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Published on: June 12, 2019
Clinical effectiveness of a child-specific dynamic stretching programme, compared to usual care, for ambulant
Tim Theologis1, Daniel C Perry2, Ines Rombach3
1Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences University of Oxford, Oxford, UK.
Insights
This study investigates if tailored dynamic stretching improves mobility in children with cerebral palsy (CP). Results will guide physiotherapy for CP management.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Physical Therapy
Background:
- Dynamic muscle stretching is a common physiotherapy intervention for children with cerebral palsy (CP).
- Current exercise regimes for CP lack standardized protocols and robust evidence of effectiveness.
- The SPELL trial addresses this gap by evaluating a tailored dynamic stretching program.
Purpose of the Study:
- To assess the clinical effectiveness of an individually tailored dynamic stretching program compared to usual care.
- To evaluate the impact of the intervention on functional mobility in ambulant children with spastic cerebral palsy.
Main Methods:
- A multicentre, two-arm, parallel group, superiority randomized controlled trial (RCT).
- Recruitment of 334 children aged 4-11 years with spastic CP (GMFCS I-III).
- Randomization to either a 16-week dynamic stretching program (6 physiotherapy sessions) or usual NHS care.
Main Results:
- Primary outcome: functional mobility (Gait Outcomes Assessment List - GOAL) at six months.
- Secondary outcomes include range of motion, motor function, quality of life, and adherence.
- Primary analysis will follow an intention-to-treat (ITT) approach.
Conclusions:
- The SPELL trial will provide crucial evidence on the effectiveness of tailored dynamic stretching for children with spastic CP.
- Findings will inform best practices in pediatric physiotherapy for cerebral palsy.
- The study aims to improve functional mobility and quality of life for affected children.
Aims:
Dynamic muscle stretching exercises are one of the interventions frequently prescribed by physiotherapists for children with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The SPELL trial will assess the clinical effectiveness of an individually tailored dynamic stretching programme, compared to usual care for ambulant children with spastic CP.
Methods:
We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit children aged four to 11 years with a diagnosis of spastic CP (bilateral or unilateral) and Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated one:one allocation ratio) to either: 1) a dynamic stretching exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment, and advice regarding self-management and exercise.
Conclusion:
The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: joint range of motion (Cerebral Palsy Integrated Pathway protocol) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A); balance (GOAL subdomain A, B, D); pain and discomfort (GOAL subdomain C); health-related quality of life (youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)); educational attendance; exercise adherence; and additional physiotherapy treatment at six and 12 months. The primary analysis will be intention to treat.
