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A Journal on Physical Medicine and Rehabilitation after Pathological Events

Official Journal of the Italian Society of Physical and Rehabilitation Medicine (SIMFER), European Society of Physical and Rehabilitation Medicine (ESPRM), European Union of Medical Specialists - Physical and Rehabilitation Medicine Section (UEMS-PRM), Mediterranean Forum of Physical and Rehabilitation Medicine (MFPRM), Hellenic Society of Physical and Rehabilitation Medicine (EEFIAP)
In association with International Society of Physical and Rehabilitation Medicine (ISPRM)
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European Journal of Physical and Rehabilitation Medicine 2015 December;51(6):677-91


language: English

An evaluator-blinded randomized controlled trial evaluating therapy effects and prognostic factors for a general and an individually defined physical therapy program in ambulant children with bilateral spastic cerebral palsy

Franki I. 1, 2, Desloovere K. 2, 3, De Cat J. 2, 3, 4, Tijhuis W. 3, Molenaers G. 2, 3, 4, Feys H. 2, Vanderstraeten G. 1, Van Den Broeck C. 1

1 Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium; 2 KU Leuven Department of Rehabilitation Sciences, Leuven, Belgium; 3 Clinical Motion Analysis Laboratory, University Hospital Leuven, Pellenberg, Belgium; 4 Department of Pediatric Orthopedics, University Hospital Leuven, Pellenberg, Belgium


BACKGROUND: Cerebral palsy (CP) is characterized by a heterogeneous nature with a variety of problems. Therefore, individualized physical therapy might be more appropriate to address the needs for these children.
AIM: The first aim was to compare the effectiveness of an individually-defined therapy program (IT) and a general therapy program (GT) on gait and gross motor function in children with CP. The second aim was to evaluate interaction-effects, time-effects, treatment with botulinum toxin A, age, gross Motor Function Classification Scale (GMFCS), treatment frequency and quality as factors influencing outcome.
DESIGN: An evaluator-blinded, randomized controlled trial.
SETTING: Outpatient rehabilitation unit.
POPULATION: Forty ambulant children with spastic bilateral CP (mean age 6 years 1 month).
METHODS: All children were randomly assigned to receive either IT or GT over a 10 week period. Nineteen of these children were enrolled into a second and/or third program, resulting in 60 interventions. Primary outcome was assessed with the Goal Attainment Scale (GAS) for gross motor function goals and z-scores for goals based on specific 3D gait parameters. Secondary outcome included the Gross Motor Function Measure-88 (GMFM-88) scores, time and distance gait parameters, Gait Profile Score, Movement Analysis Profiles and time needed to complete Timed-Up-and-Go and Five-Times-Sit-To-Stand tests.
RESULTS:There were higher, but non-significant GAS and z-score changes following the IT program compared to the GT program (GAS: 46.2 for the IT versus 42.2 for the GT group, P=0.332, ES 0.15; z-score: 0.135 for the IT compared to 0.072 for the GT group, P=0.669, ES 0.05). Significant time-effects could be found on the GAS (P<0.001) and the GMFM-88 total score (P<0.001). Age was identified as a predictor for GAS and GMFM-88 improvement (P=0.023 and P=0.044).
CONCLUSION: No significant differences could be registered between the effects of the IT and the GT. The favorable outcome after the IT program was only a trend and needs to be confirmed on larger groups and with programs of longer duration.
CLINICAL REHABILITATION IMPACT: Both programs had a positive impact on the children’s motor functioning. It is useful to involve older children more actively in the process of goal setting.

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