THE SMART-CP model has shown to significantly improve access to early diagnosis and rehabilitation services for children with cerebral palsy (CP) in rural Bangladesh, though survival outcomes remained unchanged, according to a cluster randomised clinical trial involving 968 children.
Cerebral palsy, a leading cause of childhood disability, often leaves families in low-resource settings like Bangladesh without access to timely interventions. The Sustainable Model of Early Intervention and Telerehabilitation for Children With CP (SMART-CP) aimed to address this gap through community-based strategies. This trial, conducted across eight subdistricts in Sirajganj, randomised 500 children to the SMART-CP intervention—combining local referral networks, subdistrict rehabilitation centres, and weekly telerehabilitation—and 468 to usual care. Outcomes were assessed over 12 months.
Children in the intervention arm saw rehabilitation access rise from 70.2% to 99.4%, compared to a marginal increase from 63.9% to 68.2% in controls (P<0.001). The SMART-CP group received earlier diagnoses (mean 2.0 vs. 3.8 years; Cohen’s d=–0.7) and began rehabilitation sooner (1.8 vs. 3.6 years; d=–0.9). They attended more therapy sessions (mean 23.4 vs. 4.3; d=0.7), used more assistive devices (20.8% vs. 3.0%; RR=0.82, 95% CI 0.78–0.86; P<0.001), and incurred lower out-of-pocket costs ($1.5 vs. $2.9 monthly; d=–0.4). However, survival and clinical outcomes (e.g., motor function) showed no significant differences.
These results advocate scaling the SMART-CP model in similar settings to bridge service gaps, prioritising caregiver empowerment and telehealth. Clinicians in low-resource regions should integrate community networks and peer support to expedite diagnoses. Future research must explore long-term functional benefits and adapt the model for other neurodevelopmental conditions.
Reference
Al Imam MH et al. Sustainable model of early intervention and telerehabilitation for children with cerebral palsy in rural Bangladesh: the SMART-CP randomized clinical trial. JAMA Pediatr. 2025;DOI:10.1001/jamapediatrics.2025.0150.
