizes the importance of raising awareness about the early referral of children with cerebral palsy to physiotherapy services.

1. Introduction

Cerebral palsy (CP) is a heterogeneous condition comprising various motor disorders caused by damage to an immature brain and may be associated with comorbidities such as cognitive, communication and behavioural deficits (Graham et al. 2016). CP is the most common cause of paediatric motor disability worldwide with a prevalence ranging from 2 to 4 per 1000 children in Africa, compared to around 1.6 in Northern countries (McIntyre et al. 2022; Sogbossi, Baba‐Tadja, et al. 2024).

Because CP has an impact on many systems and functions, a multidisciplinary approach is recommended for optimal management (Graham et al. 2016). Unfortunately, in low‐ and middle‐income countries such as Sub‐Saharan Africa, physiotherapy is often the only available rehabilitative care (Bernhardt et al. 2020; Donald et al. 2015), making the quality of physiotherapy care particularly important. Based on a recent review of the literature, recommended approaches based on scientific evidence include, among others, goal‐directed therapy, constraint‐induced movement therapy (CIMT) and treadmill training therapies (Novak et al. 2020). Those approaches promote the active involvement of the child and offer activities tailored to its capacities to promote voluntary motor control, with a progressive increase in difficulty or complexity of the tasks. Moreover, most of the therapies address the child's and the family's needs. These interventions promote functional outcomes, particularly activities and participation, as referred to in the framework of the International Classification of Functioning (ICF) (WHO 2001). Furthermore, the literature recommends abandoning passive approaches with insufficient evidence of any effectiveness, such as the traditional passive forms of the Bobath approach, passive mobilization and massage (Novak et al. 2020; te Velde et al. 2022).

The limited available evidence, primarily from Northern countries, presents conflicting results regarding the implementation of research‐based guidelines in the current physiotherapy practices for children with CP. Indeed, some studies, from Canada, Norway and the United Kingdom reported a high use of evidence‐based, child‐active approaches such as functional training based on motor skill‐learning principles (Anaby et al. 2017; Størvold and Jahnsen 2021; Taflampas et al. 2018). However, studies from Spain and the United Kingdom reported greater use of neurodevelopmental approaches (handling techniques aimed at inhibiting abnormal muscle tone and facilitating normal movement patterns) (Marcroft et al. 2019; Sanchez et al. 2022). In Sub‐Saharan Africa, three studies from South Africa and Nigeria (both English‐speaking countries) indicated that motor rehabilitation primarily focused on positioning, stretching, milestone exercises and neurodevelopmental therapies (Maharaj et al. 2021; Bukola et al. 2022; Okenwa and Edeh 2019). These findings suggest that many traditional therapeutic approaches implicitly aim to ‘normalize’ function by targeting the ‘impairment’—as defined at the ICF level of ‘body structure and function’—with the ultimate goal of ‘fixing’ it. In contrast, more contemporary perspectives emphasize supporting ‘activity’ and ‘participation,’ even when tasks are performed differently.

The implementation of evidence‐based interventions in clinical practice should be guided by a prior well‐conducted assessment of children with CP with standardized outcome measures (including patient‐reported and clinician‐observed outcomes) in order to guide decision in which interventions to use and to assess the effectiveness of the interventions in use (Novak et al. 2021). A well‐conducted assessment is also essential for defining functional and targeted rehabilitation goals, as well as for facilitating communication with the child and family to encourage their involvement in clinical decision‐making and the implementation of interventions (Novak et al. 2021). However, the few studies reported high, and low to moderate use of standardized outcome measures by physiotherapists in assessing children with CP, in Northern (Anaby et al. 2017; Marcroft et al. 2019; Saleh et al. 2008) and Sub‐Saharan African countries (Adeniyi et al. 2015; Maharaj et al. 2021; Obembe et al. 2019), respectively.

Given this scarcity of studies documenting the gaps between research and clinical practice in the management of children with CP worldwide and specifically in Sub‐Saharan Africa, this study aimed to describe how children with CP are taken care of by physiotherapists in Benin, a French‐speaking country in Sub‐Saharan Africa. Specifically, the study aimed to describe (i) the frequency and duration of the physiotherapy care session, and the age at which children with CP are received in physiotherapy services; (ii) the use of the standardized outcome measures; and (iii) the interventions commonly used by physiotherapists in treating children with CP.

2. Methods

2.1. Design

We conducted an online survey addressed by email to all physiotherapists working in Benin, using a Google Form link. Benin is a lower‐middle‐income country located in West Sub‐Saharan Africa, with a population of approximately 12 million and a land area of 114 760 km². The questionnaire was introduced with a brief description of the purpose of the study and the time needed to complete.

2.2. Participants

As there is no directory of paediatric physiotherapists in Benin, the survey was addressed to every physiotherapist working in Benin country. Only retired physiotherapists were excluded. Therefore, the estimation of the sample size was based on a previous study reporting a rate of one‐third of Beninese physiotherapists' participation in their online survey (Sawadogo et al. 2024). Similarly, we anticipated a minimum of one‐third of participation in the present online survey. Considering that there were 250 physiotherapists in Benin in 2023 according to the World Physiotherapy report (World Physiotherapy 2023), the sample size was estimated at a minimum of 84 physiotherapists.

The study was conducted according to the principles of the Declaration of Helsinki and approved by the School of Physiotherapy of Benin (No. 334/2024). All physiotherapists participated anonymously and voluntarily. Participants were informed that by completing the survey, they were giving their consent to participate in the study.

2.3. Procedure

2.3.1. Questionnaire Diffusion

The online survey was sent through the social network (WhatsApp) of the Beninese association of physiotherapists ‘Association Béninoise des Kinésithérapeutes Rééducateurs (ABEKIR)’, and directly as emails, social network messages and phone calls to identified physiotherapists. The Google Form link was accessible with either a smartphone or a computer. The participants having accessibility issues with the survey could contact one of the authors. A reminder message was sent every 2 weeks. Data were collected from mid‐December 2023 to mid‐March 2024. A decision was made to end the data collection when no new responses were reported despite subsequent reminder messages.

2.3.2. Development of the Questionnaire

The questionnaire included 21 items and was divided into two sections: a first section on the socio‐demographic and professional characteristics of the participants (Table 1) and a second section on the management of children with CP subdivided into four subsections. The first subsection addressed the training and experiences of the physiotherapists regarding CP, and the modalities of care. The second subsection focused on the use of the standardized outcome measures (Tables 2 and 3), the third was about the therapies used (Table 4), and the last was about the participants' perception of their confidence in providing physiotherapy care for children with CP (see Development of the questionnaire S1 for further details in Supporting Information S1).

TABLE 1.

Characteristics of physiotherapists working with children with Cerebral palsy (n = 52).

Variables	Number	Percentage (%)
Age groups
20–29	22	42.3
30–39	23	44.2
40–49	7	13.5
Gender
Men	22	42.3
Women	30	57.7
Years of professional experience
< 3	14	26.9
3–5	13	25
6–10	10	19.2
11–20	15	28.8
Sector of activity
Public	31	59.6
Private	21	40.4
Main area of intervention
Neurology	10	19.2
Rheumatology	19	36.5
Orthopaedics or Traumatology	6	11.5
Paediatrics	9	17.3
Geriatrics	1	1.9
Uro‐gynaecology	4	7.7
Skin lesions	3	5.8
Number of patients treated per day
1–5	12	23.1
6–10	32	61.5
11–15	5	9.6
> 15	3	5.8
Familiarity with CP terminology
Cerebral palsy	22	30.6
Cerebral motor infirmity	36	50
Cerebral originating motor infirmity	14	19.4
Percentage of children with CP treated per week
1–9	41	78.8
10–29	3	5.8
30–49	3	5.8
50–70	3	5.8
71–100	2	3.8
Years of practice with children with CP
< 3	22	42.3
3–5	12	23.1
6–10	8	15.4
11–20	10	19.2
Special training in paediatrics neurorehabilitation with CP included
University certificate	4	7.7
Training certificate	15	28.8
Training without certificate	5	9.6
Professional internship	8	15.4
None	20	38.5
Age of the majority of children with CP treated
[0–2]	17	32.7
[2–5]	24	46.2
[5–12]	8	15.4
[12–18]	3	5.8
Number of physiotherapy sessions per week
Less than once a week	4	7.7
Once a week	5	9.6
Twice a week	18	34.6
Thrice a week	24	46.2
Four times a week	—	—
Five times a week	1	7.7
Duration of a session of physiotherapy (minutes)
[30–45]	28	53.8
[45–60]	21	40.4
[60–90]	1	1.9
[90–120]	2	3.8

TABLE 2.

Use of selected assessment tools in assessment of children with CP.

Assessment tool	Use, n (%)
	Yes	No	Do not know the tool
GMFCS	15 (28.8)	27 (51.9)	10 (19.2)
MACS	10 (19.2)	30 (57.7)	12 (23.1)
CFCS	6 (11.5)	30 (57.7)	16 (30.8)
EDACS	6 (11.5)	31 (59.6)	15 (28.8)
GMFM	10 (19.2)	33 (63.5)	9 (17.3)
ACTIVLIM‐CP‐WA questionnaire	6 (11.5)	37 (71.1)	9 (17.3)
Goniometry	44 (84.6)	7 (13.5)	1 (1.9)
Manual muscle testing	41 (78.8)	10 (19.2)	1 (1.9)
Visual analogous scale (VAS) or numerical rating scale (NRS)	31 (59.6)	20 (38.5)	1 (1.9)
Tape measure	40 (76.9)	12 (23.1)	—
Ashworth scale (modified)	42 (80.8)	10 (19.2)	—
10 m, or 6‐min walking test	15 (28.8)	35 (67.3)	2 (3.8)
Assessment without a standardized outcome measure (simple description of observation)	36 (69.2)	12 (23.1)	4 (7.7)

Abbreviations: CFCS = Communication Function Classification System; EDACS = Eating and Drinking Ability Classification System; GMFCS = Gross Motor Function Classification System; GMFM = Gross Motor Function Measure; MACS = Manual Ability Classification System.

TABLE 3.

Obstacles to the use of standardized outcome measures in children with CP (n = 33).

Obstacles	Number
Lack of time	22/33
Lack of knowledge	15/33
Non availability of the outcome measures in the service	7/33
The severity level of the cases making the child's collaboration impossible	7/33
Feasibility (complexity of the tool and time taken to administer)	5/33
Lack of socio‐cultural contextualisation of the tools	2/33
Lack of perception of the utility of the outcome measure in guiding the plan of care	2/33
Lack of familiarity with the outcome measures	1/33

TABLE 4.

Use of selected interventions.

Interventions	Use, n (%)
	Yes	No	Do not know the approach
Weight bearing exercises	51 (98.1)	1 (1.9)	—
Rehabilitation ball exercises	49 (94.2)	3 (5.8)	—
Exercises with manual guidance	49 (94.2)	3 (5.8)	—
Exercises on developmental milestones with handling	48 (92.3)	4 (7.7)	—
Passive manual mobilization	48 (92.3)	4 (7.7)	—
Manual stretching	47 (90.4)	5 (9.6)	—
Manual positioning	45 (86.5)	7 (13.5)	—
Standing positioning with devices or support	44 (84.6)	7 (13.5)	1 (1.9)
Bobath approach	43 (82.7)	9 (17.3)	—
Functional (milestones) exercises without manual support	42 (80.8)	9 (17.3)	1 (1.9)
Use of orthosis	41 (78.8)	11 (21.2)	—
Family‐centred approach a	39 (75)	10 (19.2)	3 (5.8)
Manual muscle strengthening	37 (71.2)	15 (28.8)	—
Handling for tone normalization	34 (65.4)	12 (23.1)	6 (11.5)
Taping	34 (65.4)	18 (34.6)	—
Physical activity	33 (63.5)	19 (36.5)	—
Goal‐directed therapy	31 (59.6)	14 (26.9)	7 (13.5)
CIMT (modified)	27 (51.9)	23 (44.2)	2 (3.8)
Metayer approach	26 (50)	19 (36.5)	7 (13.5)
Neurodevelopmental therapies	24 (46.2)	19 (36.5)	9 (17.3)
Casting	19 (36.5)	31 (59.6)	2 (3.8)
Functional goals definition with standardized outcome measure with Family and children	15 (28.8)	34 (65.4)	3 (5.8)
Massage	13 (25)	37 (71.2)	2 (3.8)
HABIT therapy	9 (17.3)	30 (57.7)	13 (25)
Treadmill training	8 (15.4)	42 (80.8)	2 (3.8)
HABIT‐ILE therapy	6 (11.5)	37 (71.2)	9 (17.3)
Electrical stimulation (functional)	2 (3.8)	49 (94.2)	1 (1.9)

Note: CIMT = constraint‐induced movement therapy; HABIT (ILE) = Hand‐arm bimanual intensive therapy (including the lower extremities). In bold are evidence‐based approaches according to the review by Novak et al. (2020).

^a Family‐centred approach implies family collaboration in clinical decision‐making, particularly in setting shared therapy goals and encouraging families to participate in therapy between clinic visits.

The questionnaire took 10 to 15 min to be completed.

In the process of the development of the questionnaire, a first version was submitted to five physiotherapists for content validity. Three of them had extensive experience in the management of children with CP (years of practice were 17, 11 and 6). They were asked to comment on the relevance, the simplicity in responding as an online survey (trying with a smartphone and a computer) and the understanding of the items. They were also asked to suggest other relevant items. Based on their comments, some items were removed, others were reworded, and some new items were added. The five physiotherapists approved the final version of the questionnaire before data collection.

2.4. Data Analysis

The data on the Google Form were extracted into an Excel spreadsheet. We collected the email addresses of the participants for the only purpose of controlling for multiple participations. When there were multiple participations, we systematically kept the first completion and removed the following ones without looking into the data. That decision was made to keep the participation in the survey anonymous. Afterwards, the email addresses were deleted before any analysis. We performed descriptive analysis using the SPSS software, Version 18. For the last item of the survey with an open‐ended response, a theme coding approach was used for analysis.

3. Results/Findings

3.1. Participants' Characteristics and Physiotherapy Session Modalities

A total of 91 physiotherapists participated in the survey, with 52 (58.1%) working with children with CP. This subset of 52 physiotherapists formed the study sample, and their characteristics are presented in Table 1. The majority aged between 20 and 39 years, and 58% were women. A large proportion had less than 3 years of experience with CP (42%) and did not receive any certified CP‐specific training (63.5%).

Regarding the physiotherapy session modalities (Table 1), the frequency of sessions was thrice a week (46.2%) or twice a week (34.6%), and a typical session lasted mostly [30–45] min (53.8%). The age of children with CP treated mostly ranged from [0–2 years] (32.7%) to [2–5 years] (46.2%).

3.2. The Use of Standardized Outcome Measures

Of the 52 physiotherapists working with children with CP, only 1 (1.9%) reported using the standardized outcome measures all the time, 4 (7.7%) used them most of the time, 19 (36.5%) occasionally, 18 (34.6%) rarely and 10 (19.2%) never.

As for the selected standardized outcome measures submitted to the physiotherapists, the CP‐specific tools including the classification systems were mostly unused and unknown (proportions of use ranging from 11.5% to 28.8%) (Table 2). The most used standardized outcome measures were classical generic tools such as goniometry, manual testing or tape measurements.

When asked to name any other frequently used outcome measure, none was reported.

As for the obstacles to the use of the standardized outcome measures, only 33 of the 52 physiotherapists replied to that question (Table 3). The main obstacles were the lack of time (22/33) and lack of knowledge of the outcome measures (15/33). Non‐negligible factors were the complexity of the cases making the collaboration of the child difficult (7/33) and the non‐availability of the outcome measures in the departments (7/33).

3.3. Therapeutic Interventions

The most chosen interventions were the classical techniques, such as weight‐bearing exercises, exercises with rehabilitation balls, manually guiding exercises for developmental milestones, Bobath approach, passive manual mobilization and stretching (above 80%) (Table 4). The family‐centred approach, the goal‐directed therapy and the CIMT were also considerably selected (by more than 50% of the participants).

Only one new technique was added by one physiotherapist participant as a frequent approach that was ‘awareness stimulation with music’.

3.4. Perceived Confidence in the Management of Children With CP

From the 52 physiotherapists, 3 (5.8%) strongly agreed, 27 (51.9%) agreed, 18 (34.6%) neither agreed nor disagreed, 3 (5.8%) disagreed and 1 (1.9%) strongly disagreed that they felt confident or competent in managing children with CP.

As for the comments regarding their confidence or competence, only 17/52 responded. The main theme was the necessity of training about the modern approaches in the management of children with CP. Some participants also reported that their confidence was acquired with years of practice and attendance at some trainings.

4. Discussion

Key findings revealed that most physiotherapists working with children with CP lacked certified CP‐specific training. Most children were under 5 years old, received physiotherapy twice or thrice weekly, and sessions lasted 30–45 min. The study also highlighted limited use of standardized outcome measures, with therapy primarily relying on classical exercises targeting developmental milestones, and muscle length—approaches not deemed evidence‐based in the literature (Novak et al. 2020). Specifically, the commonly used standardized outcome measures and interventions primarily focus on the impairment domain—such as joint motion, pain, and spasticity—while placing little to no emphasis on the activity and participation domains, including engagement in home and social activities.

The lack of certified CP‐specific training is in accordance with findings from Maharaj et al., in South Africa, reporting that 60% of the physiotherapists working with children with CP had no postgraduate specific training (Maharaj et al. 2021). This was expected as the few available training programs in French‐speaking countries in Sub‐Saharan Africa (including Benin) generally offered a bachelor's degree with very few offering a master's programme for specialities (Kossi 2023).

Most treated children (79%) were under five, consistent with a previous study in Benin showing a higher proportion of younger children (< 6 years) in clinical settings (Sogbossi et al. 2019). Early interventions for CP that focus on promoting development and functioning—rather than aiming for a cure, correction, or ‘normality’—are recommended, given the neuroplasticity of the infant brain, which enhances responsiveness to therapy (Novak et al. 2017). However, only 33% of children were under two in this study, highlighting the need for awareness and collaboration between physicians and rehabilitation professionals to promote early referrals.

Interventions were mostly delivered two to three times per week, with sessions lasting 30–45 min. In South Africa, the average physiotherapy session lasted 30 min (Maharaj et al. 2021), aligning with these findings. The frequency could sometimes be lower (once a week) in Northern countries (Bleyenheuft et al. 2015; Saleh et al. 2008). However, modern, activity‐based therapies like CIMT and bimanual training are most often delivered at higher dosages, such as 5+ h daily for 2–3 weeks or 2–3 h daily, three times a week for 2 months (Novak et al. 2020). For babies, modified CIMT involves 30 min daily for 2 months (Eliasson et al. 2018), exceeding the common dosages. These findings suggest that to effectively integrate activity‐based interventions into routine clinical practice, dosage should be carefully adjusted to increase opportunities for task‐specific practice for children and their families.

The study found that while 81% reported using standardized outcome measures, only 10% used them regularly. Maharaj et al. (2021) reported that 35% of South African physiotherapists used standardized measures, with 72% relying on self‐developed forms and only 16% using standardized assessment tools like the GMFCS. In contrast, Sawadogo et al. (2024) reported 62% regular use of standardized measures by physiotherapists in French‐speaking Sub‐Saharan Africa, suggesting a lower use in paediatric neurorehabilitation. Northern countries report 56%–90% usage, likely due to their specialized training and awareness (Anaby et al. 2017; Marcroft et al. 2019; Saleh et al. 2008). Accordingly, commonly used tools in this study were classical impairment‐based tools mostly learned in physiotherapy training programs such as goniometry and the Ashworth scale, whereas standardized tools focusing on activity, participation, or specific to CP—such as the GMFCS and GMFM—were not utilized. Nigerian studies, however, reported higher use of the GMFM (58%) and GMFCS (58%), though these studies focused solely on CP‐specific assessment tools (Adeniyi et al. 2015; Obembe et al. 2019).

The main obstacles reported were lack of time, knowledge, familiarity with outcome measures, and the complexity of CP cases. Lack of time and knowledge align with previous studies (Demers et al. 2019; Sawadogo et al. 2024) and reflect the absence of certified CP‐specific training for most physiotherapists in this study. The complexity of cases appears to be a context‐specific barrier, as hospital‐based studies in Sub‐Saharan Africa report a high prevalence of more complex cases (GMFCS IV–V, MACS IV–V) (Murugasen et al. 2024; Sogbossi et al. 2019). These cases often exhibit floor effects with standardized measures (Sogbossi, Arnould, et al. 2024) and struggle with instructions due to cognitive impairments, highlighting the need for adapted measures. Consistently, intervention studies often exclude severe cases for their inability to follow instructions (Eliasson et al. 2014; Sogbossi et al. 2021).

The most used interventions were the classical handling exercises directing to developmental milestones, joint motions, and muscle length. This partly reflects the frequent use of impairment‐based assessment tools, such as goniometry and the Ashworth scale. This is consistent with the studies conducted in Sub‐Saharan Africa (Bukola et al. 2022; Maharaj et al. 2021; Okenwa and Edeh 2019) and some studies in Northern countries (Marcroft et al. 2019; Sanchez et al. 2022; Taflampas et al. 2018). These approaches suggest that physiotherapists are (i) intervening in children with CP by focusing primarily on impairments and (ii) aiming for normative (milestone‐based) developmental targets—both of which are fundamentally limited. It is essential that children actively engage in doing, rather than passively receiving, therapy. The choice of interventions in the management of children with CP in clinical practice is not yet based on the evidence‐based practice approach. Training programs in physiotherapy in Sub‐Saharan Africa need to be updated to contribute to the best quality of care provided to children with CP and beyond.

Modern evidence‐based approaches were underutilized. However, family‐centred approaches, goal‐directed therapy, and CIMT were reported by over 50% of participants, contrasting with lower use in other studies (Anaby et al. 2017; Maharaj et al. 2021; Marcroft et al. 2019; Okenwa and Edeh 2019). CIMT, originally for adults with stroke and later adapted for children with CP and stroke, is often confused with forced‐use therapy, which lacks structured task‐specific practice (Eliasson et al. 2014). Physiotherapists may have referred more to forced‐use therapy when mentioning CIMT. Regarding goal‐directed therapy, approximately 60% of respondents reported using it; however, only 29% indicated using a standardized assessment to define functional goals collaboratively with families and children. This suggests that physiotherapists may have based their responses solely on setting functional objectives, possibly independently, without fully understanding goal‐directed therapy as an approach incorporating motor learning and environmental modifications (Toovey et al. 2017). The 75% usage of the family‐centred approach contrasts with prior reports of poor family communication in Benin (Sogbossi et al. 2022). While Maharaj et al. (2021) noted frequent education of families in South Africa, a true family‐centred approach involves collaboration in clinical decision‐making, particularly in setting shared therapy goals and encouraging families to participate in therapy between clinic visits (Rosenbaum 2011). Responses might have reflected basic information provision rather than full family‐centred care.

Fifty‐eight percent (58%) of participants felt confident or competent in managing children with CP. Confidence was attributed to years of practice and attending training sessions. Participants emphasized the need for training on modern approaches to CP management, highlighting that training is essential for translating clinical research into practice and ensuring high‐quality care in health services.

4.1. Limitations

In an online self‐report survey, some participants might have been subject to a social desirability bias. Moreover, we could have given more details for some items, notably defining some of the selected interventions (such as goal‐directed therapy, CIMT, family‐centred approach). However, including definitions was attempted but made the survey too long and less practical on smartphones. Furthermore, the fact that the survey was only available online could have biased the participation towards physiotherapists who were more familiar with digital media and online content. However, the study involved a considerable sample size that could be representative of physiotherapists working in Benin.

5. Recommendations and Conclusions

There is a huge gap between the guidelines for evidence‐based practice and the actual care of children with CP in physiotherapy in Benin. The use of standardized outcome measures by physiotherapists is extremely limited, and the interventions used are mostly passive, non‐evidence‐based approaches. Physiotherapists in Benin and beyond should shift from a traditional impairment‐focused approach to modern, evidence‐based practices that enhance activity and social participation in children with CP. Additionally, physiotherapy training should incorporate the selection and use of standardized outcome measures designed to guide the setting of functional goals and to assess children's progress in activity and participation. Moreover, early referral to physiotherapy services—especially before age two—is essential to support development through activity‐based interventions and parental guidance on creating a stimulating home environment.

Upcoming research could explore the current motor and functional developmental trajectories of children with CP in Benin. Additionally, further studies might examine how physiotherapists' training in activity‐based modern approaches may enhance the developmental outcomes of children with CP.

Author Contributions

Emmanuel Segnon Sogbossi: conceptualization, investigation, writing – original draft, methodology, writing – review and editing, formal analysis, supervision. Murielle Gbaglo: conceptualization, investigation, methodology, writing – review and editing. Wilfried Dahoueto: investigation, methodology, writing – review and editing. Toussaint Kpadonou: supervision, writing – review and editing. Catherine Mercier: writing – original draft, writing – review and editing, formal analysis, supervision.

Funding

This study did not benefit from any grants from funding agencies in the public, commercial or not‐for‐profit sectors.

Ethics Statement

The study was conducted according to the principles of the Declaration of Helsinki and approved by the School of Physiotherapy of Benin (No. 334/2024). All physiotherapists participated anonymously and voluntarily. Participants were informed that by completing the survey, they were giving their consent to participate in the study.

Conflicts of Interest

The authors declare no conflicts of interest.

Supporting information

Data S1: Development of the questionnaire S1

Sogbossi, E. , Gbaglo M., Dahoueto W., Kpadonou T., and Mercier C.. 2026. “Current Practice of Physiotherapists in the Management of Children With Cerebral Palsy in Benin Country: A Cross‐Sectional Online Survey.” Child: Care, Health and Development 52, no. 1: e70192. 10.1111/cch.70192.

Data Availability Statement

The data that support the findings of this study are available from the corresponding author upon reasonable request.