Related Experiment Video
Updated: Oct 5, 2025
Author Spotlight: Repetitive Transcranial Magnetic Stimulation Combined with Movement Observation in Cerebral Palsy
Published on: August 9, 2024
Defining usual physiotherapy care in ambulant children with cerebral palsy in the United Kingdom: A mixed methods
Rachel Rapson1, Jos M Latour2,3,4, Jonathan Marsden5
1Physiotherapy, Torbay and South Devon NHS Foundation Trust, Torquay, UK.
Insights
Physiotherapists established consensus on key physiotherapy practices for ambulant children with cerebral palsy (CP). A checklist was created to guide usual care in clinical trials and inform future UK clinical guidelines.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Clinical Practice Guidelines
Background:
- Ambulant children with cerebral palsy (CP) receive physiotherapy to enhance balance and walking abilities.
- Currently, the United Kingdom lacks standardized clinical guidelines for usual physiotherapy care for children with CP.
- A consensus process is essential to define and standardize this care, improving consistency and research fidelity.
Purpose of the Study:
- To define usual physiotherapy care for ambulant children with cerebral palsy (CP) through expert consensus.
- To develop a checklist for usual care to aid in standardizing physiotherapy interventions.
- To inform the control groups in randomized controlled trials (RCTs) for children with CP.
Main Methods:
- A three-phase consensus process involving twelve expert physiotherapists.
- Phase 1: Statement development via surveys and nominal groups.
- Phase 2: Literature review of physiotherapy interventions; Phase 3: Confirmatory survey including COVID-19 pandemic impact.
Main Results:
- High consensus achieved on five outcome measures (MDM 0-0.375) and nine assessment areas (MDM 0-0.25).
- Moderate consensus on task-specific training (MDM=0.75) delivered weekly for 4-6 weeks (MDM=0.43).
- High consensus (MDM=0) on modified sport/fitness activities and long-term monitoring for GMFCS Level III children (MDM=0.29).
Conclusions:
- Consensus was reached on two key usual care interventions for pediatric cerebral palsy physiotherapy.
- A checklist was developed to standardize control group interventions in future RCTs.
- Further consensus efforts are needed to establish comprehensive clinical guidelines for UK physiotherapy care.
Background:
Ambulant children with cerebral palsy (CP) undertake physiotherapy to improve balance and walking. However, there are no relevant clinical guidelines to standardize usual physiotherapy care in the United Kingdom. A consensus process can be used to define usual physiotherapy care for children with CP. The resulting usual care checklist can support the development of clinical guidelines and be used to measure fidelity to usual care in the control groups of trials for children with CP.
Methods:
Twelve expert physiotherapists were recruited. In Phase 1, statements on usual care were developed using a survey and two nominal groups. Phase 2 included a literature review to support usual physiotherapy interventions. Phase 3 used a confirmatory survey, which also captured changes to provision during the COVID-19 pandemic. Consensus was calculated by deriving the mean of the deviations from the median score (MDM). High consensus was deemed to be where MDM < 0.42.
Results:
Physiotherapists reached high consensus on five outcome measures (MDM range 0-0.375) and nine areas of assessment (MDM range 0-0.25). Physiotherapists reached moderate consensus on task-specific training (MDM = 0.75), delivered at weekly intensity for 4-6 weeks (MDM = 0.43). There was high consensus (MDM = 0) that children should participate in modified sport and fitness activities and that children with Gross Motor Function Classification System Level III should be monitored on long-term pathways (MDM = 0.29).
Conclusions:
Physiotherapists reached consensus on two usual care interventions, and a checklist was developed to inform the control groups of future randomized controlled trials. Further consensus work is required to establish clinical guidelines to standardize usual physiotherapy care in the United Kingdom.
