Determinants of discontinuation of rehabilitation follow-up from pediatric neuro-rehabilitation services in cerebral palsy: a matched case-control study

Long-term neurorehabilitation is essential to optimize functional outcomes and prevent secondary complications in children with cerebral palsy (CP). However, premature discontinuation of rehabilitation follow-up represents a critical barrier to care, particularly in low- and middle-income countries (LMICs). This study aimed to identify independent factors associated with discontinuation of pediatric neuro-rehabilitation follow-up in Sri Lanka. An analytical matched case-control study was conducted at Lady Ridgeway Hospital for Children, Colombo. The post-COVID-19 indexing cohort (July 2022–June 2023) comprised 279 eligible children relying exclusively on institutional primary rehabilitation. Follow-up discontinuation was operationally defined as continuous absence for > 1 calendar year. Cases ( n = 72; 55.6% male) were compared with frequency-matched adherent controls ( n = 144, 2:1 ratio; 54.9% male). Data collection integrated medical record reviews and structured interviews evaluating clinical severity, transport logistics, out-of-pocket costs, and household-level barriers. Univariate and forward-stepwise multivariable logistic regression models were constructed. Multivariable analysis identified five independent predictors of follow-up discontinuation: non-ambulatory status (Gross Motor Function Classification System [GMFCS] IV–V: (adjusted odds ratio (aOR) = 4.12, 95% CI: 2.05–8.28, p < 0.001), reliance on public transport (aOR} = 3.84, 95% CI: 1.88–7.85, p < 0.001), primary breadwinner engaging in daily wage labour (aOR = 3.25, 95% CI: 1.62–6.52, p = 0.001), poorly controlled epilepsy (aOR = 3.10, 95% CI: 1.48–6.48, p = 0.003), and absence of state disability allowance (aOR = 2.41, 95% CI: 1.12–5.18, p = 0.024). Physical travel distance ( p = 0.082) and median direct transit expenses ( p = 0.108, Mann-Whitney U test) did not significantly diverge between groups, although mean out-of-pocket costs were elevated among cases ( p = 0.007, t-test), indicating that indirect daily wage forfeiture (3.00–4.50 USD/visit) and public transit vulnerability serve as the primary economic predictors of discontinuation, rather than direct travel expenses alone. Comparative household analysis ( N = 69 vs. N = 144) demonstrated that families who discontinued care had significantly higher reported information deficits regarding rehabilitation importance (66.7% vs. 21.5%), alternative medicine reliance (62.3% vs. 18.1%), apprehension of staff reprimands (30.4% vs. 6.3%), and spousal isolation (42.0% vs. 11.8%; p < 0.001). Discontinuation of neuro-rehabilitation follow-up in CP is independently associated with severe motor dependency, public transit reliance, unmitigated daily wage forfeiture, active seizure burden, and lack of state welfare support, while also co-occurring with univariable household barriers including caregiver information gaps and spousal isolation. Mitigating attrition requires shifting from centralized tertiary models toward decentralized community-based rehabilitation, targeted cash subsidies, tele-health outreach, and structured caregiver education. Not applicable.