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Does dosage matter? A pilot study of hand-arm bimanual intensive training (HABIT) dose and dosing schedule in children with unilateral cerebral palsy
Brandao MB, Mancini MC, Ferre CL, Figueiredo PRP, Oliveira RHS, Goncalves SC, Dias MCS, Gordon AM
Physical & Occupational Therapy in Pediatrics 2018;38(3):227-242
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: Yes; Adequate follow-up: Yes; Intention-to-treat analysis: No; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

AIM: We compared the efficacy of hand-arm bimanual intensive training (HABIT) in two doses (90 versus 45 hours) and two schedules of the same dose (90 versus 2x45 hours) on hand and daily functioning. METHOD: Eighteen children with unilateral cerebral palsy were randomized to receive 6 hours of daily training over 3 weeks, totaling 90 hours (group 90, n = 9) or receive 6 hours of daily training over 1.5 weeks, totaling 45 hours (group 2x45, n = 9). After 6 months, group 2x45 received an additional 45 hours. Hand (Jebsen-Taylor Test of Hand Function, Assisting Hand Assessment) and daily functioning tests (Canadian Occupational Performance Measure, Pediatric Evaluation of Disability Inventory) were administered before, immediately after, and 6 months after interventions. RESULTS: Both groups demonstrated significant improvements in hand and daily functioning after 90 hours (group 90) or the first 45 hours (group 2x45), without differences between groups. However, more children from group 90 obtained smallest detectable differences in the Assisting Hand Assessment. The addition of the second bout of 45 hours (group 2x45) did not lead to further improvements. CONCLUSIONS: As this study was powered to test for large differences between groups, future investigations on larger samples will be needed to compare differences at the two dosage levels.
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