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Participation outcomes in a randomized trial of 2 models of upper-limb rehabilitation for children with congenital hemiplegia
Sakzewski L, Ziviani J, Abbott DF, Macdonell RA, Jackson GD, Boyd RN
Archives of Physical Medicine and Rehabilitation 2011 Apr;92(4):531-539
clinical trial
7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed*

OBJECTIVE: To determine if constraint-induced movement therapy (CIMT) is more effective than bimanual training to improve occupational performance and participation in children with congenital hemiplegia. DESIGN: Single-blind randomized comparison trial with evaluations at baseline, 3, and 26 weeks. SETTING: Community facilities in 2 Australian states. PARTICIPANTS: Referred sample of children (n = 64; mean age +/- SD 10.2 +/- 2.7y, 52% boys) were matched for age, sex, side of hemiplegia, and upper-limb function and were randomized to CIMT or bimanual training. After random allocation, 100% of CIMT and 94% of the bimanual training group completed the intervention. INTERVENTIONS: Each intervention was delivered in day camps (total 60 h over 10d) using a circus theme with goal-directed training. Children receiving CIMT wore a tailor-made glove during the camp. MAIN OUTCOME MEASURES: The primary outcome was the Canadian Occupational Performance Measure (COPM). Secondary measures included the Assessment of Life Habits (LIFE-H), Children's Assessment of Participation and Enjoyment, and School Function Assessment. RESULTS: There were no between-group differences at baseline. Both groups made significant changes for COPM performance at 3 weeks (estimated mean difference 2.9; 95% confidence interval (CI) 2.3 to 3.6; p < 0.001 for CIMT; estimated mean difference 2.8; 95% CI 2.2 to 3.4; p < 0.001 for bimanual training) that were maintained at 26 weeks. Significant gains were made in the personal care LIFE-H domain following CIMT (estimated mean difference 0.5; 95% CI 0.1 to 0.9; p = 0.01) and bimanual training (estimated mean difference 0.6; 95% CI 0.2 to 1.1; p = 0.006). CONCLUSIONS: There were minimal differences between the 2 training approaches. Goal-directed, activity-based, upper-limb training, addressed through either CIMT or bimanual training achieved gains in occupational performance. Changes in participation on specific domains of participation assessments appear to correspond with identified goals.

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