title: Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial.
abstract: This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.
authors.affiliation: Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia. Electronic address: rachel.thomas@health.qld.gov.au.
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Thomas
authors.affiliation: Division of Physiotherapy, School of Health & Rehabilitation Sciences, The University of Queensland, Brisbane, Australia.
authors.forename: Leanne M
authors.initials: LM
authors.lastname: Johnston
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Leanne
authors.initials: L
authors.lastname: Sakzewski
authors.affiliation: Queensland Paediatric Rehabilitation Service, Lady Cilento Children's Hospital, Brisbane, Australia.
authors.forename: Megan J
authors.initials: MJ
authors.lastname: Kentish
authors.affiliation: Queensland Cerebral Palsy and Rehabilitation Research Centre, School of Medicine, The University of Queensland, Brisbane, Australia.
authors.forename: Roslyn N
authors.initials: RN
authors.lastname: Boyd
mesh_terms: D001315:Australia; D019274:Botulinum Toxins, Type A / Q000627:therapeutic use*; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002675:Child, Preschool; D003131:Combined Modality Therapy; D003695:Delivery of Health Care; D005260:Female; D006801:Humans; D007273:Injections, Intramuscular; D035002:Lower Extremity; D008297:Male; D009465:Neuromuscular Agents / Q000627:therapeutic use*; D026741:Physical Therapy Modalities; D016037:Single-Blind Method; D016896:Treatment Outcome
chemical_list: D009465:Neuromuscular Agents; D019274:Botulinum Toxins, Type A
keywords: Botulinum Toxin-A; Cerebral palsy; Lower limb; Model of care; Physiotherapy