Is more frequent physical therapy associated with increased gross motor improvement in children with cerebral palsy? A national prospective cohort study

Abstract

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.

Keywords:

• Cerebral palsy
• physical therapy frequency
• gross motor improvement
• cohort
• GMFM-66 reference percentiles
• CPRN/CPOP

Acknowledgements

We thank all the children and their families who participate in CPRN and CPOP and thus made our research possible.

Disclosure statement

The authors report no conflicts of interest.

Additional information

Funding

The main funding for the study was provided by the Sophie Minde Foundation. One of the authors (Dr Jahnsen) also received a minor contribution from the Norwegian Fund for Post-graduate Training in Physiotherapy.