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Published on: August 9, 2024
Randomized controlled trial of physiotherapy in 56 children with cerebral palsy followed for 18 months
Insights
Intensive physiotherapy and collaborative goal-setting did not significantly improve motor function in children with cerebral palsy (CP). While intensive therapy showed a brief trend, the benefits for CP motor enhancement were not sustained.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Physical Therapy
Background:
- Cerebral palsy (CP) affects motor function in children.
- Optimizing physiotherapy interventions is crucial for improving motor outcomes.
Purpose of the Study:
- To compare the effectiveness of intensive versus routine physiotherapy.
- To evaluate the impact of collaborative goal-setting versus generalized aims on motor function and performance in children with CP.
Main Methods:
- A 2x2 factorial design study involving 56 children with bilateral CP (GMFCS level III or below, aged 3-12).
- Interventions compared: intensive vs. routine physiotherapy; goal-directed vs. aim-directed therapy.
- Motor function and performance assessed using GMFM and GMPM over a 6-month treatment and 6-month observation period.
Main Results:
- No statistically significant differences were found between intensive and routine physiotherapy or between goal-directed and aim-directed therapy for motor function or performance.
- A trend towards significant improvement with intensive therapy was observed during the treatment period, but this advantage diminished post-treatment.
- Goal-setting procedures did not demonstrate a detectable effect on gross motor function or performance acquisition.
Conclusions:
- Intensive physiotherapy and collaborative goal-setting, as implemented, did not yield superior motor function or performance improvements in children with CP compared to standard approaches.
- The transient benefits of intensive therapy suggest potential but require further investigation for sustained effects.
Abstract:
This study aimed to determine whether motor function and performance is better enhanced by intensive physiotherapy or collaborative goal-setting in children with cerebral palsy (CP). Participants were a convenience sample of 56 children with bilateral CP classified at level III or below on the Gross Motor Function Classification System (GMFCS), aged between 3 and 12 years. A 2 x 2 factorial design was used to compare the effects of routine amounts of physiotherapy with intensive amounts, and to compare the use of generalized aims set by the child's physiotherapist with the use of specific, measurable goals negotiated by the child's physiotherapist with each child, carer, and teacher. Following the six-month treatment period there was a further six-month period of observation. Changes in motor function and performance were assessed by a masked assessor using the Gross Motor Function Measure (GMFM) and the Gross Motor Performance Measure (GMPM) at three-month intervals. There was no statistically significant difference in the scores achieved between intensive and routine amounts of therapy or between aim-directed and goal-directed therapy in either function or performance. Inclusion of additional covariates of age and severity levels showed a trend towards a statistically significant difference in children receiving intensive therapy during the treatment period. This advantage declined over the subsequent six months during which therapy had reverted to its usual amount. Differences in goal-setting procedures did not produce any detectable effect on the acquisition of gross motor function or performance.