Is more frequent physical therapy associated with increased gross motor improvement in children with cerebral palsy? A national prospective cohort study
Journal article, Peer reviewed
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Original versionDisability and Rehabilitation. 2018, . 10.1080/09638288.2018.1528635
Purpose: To investigate the association between physical therapy frequency and gross motor improvement in children with cerebral palsy (CP). Materials and methods: This is a prospective cohort study of 442 children aged 2–12 years, Gross Motor Function Classification System levels I–V, from the Cerebral Palsy Follow-up Program and the Cerebral Palsy Register of Norway. Outcome was change in reference percentiles for the Gross Motor Function Measure (GMFM-66) between two subsequent assessments (N = 1056) analyzed in a linear mixed model. Results: It was a dose response association between physical therapy frequency and gross motor improvement. Mean change was 4.2 (95% CI: 1.4–7.1) percentiles larger for physical therapy 1–2 times per week and 7.1 (95% CI: 2.6–11.6) percentiles larger for physical therapy >2 times per week, compared to less frequent physical therapy when analyzed in a multivariable model including multiple child and intervention factors. The only statistically significant confounder was number of contractures which was negatively associated with gross motor improvement. Conclusions: When gross motor improvement is a goal for children with CP, more frequent physical therapy should be considered. Implications for rehabilitation - In general, the gross motor development of Norwegian children with cerebral palsy was as expected according to the reference percentiles for the GMFM-66. - When gross motor improvement is a goal for children with cerebral palsy, high-frequency physical therapy should be considered. - Contractures should be addressed in order to optimize gross motor improvement for children with cerebral palsy.