title: Strength Training for Adolescents with cerebral palsy (STAR): study protocol of a randomised controlled trial to determine the feasibility, acceptability and efficacy of resistance training for adolescents with cerebral palsy.
abstract: Gait is inefficient in children with cerebral palsy, particularly as they transition to adolescence. Gait inefficiency may be associated with declines in gross motor function and participation among adolescents with cerebral palsy. Resistance training may improve gait efficiency through a number of biomechanical and neural mechanisms. The aim of the Strength Training for Adolescents with cerebral palsy (STAR) trial is to evaluate the effect of resistance training on gait efficiency, activity and participation in adolescents with cerebral palsy. We also aim to determine the biomechanical and neural adaptations that occur following resistance training and evaluate the feasibility and acceptability of such an intervention for adolescents with cerebral palsy.
  
  
  
  60 adolescents (Gross Motor Function Classification System level I-III) will be randomised to a 10-week resistance training group or a usual care control group according to a computer-generated random schedule. The primary outcome is gait efficiency. Secondary outcomes are habitual physical activity, participation, muscle-tendon mechanics and gross motor function. General linear models will be used to evaluate differences in continuous data between the resistance training and usual care groups at 10 and 22 weeks, respectively. A process evaluation will be conducted alongside the intervention. Fidelity of the resistance training programme to trial protocol will be quantified by observations of exercise sessions. Semistructured interviews will be conducted with participants and physiotherapists following the resistance training programme to determine feasibility and acceptability of the programme.
  
  
  
  This trial has ethical approval from Brunel University London's Department of Clinical Sciences' Research Ethics Committee and the National Research Ethics Service (NRES) Committee London-Surrey Borders. The results of the trial will be submitted for publication in academic journals, presented at conferences and distributed to adolescents, families and healthcare professionals through the media with the assistance of the STAR advisory group.
  
  
  
  ISRCTN90378161; Pre-results.
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, UK.
authors.forename: Jennifer M
authors.initials: JM
authors.lastname: Ryan
authors.affiliation: School of Sport, Health and Applied Science, St. Mary's University, Twickenham, UK.
authors.forename: Nicola
authors.initials: N
authors.lastname: Theis
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, UK.
authors.forename: Cherry
authors.initials: C
authors.lastname: Kilbride
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, UK.
authors.forename: Vasilios
authors.initials: V
authors.lastname: Baltzopoulos
authors.affiliation: Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Charlie
authors.initials: C
authors.lastname: Waugh
authors.affiliation: One Small Step Gait Laboratory, Guy's Hospital, Guy's and St. Thomas' NHS Foundation Trust, London, UK.
authors.forename: Adam
authors.initials: A
authors.lastname: Shortland
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, UK.
authors.forename: Grace
authors.initials: G
authors.lastname: Lavelle
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, UK.
authors.forename: Marika
authors.initials: M
authors.lastname: Noorkoiv
authors.affiliation: Department of Physiotherapy, Royal Free London NHS Foundation Trust, Swiss Cottage School Development and Research Centre, London, UK.
authors.forename: Wendy
authors.initials: W
authors.lastname: Levin
authors.affiliation: College of Health and Life Sciences, Brunel University London, London, UK.
authors.forename: Thomas
authors.initials: T
authors.lastname: Korff
mesh_terms: D000293:Adolescent; D000328:Adult; D002547:Cerebral Palsy / Q000503:physiopathology / Q000628:therapy*; D002648:Child; D015444:Exercise; D005081:Exercise Therapy; D005684:Gait; D006801:Humans; D053580:Muscle Strength; D018482:Muscle, Skeletal / Q000503:physiopathology*; D010342:Patient Acceptance of Health Care; D012107:Research Design; D055070:Resistance Training; D016037:Single-Blind Method; D016896:Treatment Outcome; D016138:Walking; D055815:Young Adult
keywords: PAEDIATRICS; QUALITATIVE RESEARCH; REHABILITATION MEDICINE