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Development and implementation of a child-specific dynamic stretching exercise programme for ambulant children with
Catherine Barry1, Helen Wood1, Sally Hopewell2
1Surgical Interventions Trials Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
Insights
The SPELL trial developed a tailored dynamic stretching program for children with spastic cerebral palsy (CP). This physiotherapy-led intervention aims to improve functional mobility compared to usual care.
Area of Science:
- Physiotherapy interventions
- Paediatric rehabilitation
- Clinical trial design
Background:
- Spastic cerebral palsy (CP) affects ambulant children, necessitating effective rehabilitation strategies.
- The SPELL trial addresses the need for evidence-based physiotherapy interventions in paediatric CP.
- A tailored dynamic stretching program was developed based on established guidelines and stakeholder input.
Purpose of the Study:
- To describe the development and implementation of a physiotherapy-led dynamic stretching program for ambulant children with spastic cerebral palsy (CP).
- To assess the clinical effectiveness of this tailored program compared to usual care.
- To provide details of the intervention components and delivery.
Main Methods:
- The SPELL trial is a superiority randomised controlled trial following Medical Research Council guidance for complex interventions.
- A stakeholder meeting informed the design of the physiotherapy-led interventions, focusing on clinical guidelines, expert opinion, and patient representatives.
- A six-month internal pilot tested the deliverability of the interventions within the UK's National Health Service.
Main Results:
- A 16-week, 6-session dynamic stretching program was developed, overseen by physiotherapists, with exercises performed 4-5 times weekly.
- The program integrates behavior change strategies and utilizes a web-based app with exercise videos to promote adherence.
- The usual care group received one face-to-face physiotherapy session with standardized components and continuation of normal care.
Conclusions:
- A well-defined, widely accepted dynamic stretching program for children with spastic CP was successfully developed despite complexities.
- The SPELL trial is poised to evaluate the impact of this dynamic stretching program on functional mobility in ambulant children with CP.
- Study findings are anticipated for dissemination in 2027.
Objectives:
The SPELL trial is a large-scale, multicentre, two arm, parallel group, superiority randomised controlled trial assessing the clinical effectiveness of an individually tailored dynamic stretching exercise programme compared to usual care in ambulant children with spastic cerebral palsy (CP). Here we describe the development, implementation and details of the physiotherapy-led interventions.
Methods:
Medical Research Council guidance for developing complex interventions were used, taking into account clinical guidelines, expert and patient opinion, research evidence, current practice variation, and deliverability. A stakeholder meeting of 26 experts, clinicians, researchers, and patient representatives was used to design key components of the interventions. The interventions were designed to be deliverable across the UK's National Health Service, and this was tested during a six-month internal pilot.
Results:
A child-specific dynamic stretching exercise programme was developed consisting of 6 sessions, overseen by a physiotherapist, over 16 weeks. Participants are asked to complete the dynamic stretching exercises 4-5 times per week. The programme incorporates behaviour change strategies designed to support long-term exercise adherence and is hosted on a fun web-based app, including exercise videos. Follow up sessions offer the opportunity for progression, supervised practice and feedback. The usual care comparator consists of one face-to-face session with a physiotherapist and content includes core, standardised components, alongside continuation of their normal physiotherapy care.
Conclusion:
Despite complexities and lack of good quality evidence, it was possible to develop, a widely accepted, well-defined dynamic stretching exercise programme. The SPELL trial will assess the effect of the dynamic stretching exercise programme on functional mobility in ambulant children with CP compared with usual care. Dissemination is anticipated in 2027.
Trial Registration Number:
ISRCTN 15808719. CONTRIBUTION OF PAPER.
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