Comparing Two Physical Therapy Schedules for Children with Cerebral Palsy -- The ACHIEVE Study

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What was the research about?

Almost 230,000 children in the United States have cerebral palsy, or CP. CP is a health problem that affects motor skills, which include the ability to move and to maintain balance and posture. Physical therapy, or PT, is one way to improve motor skills. PT includes exercises, repeated activities, and other actions to improve motor and mental skills.

In this study, the research team compared two PT schedules for children with CP. The first was one hour of PT once a week for 40 weeks. The second was two periods of 10 weekdays each, where children got two hours of PT each day. The team compared how well these two schedules improved children’s health and well-being. They looked at

• Motor skills and ability to move
• Physical development
• Ability to do activities independently
• Quality of life, social function, and involvement in community activities

The research team also looked at how parents rated working with physical therapists.

What were the results?

Children in both physical therapy groups had improved motor skills and other health outcomes. The two schedules didn’t make a difference in the amount of improvement. Parents in both groups gave positive ratings to working with therapists.

Who was in the study?

The study included 100 children ages 2–8 with cerebral palsy. The average age was 5 years, and 55 percent were boys.

What did the research team do?

The research team first assigned children by chance to one of two PT schedules. If parents didn’t want their children to be assigned by chance, the team let parents choose one of the PT schedules. The team assigned 46 children by chance, while parents of 54 children chose their PT schedule. Of these parents, 26 chose weekly PT and 28 chose everyday PT. Licensed and trained physical therapists provided the PT. The team looked at health outcomes before children started PT and again nine months later.

Parents of children with cerebral palsy, an adult with cerebral palsy, and cerebral palsy support groups helped plan the study.

What were the limits of the study?

Fewer children took part in the study than expected, making it hard to find differences in health outcomes. Future studies could look at how to better support patients with cerebral palsy to take part in studies comparing PT schedules.

How can people use the results?

Parents of children with CP and their healthcare providers can use these results when considering PT schedules.

Objective

To compare the effectiveness of regular weekly physical therapy versus intensive periodic physical therapy for improving motor function in children with cerebral palsy

Study Design

This observational cohort study compared the effectiveness of regular weekly physical therapy versus intensive periodic physical therapy on improving motor function and other measures of function and well-being in children with cerebral palsy.

Researchers initially randomized children to one of two physical therapy schedules. In the first schedule, children had regular physical therapy, which involved one hour of physical therapy once a week for 40 consecutive weeks. In the second schedule, children had intensive physical therapy, which involved two hours of physical therapy per day for two 10-consecutive-weekday periods.

Licensed and trained pediatric physical therapists provided physical therapy in an outpatient setting. To increase patient recruitment, participants who declined randomization were permitted to participate and to choose one of the physical therapy schedules. Researchers randomized 46 children, while 54 children were in the nonrandomized cohort. Of children in the nonrandomized cohort, 26 received regular physical therapy and 28 received intensive physical therapy. Researchers assessed outcomes before children started physical therapy and again nine months later.

The study included 100 children ages 2–8 with a diagnosis of cerebral palsy. The average age was 5, and 55% were male.

Parents of children with cerebral palsy, an adult patient with cerebral palsy, and cerebral palsy support organizations helped plan the study.

Results

For both the randomized and non-randomized cohorts,

• Both physical therapy groups had improvements in motor function and all secondary outcomes (all p<0.05).
• The two groups did not differ in the amount of improvement in motor function or the secondary outcomes.
• Parents in both groups reported positive ratings of interactions with therapists.

Limitations

Researchers recruited and retained fewer children than planned, which may have affected their ability to detect differences between the groups.

Conclusions and Relevance

In this study, regular weekly physical therapy and intensive periodic physical therapy schedules did not differ in improvements in motor function and other outcomes in children with cerebral palsy.

Future Research Needs

Future research could examine how to better recruit and retain patients with cerebral palsy in studies comparing physical therapy schedules.