Multimorbidity Profiles and Health-related Quality of Life in Children with Cerebral Palsy: A Multidimensional Analysis Serebral Palsili Çocuklarda Multimorbidite Profilleri ve Sağlıkla İlişkili Yaşam Kalitesi: Çok Boyutlu Bir Analiz

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Baykan M., Baykan Çopuroğlu Ö.

Anatolian Journal of General Medical Research, cilt.36, sa.2, ss.190-199, 2026 (Scopus, TRDizin)

Özet

Objective: To quantify the relative contributions of motor severity and non-motor comorbidities to health-related quality of life (HRQoL) in individuals with cerebral palsy (CP) and to evaluate their statistical associations. Methods: In this cross-sectional study, 218 children with CP (aged 6-18 years) were evaluated using the gross motor function classification system (GMFCS), pediatric evaluation of disability inventory (PEDI), pediatric quality of life inventory (PedsQL), and Pittsburgh sleep quality index. Comorbidities were identified through clinical records. Results: A higher GMFCS level was the strongest independent predictor of lower HRQoL (β=-0.58, p<0.001), followed by poorer sleep quality (β=-0.25, p=0.002), epilepsy (β=-0.22, p=0.004), and malnutrition (β=-0.18, p=0.010). Dominance analysis showed that GMFCS and sleep quality together accounted for most of the explained variance in HRQoL. Latent class analysis identified three comorbidity clusters: low-burden (43%), moderate-burden (33%), and high-burden (24%), with the high-burden cluster demonstrating markedly lower PEDI and PedsQL scores (p<0.001). Sleep quality was indirectly and significantly associated with the relationships among epilepsy, malnutrition, and HRQoL. Conclusion: Motor severity explains a large proportion of HRQoL differences in CP; however, non-motor comorbidities-especially sleep disturbance, epilepsy, and malnutrition-represent substantial and potentially modifiable contributors. Distinct multimorbidity clusters and identified mediating pathways indicate the need for integrated care models that address motor and systemic factors simultaneously. Early targeting of sleep and nutritional health may meaningfully improve quality of life trajectories in children with CP.