Add-on Home-Centered Activity-Based Therapy vs Conventional Physiotherapy in Improving Walking Ability at 6-Months in Children With Diplegic Cerebral Palsy: A Randomized Controlled Trial

Background Institutional physiotherapy as a standard of care for management of cerebral palsy (CP) has certain shortcomings, especially in resource-constrained settings. This is a proof-of-concept trial to evaluate the efficacy of individualized home-centered activity-based therapy in children with spastic diplegic CP. Design Randomized controlled trial (open-label). Settings Tertiary-care hospital with pediatric neurology services (July, 2014 to July, 2016). Participants Consecutive sample of 59 children (5–12 y) with spastic diplegic CP (Gross Motor Function Classification System scores II–III) without fixed lower-limb contractures, illnesses impeding physiotherapy or history of recent botulinum toxin injection/surgery were recruited. Procedure Children were randomized to Intervention or Control arms. Their 6-minute-walk Test (6MWT) scoring and clinical examination were performed at baseline, 3 and 6 months. Children in Intervention arm ( n =30) were prescribed parent-supervised home-centered activity-based therapy (walking, standing, squatting, climbing upstairs/downstairs, kicking a ball, dancing, riding a tricycle/bicycle) in addition to their institutional physiotherapy. Children in Control arm ( n =29) were prescribed ongoing institutional physiotherapy alone. Logbooks, home videos and telephonic follow-ups were used to ensure compliance. Main outcome measures Comparison of the mean change in 6MWT scores at 6 months (from baseline) between the two groups. Results Median (IQR) change in 6MWT scores at 6 months (from baseline) in the Intervention and Control arms were 3.5 (−5.3, 9) m and 3 (−7.8, 6.3) m Conclusions Adjunct home-centered activity-based therapy was safe and feasible, but did not result in appreciable gains over 6 months.