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Impact of intensive upper limb rehabilitation on quality of life: a randomized trial in children with unilateral cerebral palsy [with consumer summary]
Sakzewski L, Carlon S, Shields N, Ziviani J, Ware RS, Boyd RN
Developmental Medicine and Child Neurology 2012 May;54(5):415-423
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*

AIM: The aim of this study was to determine whether constraint-induced movement therapy is more effective than bimanual training in improving the quality of life of children with unilateral cerebral palsy (CP). METHOD: Sixty-three children (mean age 10 y 2 mo (SD 2 y 6 mo); 33 males, 30 females) with CP of the spastic motor type (n = 59) or with spasticity and dystonia (n = 4) were randomly allocated to two groups. The children were assessed as Manual Ability Classification System level I (n = 16), II (n = 46), or III (n = 1). Each group received 6 hours of daily intervention (either constraint-induced movement therapy (CIMT) or bimanual training (BIM)) for 10 days over a 2-week period (total intervention time 60h). Children aged 9 years and older completed the Cerebral Palsy Quality of Life Questionnaire for Children (CPQOL-Child) and those aged 8 years and older completed the KIDSCREEN-52. All parents completed proxy versions of each measure. Assessments were made at baseline and at 3, 26, and 52 weeks after the end of the intervention. RESULTS: Thirty-five children completed the CPQOL-Child and 41 completed the KIDSCREEN-52. No changes in social or emotional well-being were reported by children in either group. Children and parents from both groups reported a significant improvement in their or their child's feelings about functioning as well as participation and physical health on the CPQOL-Child. The parents of children receiving CIMT reported positive and sustained changes in their child's social well-being (CPQOL-Child). The CIMT group showed significant improvements in physical well-being, psychological well-being, and moods and emotions (KIDSCREEN-52) at 3 weeks post intervention, which were maintained over the study period. INTERPRETATION: Intensive goal-directed upper limb training programmes using either CIMT or BIM achieved domain-specific changes in quality of life relating to feelings about functioning and participation and physical health. A condition-specific quality of life compared with a generic measure may be better able to detect changes in quality of life in children with unilateral CP.

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