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Can Respiratory Hospital Admissions in Children with Cerebral Palsy Be Reduced? A Feasibility Randomized Controlled
Rachael M Marpole1, A Marie Blackmore2, Andrew C Wilson1
1Department of Respiratory and Sleep Medicine, Perth Children's Hospital, Nedlands, Western Australia, Australia.
Insights
Implementing a new respiratory care service for children with severe cerebral palsy (CP) is feasible. Caregivers and clinicians found the service acceptable, paving the way for larger trials on respiratory disease management in CP.
Area of Science:
- Pediatric Pulmonology
- Clinical Trial Design
- Healthcare Management
Background:
- Children with severe cerebral palsy (CP) face a high risk of respiratory disease.
- Existing guidelines for respiratory disease management in CP require practical implementation strategies.
- The RESPiratory hospital Admissions in children with cerebral palsy (RESP-ACT) trial aimed to test a new service model.
Purpose of the Study:
- To assess the feasibility of implementing a consensus-based respiratory care program for children with severe CP.
- To evaluate the acceptability and practicality of the intervention from caregiver and clinician perspectives.
- To gather preliminary data on efficacy for future large-scale randomized controlled trials.
Main Methods:
- A randomized controlled trial (RESP-ACT) involving 22 children (aged 0-12 years) at risk of respiratory disease.
- Intervention group received a comprehensive assessment and individualized care plan.
- Control group received usual care; outcomes measured via caregiver surveys and interviews.
Main Results:
- High participant engagement with 73% complete 1-year data and 89% survey completion.
- Intervention group participants reported high satisfaction with the service.
- Caregivers and clinicians strongly supported the establishment of such a service, noting practical considerations like staffing and home-based care.
Conclusions:
- The proposed respiratory care service is feasible for implementation in children with severe CP.
- The trial provides valuable data to inform the design of a larger, definitive randomized controlled trial.
- Close monitoring is recommended for successful service delivery and management of respiratory disease in this population.
Objective:
To investigate the feasibility of implementing recommendations of the consensus statement for the Prevention and Management of Respiratory Disease in children with severe cerebral palsy (CP) via RESPiratory hospital Admissions in children with cerebral palsy: a feasibility randomized Controlled Trial (RESP-ACT).
Study Design:
Twenty-two children with CP aged 0-12 years at risk of respiratory disease and receiving care through Perth Children's Hospital in Western Australia were randomized into parallel groups. The control group (n = 10) continued with their usual teams, while the intervention group (n = 12) received a comprehensive assessment followed by individualized investigations and appointments as needed. The primary outcomes include implementation, acceptability, practicality, and measuring efficacy. During the following year, with the help of a blind assessor, caregivers reported their children's health service use on a fortnightly basis. Caregivers and treating clinicians were interviewed at the end of the trial.
Results:
Complete data were obtained from 73% of participants at 1 year. They completed 89% of the fortnightly surveys. Hospital service data were assessed for all. The 9 intervention participants interviewed at the end of the trial were satisfied or very satisfied with the service, and all caregivers and clinicians agreed or strongly agreed that such a service should be established. Their practical concerns included managing time, preference for home-based interventions and adequate staffing.
Conclusions:
The service is feasible to implement but requires close monitoring. This trial provides data on which to base a larger randomized control trial.
Trial Registration:
Australian New Zealand Clinical Trials Registry-Registration number 12620000114943.
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