title: 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.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  METHODS
  An evaluator-blinded, randomized controlled trial.
  
  
  METHODS
  Outpatient rehabilitation unit.
  
  
  METHODS
  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).
  
  
  CONCLUSIONS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Rehabilitation Sciences and Physiotherapy, Ghent University, Gent, Belgium - inge.franki@kuleuven.be.
authors.forename: I
authors.initials: I
authors.lastname: Franki
authors.forename: K
authors.initials: K
authors.lastname: Desloovere
authors.forename: J
authors.initials: J
authors.lastname: De Cat
authors.forename: W
authors.initials: W
authors.lastname: Tijhuis
authors.forename: G
authors.initials: G
authors.lastname: Molenaers
authors.forename: H
authors.initials: H
authors.lastname: Feys
authors.forename: G
authors.initials: G
authors.lastname: Vanderstraeten
authors.forename: C
authors.initials: C
authors.lastname: Van Den Broeck
mesh_terms: D001530:Belgium; D002547:Cerebral Palsy / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D026741:Physical Therapy Modalities; D057285:Precision Medicine; D011379:Prognosis; D011597:Psychomotor Performance