Project Summary
The dose of a treatment is very important for making someone better. Dose can mean taking an accurate amount of a medicine at specific times throughout the day or completing a defined number of repetitions of an exercise. Most children with cerebral palsy (CP) receive outpatient physical therapy to improve their motor skills, independence, and other areas of development like language and cognition. Going to a clinic and getting therapy one-on-one with a therapist for two hours per week is the dose.
Recent evidence suggests that going to therapy for high-intense periods, like every day for many days in a row, results in fast improvements in motor skills. As a result, parents, physical therapists, and physicians are questioning the best way to dose therapy services to children with CP. Dosing strategies including usual weekly or high-intense periodic have never been compared. Parents often seek out high-intensity periodic programs without comparative knowledge of the effectiveness versus weekly treatment. We want to know which strategy is better for most children, and if factors specific to individual children, such as age or severity of CP, make certain strategies better than the others. We also want to determine if there are long-term benefits or harms of these two strategies. Because families of children with CP identify motor skill development as the foremost outcome that matters to them, our primary outcomes are motor based and patient centered.
Currently, our large medical center runs a combination of these services at two sites, and we will expand to seven sites with increasing enrollment. As a result, we will be able to make comparisons with a large enough number of patients among services that are currently being used in a clinical setting. For the current study, ACHIEVE, we will randomly assign 300 children ages 2–8 with CP into one of two groups (weekly or high-intense periodic). Random assignment is like flipping a coin, ensuring the two groups start off equally so one group does not have an unfair advantage over the other.
As a result of this project, we will be able to help parents and clinicians make important decisions about their health care. For example, if these doses of therapy produce the same benefits for all children with CP, then parents can choose the one that fits in best with their family schedule and financial resources. If high-intense periodic produces better benefits for younger children but not older children, then therapists and referring physicians can help parents make informed decisions about intensity and service delivery of therapy based on the age of their child. Overall, this project will give parents and healthcare professionals the best possible information about treatment choices so they can make informed decisions on which treatment is best for each child with CP.
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