Adding parent-delivered therapy does not improve upper limb function more than repeated practice alone in children with cerebral palsy [commentary]

摘要

Summary of: Kirkpatrick E, Pearse J, James P, Basu A. Effect of parent-delivered action observation therapy on upper limb function in unilateral cerebral palsy: a randomized controlled trial. Dev Med Child Neuro 2016; doi: 10.1111/dmcn.13109. Question: Does parent-delivered action observation therapy improve hand function in children with unilateral cerebral palsy? Design: Randomised, controlled trial with concealed allocation and blinded outcome assessment. Setting: One tertiary hospital centre in England. Participants: Children aged 3 to 10 years with unilateral cerebral palsy predominantly affecting arm and hand function. Children with no active grasp in the affected hand or who had undergone or were about to undergo another intervention were excluded. Randomisation of 70 participants allocated 35 to an action observation and repeated D[D3T_$IFF]practice group and 35 to a repeated D[D3T_$IFF]practice only group. Interventions: Both groups received an individualised parent-delivered home-based play therapy program based on repeated movement 3F_$TIDD[F]practice. Each child received about 12 tailored activities. The control group played independently with parent supervision. Children in the interven- tion group watched a parent perform the movement each time before attempting it. Both groups were asked to complete 15 minutes of play daily, 5 days a week for 3 months. Families were telephoned fortnightly and received a home visit at 6 weeks.1836-9553/ 2016 Australian Physiotherapy Association. Published by Elsevier B creativecommons.org/licenses/by-nc-nd/4.0/).Outcome measures: The primary outcome was change in spontaneous use of the affected hand in bimanual activities (Assisting Hand Assessment) at 3 and 6 months. Secondary outcomes were unimanual capacity (Melbourne Assessment 2) and hand function in activities of daily living (ABILHAND-Kids questionnaire). Results: Fifty-nine participants completed the study. Adherence was 80% in the intervention group and 92% in the control group. There was no difference in change scores between the groups for the primary outcome at 3 months ( [T4$_DDIFF]MD 0.6 units 95% [T5$_DDIFF]CI C0.7 to 1.9), at 6 months ( 4T[_DD$IFF]MD 0.5 units 95% _[D5T$DIFF]CI C1.4 to 2.4), or for any secondary outcome. Conclusion: There were no differences in hand function among children with unilateral cerebral palsy after a home-based parent-delivered action observation and repeated DFD_T[$3IF]practice therapy program compared to repeated [3D_DT$IFF]practice only. [Adherence rates, [6D_DT$IFF]MD and 95% CI calculated by the CAP Editor] Provenance: Invited. Not peer reviewed. Nora Shields Department of Physiotherapy, La Trobe University and Northern Health, Australia http://dx.doi.org/10.1016/j.jphys.2016.07.003.