Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?: A Randomized, Controlled Trial
BackgroundCerebral palsy is the most common cause of childhood physical disability in developed countries, affecting two children per 1000 live births. Hip displacement affects about one-third of children with cerebral palsy and may result in pain, deformity, and impaired function. The prevention of...
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| Veröffentlicht in: | Journal of bone and joint surgery. American volume 2008-01, Vol.90 (1), p.23-33 |
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| creator | Graham, H Kerr Boyd, Roslyn Carlin, John B Dobson, Fiona Lowe, Kevin Nattrass, Gary Thomason, Pam Wolfe, Rory Reddihough, Dinah |
| description | BackgroundCerebral palsy is the most common cause of childhood physical disability in developed countries, affecting two children per 1000 live births. Hip displacement affects about one-third of children with cerebral palsy and may result in pain, deformity, and impaired function. The prevention of hip displacement has not been studied in a randomized trial as far as we know.MethodsA randomized, controlled trial was conducted to examine the effect of intramuscular injections of botulinum toxin A combined with use of a variable hip abduction brace on the progression of hip displacement in children with cerebral palsy. The patients in the treatment group received injections of botulinum toxin A to the adductor and hamstring muscles every six months for three years and were prescribed a hip abduction brace to be worn for six hours per day. In the control group, no hip bracing was used nor were injections performed. The primary outcome measure was hip displacement from the acetabulum as determined by serial measurements of the migration percentage.ResultsNinety children with bilateral cerebral palsy and so-called hips at risk (a migration percentage of >10% but |
| doi_str_mv | 10.2106/JBJS.F.01416 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_19896149</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>19896149</sourcerecordid><originalsourceid>FETCH-LOGICAL-c2675-750e631631da599a4a5fa25147ec4412f8a05c2b58a65e609f38fd12a71ac8f13</originalsourceid><addsrcrecordid>eNpFkc9u1DAQxi0Eokvhxhn5Aqdm8Th2_nCpummXUlWiKss5mk0mrKmTLHbCtpz6IPTl-iR42RVIlkae-X3zSfMx9hrEVIJI3l_MLr5M51MBCpInbAI61hHEWfKUTYSQEOWx1gfshfffhRBKifQ5O4AMUsi1mrCH0548n_XDaE03tnzR35qOn_Cib5emo5pvzLDiM4eV6b7xK0c_qRv4uVnzU-PXFitqt42gKVbG1o66naIgR0uHll-h9Xccu5o_3v8OOs9x4NfG3zzePxx_CE7XYda35hfVR8G1G1xvbfBdOIP2JXvWBD292tdD9nV-tijOo8vPHz8VJ5dRJZNUR6kWlMQQXo06z1GhblBqUClVSoFsMhS6kkudYaIpEXkTZ00NElPAKmsgPmTvdnvXrv8xkh_K1viKrMWO-tGXkGd5AioP4NEOrFzvvaOmXDvTorsrQZTbOMptHOW8_BtHwN_s947Llur_8P7-AXi7B9BXaBuHXWX8P05KJSFRMnBqx216O5DzN3bckCtXhHZYlWKbbCLjSAqRCQi_aNvS8R9QXqO5</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>19896149</pqid></control><display><type>article</type><title>Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?: A Randomized, Controlled Trial</title><source>MEDLINE</source><source>Alma/SFX Local Collection</source><creator>Graham, H Kerr ; Boyd, Roslyn ; Carlin, John B ; Dobson, Fiona ; Lowe, Kevin ; Nattrass, Gary ; Thomason, Pam ; Wolfe, Rory ; Reddihough, Dinah</creator><creatorcontrib>Graham, H Kerr ; Boyd, Roslyn ; Carlin, John B ; Dobson, Fiona ; Lowe, Kevin ; Nattrass, Gary ; Thomason, Pam ; Wolfe, Rory ; Reddihough, Dinah</creatorcontrib><description>BackgroundCerebral palsy is the most common cause of childhood physical disability in developed countries, affecting two children per 1000 live births. Hip displacement affects about one-third of children with cerebral palsy and may result in pain, deformity, and impaired function. The prevention of hip displacement has not been studied in a randomized trial as far as we know.MethodsA randomized, controlled trial was conducted to examine the effect of intramuscular injections of botulinum toxin A combined with use of a variable hip abduction brace on the progression of hip displacement in children with cerebral palsy. The patients in the treatment group received injections of botulinum toxin A to the adductor and hamstring muscles every six months for three years and were prescribed a hip abduction brace to be worn for six hours per day. In the control group, no hip bracing was used nor were injections performed. The primary outcome measure was hip displacement from the acetabulum as determined by serial measurements of the migration percentage.ResultsNinety children with bilateral cerebral palsy and so-called hips at risk (a migration percentage of >10% but <40%) were entered into the study. Fifty-nine patients were boys, and the mean age was three years. Progressive hip displacement, as determined by serial measurements of the migration percentage, was found in both the treatment and control groups. The rate of hip displacement was reduced in the treatment group by 1.4% per year (95% confidence interval, −0.6% to 3.4%; p = 0.16) when weighted for the uncertainty in rates due to the differing numbers of migration percentage measurements per subject.ConclusionsThere may be a small treatment benefit for the combined intervention of intramuscular injection of botulinum toxin A and abduction hip bracing in the management of spastic hip displacement in children with cerebral palsy. However, progressive hip displacement continued to occur in the treatment group, and our data do not support recommending this treatment.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.</description><identifier>ISSN: 0021-9355</identifier><identifier>EISSN: 1535-1386</identifier><identifier>DOI: 10.2106/JBJS.F.01416</identifier><identifier>PMID: 18171954</identifier><identifier>CODEN: JBJSA3</identifier><language>eng</language><publisher>Boston, MA: Copyright by The Journal of Bone and Joint Surgery, Incorporated</publisher><subject>Biological and medical sciences ; Botulinum Toxins, Type A - adverse effects ; Botulinum Toxins, Type A - therapeutic use ; Braces ; Cerebral Palsy - complications ; Cerebral Palsy - diagnosis ; Child, Preschool ; Combined Modality Therapy ; Diseases of the osteoarticular system ; Dose-Response Relationship, Drug ; Drug Administration Schedule ; Female ; Follow-Up Studies ; Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy ; Hip Dislocation, Congenital - complications ; Hip Dislocation, Congenital - diagnosis ; Hip Dislocation, Congenital - therapy ; Humans ; Infant ; Injections, Intramuscular ; Linear Models ; Male ; Medical sciences ; Nervous system (semeiology, syndromes) ; Neurology ; Orthopedic surgery ; Probability ; Range of Motion, Articular - physiology ; Reference Values ; Risk Assessment ; Severity of Illness Index ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Treatment Outcome</subject><ispartof>Journal of bone and joint surgery. American volume, 2008-01, Vol.90 (1), p.23-33</ispartof><rights>Copyright 2008 by The Journal of Bone and Joint Surgery, Incorporated</rights><rights>2015 INIST-CNRS</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><cites>FETCH-LOGICAL-c2675-750e631631da599a4a5fa25147ec4412f8a05c2b58a65e609f38fd12a71ac8f13</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,4022,27922,27923,27924</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=22421642$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18171954$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Graham, H Kerr</creatorcontrib><creatorcontrib>Boyd, Roslyn</creatorcontrib><creatorcontrib>Carlin, John B</creatorcontrib><creatorcontrib>Dobson, Fiona</creatorcontrib><creatorcontrib>Lowe, Kevin</creatorcontrib><creatorcontrib>Nattrass, Gary</creatorcontrib><creatorcontrib>Thomason, Pam</creatorcontrib><creatorcontrib>Wolfe, Rory</creatorcontrib><creatorcontrib>Reddihough, Dinah</creatorcontrib><title>Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?: A Randomized, Controlled Trial</title><title>Journal of bone and joint surgery. American volume</title><addtitle>J Bone Joint Surg Am</addtitle><description>BackgroundCerebral palsy is the most common cause of childhood physical disability in developed countries, affecting two children per 1000 live births. Hip displacement affects about one-third of children with cerebral palsy and may result in pain, deformity, and impaired function. The prevention of hip displacement has not been studied in a randomized trial as far as we know.MethodsA randomized, controlled trial was conducted to examine the effect of intramuscular injections of botulinum toxin A combined with use of a variable hip abduction brace on the progression of hip displacement in children with cerebral palsy. The patients in the treatment group received injections of botulinum toxin A to the adductor and hamstring muscles every six months for three years and were prescribed a hip abduction brace to be worn for six hours per day. In the control group, no hip bracing was used nor were injections performed. The primary outcome measure was hip displacement from the acetabulum as determined by serial measurements of the migration percentage.ResultsNinety children with bilateral cerebral palsy and so-called hips at risk (a migration percentage of >10% but <40%) were entered into the study. Fifty-nine patients were boys, and the mean age was three years. Progressive hip displacement, as determined by serial measurements of the migration percentage, was found in both the treatment and control groups. The rate of hip displacement was reduced in the treatment group by 1.4% per year (95% confidence interval, −0.6% to 3.4%; p = 0.16) when weighted for the uncertainty in rates due to the differing numbers of migration percentage measurements per subject.ConclusionsThere may be a small treatment benefit for the combined intervention of intramuscular injection of botulinum toxin A and abduction hip bracing in the management of spastic hip displacement in children with cerebral palsy. However, progressive hip displacement continued to occur in the treatment group, and our data do not support recommending this treatment.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.</description><subject>Biological and medical sciences</subject><subject>Botulinum Toxins, Type A - adverse effects</subject><subject>Botulinum Toxins, Type A - therapeutic use</subject><subject>Braces</subject><subject>Cerebral Palsy - complications</subject><subject>Cerebral Palsy - diagnosis</subject><subject>Child, Preschool</subject><subject>Combined Modality Therapy</subject><subject>Diseases of the osteoarticular system</subject><subject>Dose-Response Relationship, Drug</subject><subject>Drug Administration Schedule</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</subject><subject>Hip Dislocation, Congenital - complications</subject><subject>Hip Dislocation, Congenital - diagnosis</subject><subject>Hip Dislocation, Congenital - therapy</subject><subject>Humans</subject><subject>Infant</subject><subject>Injections, Intramuscular</subject><subject>Linear Models</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Nervous system (semeiology, syndromes)</subject><subject>Neurology</subject><subject>Orthopedic surgery</subject><subject>Probability</subject><subject>Range of Motion, Articular - physiology</subject><subject>Reference Values</subject><subject>Risk Assessment</subject><subject>Severity of Illness Index</subject><subject>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</subject><subject>Treatment Outcome</subject><issn>0021-9355</issn><issn>1535-1386</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2008</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpFkc9u1DAQxi0Eokvhxhn5Aqdm8Th2_nCpummXUlWiKss5mk0mrKmTLHbCtpz6IPTl-iR42RVIlkae-X3zSfMx9hrEVIJI3l_MLr5M51MBCpInbAI61hHEWfKUTYSQEOWx1gfshfffhRBKifQ5O4AMUsi1mrCH0548n_XDaE03tnzR35qOn_Cib5emo5pvzLDiM4eV6b7xK0c_qRv4uVnzU-PXFitqt42gKVbG1o66naIgR0uHll-h9Xccu5o_3v8OOs9x4NfG3zzePxx_CE7XYda35hfVR8G1G1xvbfBdOIP2JXvWBD292tdD9nV-tijOo8vPHz8VJ5dRJZNUR6kWlMQQXo06z1GhblBqUClVSoFsMhS6kkudYaIpEXkTZ00NElPAKmsgPmTvdnvXrv8xkh_K1viKrMWO-tGXkGd5AioP4NEOrFzvvaOmXDvTorsrQZTbOMptHOW8_BtHwN_s947Llur_8P7-AXi7B9BXaBuHXWX8P05KJSFRMnBqx216O5DzN3bckCtXhHZYlWKbbCLjSAqRCQi_aNvS8R9QXqO5</recordid><startdate>20080101</startdate><enddate>20080101</enddate><creator>Graham, H Kerr</creator><creator>Boyd, Roslyn</creator><creator>Carlin, John B</creator><creator>Dobson, Fiona</creator><creator>Lowe, Kevin</creator><creator>Nattrass, Gary</creator><creator>Thomason, Pam</creator><creator>Wolfe, Rory</creator><creator>Reddihough, Dinah</creator><general>Copyright by The Journal of Bone and Joint Surgery, Incorporated</general><general>Journal of Bone and Joint Surgery Incorporated</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7U7</scope><scope>C1K</scope></search><sort><creationdate>20080101</creationdate><title>Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?: A Randomized, Controlled Trial</title><author>Graham, H Kerr ; Boyd, Roslyn ; Carlin, John B ; Dobson, Fiona ; Lowe, Kevin ; Nattrass, Gary ; Thomason, Pam ; Wolfe, Rory ; Reddihough, Dinah</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c2675-750e631631da599a4a5fa25147ec4412f8a05c2b58a65e609f38fd12a71ac8f13</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2008</creationdate><topic>Biological and medical sciences</topic><topic>Botulinum Toxins, Type A - adverse effects</topic><topic>Botulinum Toxins, Type A - therapeutic use</topic><topic>Braces</topic><topic>Cerebral Palsy - complications</topic><topic>Cerebral Palsy - diagnosis</topic><topic>Child, Preschool</topic><topic>Combined Modality Therapy</topic><topic>Diseases of the osteoarticular system</topic><topic>Dose-Response Relationship, Drug</topic><topic>Drug Administration Schedule</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy</topic><topic>Hip Dislocation, Congenital - complications</topic><topic>Hip Dislocation, Congenital - diagnosis</topic><topic>Hip Dislocation, Congenital - therapy</topic><topic>Humans</topic><topic>Infant</topic><topic>Injections, Intramuscular</topic><topic>Linear Models</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Nervous system (semeiology, syndromes)</topic><topic>Neurology</topic><topic>Orthopedic surgery</topic><topic>Probability</topic><topic>Range of Motion, Articular - physiology</topic><topic>Reference Values</topic><topic>Risk Assessment</topic><topic>Severity of Illness Index</topic><topic>Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Graham, H Kerr</creatorcontrib><creatorcontrib>Boyd, Roslyn</creatorcontrib><creatorcontrib>Carlin, John B</creatorcontrib><creatorcontrib>Dobson, Fiona</creatorcontrib><creatorcontrib>Lowe, Kevin</creatorcontrib><creatorcontrib>Nattrass, Gary</creatorcontrib><creatorcontrib>Thomason, Pam</creatorcontrib><creatorcontrib>Wolfe, Rory</creatorcontrib><creatorcontrib>Reddihough, Dinah</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Toxicology Abstracts</collection><collection>Environmental Sciences and Pollution Management</collection><jtitle>Journal of bone and joint surgery. American volume</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Graham, H Kerr</au><au>Boyd, Roslyn</au><au>Carlin, John B</au><au>Dobson, Fiona</au><au>Lowe, Kevin</au><au>Nattrass, Gary</au><au>Thomason, Pam</au><au>Wolfe, Rory</au><au>Reddihough, Dinah</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?: A Randomized, Controlled Trial</atitle><jtitle>Journal of bone and joint surgery. American volume</jtitle><addtitle>J Bone Joint Surg Am</addtitle><date>2008-01-01</date><risdate>2008</risdate><volume>90</volume><issue>1</issue><spage>23</spage><epage>33</epage><pages>23-33</pages><issn>0021-9355</issn><eissn>1535-1386</eissn><coden>JBJSA3</coden><abstract>BackgroundCerebral palsy is the most common cause of childhood physical disability in developed countries, affecting two children per 1000 live births. Hip displacement affects about one-third of children with cerebral palsy and may result in pain, deformity, and impaired function. The prevention of hip displacement has not been studied in a randomized trial as far as we know.MethodsA randomized, controlled trial was conducted to examine the effect of intramuscular injections of botulinum toxin A combined with use of a variable hip abduction brace on the progression of hip displacement in children with cerebral palsy. The patients in the treatment group received injections of botulinum toxin A to the adductor and hamstring muscles every six months for three years and were prescribed a hip abduction brace to be worn for six hours per day. In the control group, no hip bracing was used nor were injections performed. The primary outcome measure was hip displacement from the acetabulum as determined by serial measurements of the migration percentage.ResultsNinety children with bilateral cerebral palsy and so-called hips at risk (a migration percentage of >10% but <40%) were entered into the study. Fifty-nine patients were boys, and the mean age was three years. Progressive hip displacement, as determined by serial measurements of the migration percentage, was found in both the treatment and control groups. The rate of hip displacement was reduced in the treatment group by 1.4% per year (95% confidence interval, −0.6% to 3.4%; p = 0.16) when weighted for the uncertainty in rates due to the differing numbers of migration percentage measurements per subject.ConclusionsThere may be a small treatment benefit for the combined intervention of intramuscular injection of botulinum toxin A and abduction hip bracing in the management of spastic hip displacement in children with cerebral palsy. However, progressive hip displacement continued to occur in the treatment group, and our data do not support recommending this treatment.Level of EvidenceTherapeutic Level I. See Instructions to Authors for a complete description of levels of evidence.</abstract><cop>Boston, MA</cop><pub>Copyright by The Journal of Bone and Joint Surgery, Incorporated</pub><pmid>18171954</pmid><doi>10.2106/JBJS.F.01416</doi><tpages>11</tpages></addata></record> |
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| subjects | Biological and medical sciences Botulinum Toxins, Type A - adverse effects Botulinum Toxins, Type A - therapeutic use Braces Cerebral Palsy - complications Cerebral Palsy - diagnosis Child, Preschool Combined Modality Therapy Diseases of the osteoarticular system Dose-Response Relationship, Drug Drug Administration Schedule Female Follow-Up Studies Headache. Facial pains. Syncopes. Epilepsia. Intracranial hypertension. Brain oedema. Cerebral palsy Hip Dislocation, Congenital - complications Hip Dislocation, Congenital - diagnosis Hip Dislocation, Congenital - therapy Humans Infant Injections, Intramuscular Linear Models Male Medical sciences Nervous system (semeiology, syndromes) Neurology Orthopedic surgery Probability Range of Motion, Articular - physiology Reference Values Risk Assessment Severity of Illness Index Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Treatment Outcome |
| title | Does Botulinum Toxin A Combined with Bracing Prevent Hip Displacement in Children with Cerebral Palsy and “Hips at Risk”?: A Randomized, Controlled Trial |
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