Train, gain and maintain: Maintenance of functional gains following an 8-week goal-directed training program for children with cerebral palsy

Abstract

Background and Objective(s): Children with cerebral palsy (CP) who participated in an 8-week waitlist randomized controlled trial (RCT), 'Let's Ride a Bike!', demonstrated significant and meaningful improvements in goal performance, satisfaction and gross motor function. All RCT participants completed the intervention. The aim of this study was to determine whether functional gains could be maintained 8-weeks after completing the 'Let's Ride a Bike!' program. Study Design: Longitudinal analysis of RCT data. Study Participants & Setting: Twenty children with CP (10.3±3.0y; GMFCS level: II=5, III=6, IV=9) completed the 'Let's Ride a Bike!' program at a tertiary children's hospital in Brisbane, Australia between December 2017 and August 2019. Materials/Methods: Participants in the 'Let's Ride a Bike!' program completed 24 hours of training across 8 weeks, including 2-1-hour hospital-based sessions, and a 1-hour home program per week. Hospital sessions included 30 minutes of functional electrical stimulation (FES) cycling and 30 minutes of goal-directed exercises. The home exercise program included adapted cycling and similar goal-directed exercises. Functional outcomes were assessed at three time points: immediately pre-training (T1), after 8-weeks receiving training (T2) and at 8-weeks after the last training session (T3). Primary outcomes were the Gross Motor Function Measure (GMFM) and Canadian Occupational Performance Measure (COPM). Secondary outcomes were the Paediatric Evaluation of Disability Inventory (PEDI-CAT) and cycling power output. Pooled data from the intervention and waitlist control groups were analysed using one-way repeated measures ANOVA with a post hoc test (Bonferroni adjustment) to determine whether there was a change in functional outcomes across time points. Statistical analyses were performed in SPSS v25 (IBM). Results: The training program resulted in statistically significant functional improvements over time. Gross motor function significantly improved from T1 to T2 (7.5 [95% CI, 3.7-11.2], p<0.001) and was maintained from T2 to T3 (-1.1 [95% CI, -4.0 to 1.8-, p=1.00). COPM scores improved significantly from T1 to T2 for goal performance (4.6 [95% CI, 3.7-5.5], p<0.001) and satisfaction (5.1 [95% CI, 3.4-6.2], p<0.001), and were maintained from T2 to T3 (-1.8 [95% CI, -1.0 to 0.6], p=1.00) and (-0.5 [95% CI, -1.3 to 0.4], p=0.5) respectively. Scores on the PEDICAT daily activities domain improved significantly from T1 to T2 (0.9 [95% CI, 0.1-1.7], p=0.03) and were maintained from T2 to T3 (-0.6 [95% CI, -1.8 to 0.5], p=0.47). Similarly, cycling power increased significantly from T1 to T2 (27.2 [95% CI, 12.8-41.5], p<.001) and was maintained from T2 to T3 (-6.7 [95% CI, -16.1 to 2.8], p=0.24). Conclusions/Significance: Functional improvements gained during an 8-week goal-directed training program of FES-cycling, adapted cycling and goal-directed training can be maintained 8-weeks after program completion. These important results provide additional support for an alternative therapy approach for children with CP who are susceptible to functional decline.L6338698972021-01-13 <br />