title: Efficacy of three therapy approaches in preschool children with cerebral palsy: a randomized controlled trial.
abstract: OBJECTIVE
  To examine the efficacy of child-focused, context-focused, and regular care approaches, delivered in a rehabilitation setting by physical or occupational therapists to preschool children with cerebral palsy (CP), in optimizing the child's self-care and mobility capabilities.
  
  
  METHODS
  A multicentre randomized controlled trial clustered at therapist level was conducted in 13 rehabilitation centres. It included 68 children with CP (38 males, 30 females; mean age 3y, SD 6mo, range 1y 11mo-4y), classified as Gross Motor Function Classification System levels I to IV, who were already receiving therapy. Children received a child-focused, context-focused, or regular care approach during a 6-month period. Self-care and mobility capabilities were assessed with the Functional Skills Scale of the Pediatric Evaluation of Disability Inventory.
  
  
  RESULTS
  The child-focused, context-focused, and regular care approaches all resulted in significant but similar improvements in self-care (regular: reference; child-focused: β=-0.11, 95% confidence interval [CI] -0.68 to 0.46; context-focused: β=0.13, CI -0.38 to 0.64) and mobility (regular: reference; child-focused: β=-0.09, CI=-0.93 to 0.75; and context-focused: β=0.14, CI -0.65 to 0.94) capabilities.
  
  
  CONCLUSIONS
  The results suggest that the three therapy approaches were equally efficacious for preschool children with CP. Depending on a child's individual situation each approach can be selected.
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
authors.forename: Anne J A
authors.initials: AJA
authors.lastname: Kruijsen-Terpstra
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
authors.forename: Marjolijn
authors.initials: M
authors.lastname: Ketelaar
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
authors.forename: Olaf
authors.initials: O
authors.lastname: Verschuren
authors.affiliation: CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, ON, Canada.
authors.forename: Jan Willem
authors.identifier: http://orcid.org/0000-0002-3012-2119
authors.initials: JW
authors.lastname: Gorter
authors.affiliation: Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, the Netherlands.
authors.forename: Rimke C
authors.initials: RC
authors.lastname: Vos
authors.affiliation: BOSK, Association of People with a Physical Disability, Utrecht, the Netherlands.
authors.forename: Johannes
authors.initials: J
authors.lastname: Verheijden
authors.affiliation: Faculty of Social and Behavioural Sciences, Department of Child, Family & Education Studies, Utrecht University, Utrecht, the Netherlands.
authors.forename: Marian J
authors.initials: MJ
authors.lastname: Jongmans
authors.affiliation: Brain Center Rudolf Magnus and Center of Excellence for Rehabilitation Medicine, University Medical Center Utrecht and De Hoogstraat Rehabilitation, Utrecht, the Netherlands.
authors.forename: Anne
authors.initials: A
authors.lastname: Visser-Meily