[논문]Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy

Sakzewski, Leanne; Miller, Laura; Ziviani, Jenny; Abbott, David F; Rose, Stephen; Macdonell, Richard A L; Boyd, Roslyn N

doi:10.1111/dmcn.12702

Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy 원문보기

Developmental medicine and child neurology, v.57 no.6, 2015년, pp.539 - 547

Sakzewski, Leanne (Faculty of Health, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Qld, Australia) , Miller, Laura (Faculty of Health, Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Qld, Australia) , Ziviani, Jenny (School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Qld, Australia) , Abbott, David F (Brain Research Institute, Florey Neurosciences Institutes (Austin), Melbourne, Vic., Australia) , Rose, Stephen (CSIRO, Australian e‐) , Macdonell, Richard A L (Health Research Centre, University of Queensland Centre for Clinical Research, Brisbane, Qld, Australia) , Boyd, Roslyn N (Brain Research Institute, Florey Neurosciences Institutes (Austin), Melbourne, Vic., Australia)

Abstract ▼ AI-Helper

AimTo determine whether short‐term intensive group‐based therapy combining modified constraint‐induced movement therapy and bimanual therapy (hybrid‐CIMT) is more effective than an equal total dose of distributed individualized occupational therapy (standard care) on upper limb motor and individualized outcomes.MethodFifty‐three children with unilateral cerebral palsy (69% males; mean age 7y 10mo, SD 2y 4mo; Manual Ability Classification System level I, n=24; level II, n=23) were randomly allocated, and 44 received either hybrid‐CIMT (n=25) or standard care (n=19). Standard care comprised six weekly occupational therapy sessions and a 12‐week home programme. Outcomes were assessed at baseline, 13？weeks, and 26？weeks after treatment.ResultsGroups were equivalent at baseline. Standard care achieved greater gains on satisfaction with occupational performance after intervention (estimated mean difference −1.2, 95% CI −2.2 to −0.1; p=0.04) and Assisting Hand Assessment at 26？weeks (estimated mean difference 3.1, 95% CI 0.2–6.0; p=0.04). Both groups demonstrated significant improvements in dexterity of the impaired upper limb, and bimanual and occupational performance over time. The differences between groups were not clinically meaningful.InterpretationThere were no differences between the two models of therapy delivery. Group‐based intensive camps may not be readily available; however, individualized standard care augmented with a home programme may offer an effective alternative but needs to be provided at a sufficient dose.

Abstract

What this paper addsDistributed occupational therapy with a home programme was equivalent to an intensive group‐based therapy on unimanual, bimanual, and individualized outcomes.The target dose of therapy was not achieved for the distributed model of occupational therapy group as home practice was substantially less than anticipated.The challenges for both researchers and clinicians in reliance on home practice to augment direct therapy provision are highlighted.Clinically meaningful long‐term changes in upper limb outcomes should be considered in relation to both the amount of therapy and nature of intervention.This article is commented on by Eliasson on page 498 of this issue.

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Randomized comparison trial of density and context of upper limb intensive group versus individualized occupational therapy for children with unilateral cerebral palsy 원문보기

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