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Factors Influencing the Gross Motor Outcome of Intensive Therapy in Children with Cerebral Palsy and Developmental Delay

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ABSTRACT

The study was designed to identify factors influencing the short term effect of intensive therapy on gross motor function in children with cerebral palsy or developmental delay. Retrospectively, total Gross Motor Function Measure-88 (GMFM-88) scores measured during the first and last weeks of intensive therapy were analyzed (n = 103). Good and poor responder groups were defined as those in the top and bottom 25% in terms of score difference, respectively. The GMFM-88 score increased to 4.67 ± 3.93 after 8 weeks of intensive therapy (P < 0.001). Gross Motor Function Classification System (GMFCS) level (I–II vs. IV–V; odds ratio [OR] = 7.763, 95% confidence interval [CI] = 2.177–27.682, P = 0.002) was a significant factor in a good response to therapy. Age (≥ 36 months; OR = 2.737, 95% CI = 1.003–7.471, P = 0.049) and GMFCS level (I–II vs. IV–V; OR = 0.189, 95% CI = 0.057–0.630, P = 0.007; and III vs. IV–V; OR = 0.095, 95% CI = 0.011–0.785, P = 0.029) were significantly associated with a poor response. GMFCS level is the most important prognostic factor for the effect of intensive therapy on gross motor function. In addition, age ≥ 36 months, is associated with a poor outcome.

No MeSH data available.


Differences in GMFM-88 score after 8 weeks of intensive therapy according to the GMFCS level.GMFM = gross motor function measure, GMFCS = gross motor function classification system.*,†,‡,§The post-hoc tests to identify the pairs of means that differ, P<0.05.
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Figure 2: Differences in GMFM-88 score after 8 weeks of intensive therapy according to the GMFCS level.GMFM = gross motor function measure, GMFCS = gross motor function classification system.*,†,‡,§The post-hoc tests to identify the pairs of means that differ, P<0.05.

Mentions: The mean difference in GMFM-88 score after 8 weeks of therapy was 4.67 ± 3.93 (P < 0.001). There was no significant difference in changes in gross motor function according to diagnosis (P > 0.05). There were 16, 19, 18, 23, and 27 patients categorized as GMFCS levels I to V, respectively. The mean differences in GMFM-88 score, pre- vs. post-8-week treatment course, were 5.80 ± 3.59, 8.86 ± 5.43, 4.41 ± 2.02, 3.46 ± 2.72, and 2.26 ± 1.69 for patients categorized as GMFCS levels I to V, respectively (Fig. 2). Children with a GMFCS level of II showed the greatest changes in GMFM-88 scores; the magnitude of change was statistically significantly larger compared to those with GMFCS levels of III (P = 0.001), IV (P < 0.001), and V (P < 0.001). Concerning the good vs. poor responders, a mean change in GMFM score of 6.18% or more represented the top 25th percentile, and a mean change of 2.24% or less represented the bottom 25th percentile. In the univariable analysis, absence of seizure disorder (P = 0.002), a GMFCS level of I–II compared to IV–V (P < 0.001), and absence of cognitive impairment (cognition DQ ≥ 70, P = 0.030) were the factors significantly associated with a good response to intensive treatment. In multivariable analysis, only GMFCS level (I–II vs. IV–V; odds ratio [OR] = 7.763, 95% confidence interval [CI] = 2.177–27.682, P = 0.002) was significantly associated with a good response (Table 2). In the poor responders group, univariable analysis showed that older age (≥ 36 months; P = 0.013), GMFCS level (IV–V vs. I–II or III; P = 0.002) and cognitive impairment (cognition DQ < 70; P = 0.039) were significantly associated with a good response (Table 3). In the multivariable analysis, older age (≥ 36 months; OR = 2.737, 95% CI = 1.003–7.471, P = 0.049) and GMFCS level (I–II vs. IV–V; OR = 0.189, 95% CI = 0.057–0.630, P = 0.007; and III vs. IV–V; OR = 0.095, 95% CI = 0.011–0.785, P = 0.005) were significantly associated with a poor outcome (Table 3).


Factors Influencing the Gross Motor Outcome of Intensive Therapy in Children with Cerebral Palsy and Developmental Delay
Differences in GMFM-88 score after 8 weeks of intensive therapy according to the GMFCS level.GMFM = gross motor function measure, GMFCS = gross motor function classification system.*,†,‡,§The post-hoc tests to identify the pairs of means that differ, P<0.05.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5383623&req=5

Figure 2: Differences in GMFM-88 score after 8 weeks of intensive therapy according to the GMFCS level.GMFM = gross motor function measure, GMFCS = gross motor function classification system.*,†,‡,§The post-hoc tests to identify the pairs of means that differ, P<0.05.
Mentions: The mean difference in GMFM-88 score after 8 weeks of therapy was 4.67 ± 3.93 (P < 0.001). There was no significant difference in changes in gross motor function according to diagnosis (P > 0.05). There were 16, 19, 18, 23, and 27 patients categorized as GMFCS levels I to V, respectively. The mean differences in GMFM-88 score, pre- vs. post-8-week treatment course, were 5.80 ± 3.59, 8.86 ± 5.43, 4.41 ± 2.02, 3.46 ± 2.72, and 2.26 ± 1.69 for patients categorized as GMFCS levels I to V, respectively (Fig. 2). Children with a GMFCS level of II showed the greatest changes in GMFM-88 scores; the magnitude of change was statistically significantly larger compared to those with GMFCS levels of III (P = 0.001), IV (P < 0.001), and V (P < 0.001). Concerning the good vs. poor responders, a mean change in GMFM score of 6.18% or more represented the top 25th percentile, and a mean change of 2.24% or less represented the bottom 25th percentile. In the univariable analysis, absence of seizure disorder (P = 0.002), a GMFCS level of I–II compared to IV–V (P < 0.001), and absence of cognitive impairment (cognition DQ ≥ 70, P = 0.030) were the factors significantly associated with a good response to intensive treatment. In multivariable analysis, only GMFCS level (I–II vs. IV–V; odds ratio [OR] = 7.763, 95% confidence interval [CI] = 2.177–27.682, P = 0.002) was significantly associated with a good response (Table 2). In the poor responders group, univariable analysis showed that older age (≥ 36 months; P = 0.013), GMFCS level (IV–V vs. I–II or III; P = 0.002) and cognitive impairment (cognition DQ < 70; P = 0.039) were significantly associated with a good response (Table 3). In the multivariable analysis, older age (≥ 36 months; OR = 2.737, 95% CI = 1.003–7.471, P = 0.049) and GMFCS level (I–II vs. IV–V; OR = 0.189, 95% CI = 0.057–0.630, P = 0.007; and III vs. IV–V; OR = 0.095, 95% CI = 0.011–0.785, P = 0.005) were significantly associated with a poor outcome (Table 3).

View Article: PubMed Central - PubMed

ABSTRACT

The study was designed to identify factors influencing the short term effect of intensive therapy on gross motor function in children with cerebral palsy or developmental delay. Retrospectively, total Gross Motor Function Measure-88 (GMFM-88) scores measured during the first and last weeks of intensive therapy were analyzed (n = 103). Good and poor responder groups were defined as those in the top and bottom 25% in terms of score difference, respectively. The GMFM-88 score increased to 4.67 &plusmn; 3.93 after 8 weeks of intensive therapy (P &lt; 0.001). Gross Motor Function Classification System (GMFCS) level (I&ndash;II vs. IV&ndash;V; odds ratio [OR] = 7.763, 95% confidence interval [CI] = 2.177&ndash;27.682, P = 0.002) was a significant factor in a good response to therapy. Age (&ge; 36 months; OR = 2.737, 95% CI = 1.003&ndash;7.471, P = 0.049) and GMFCS level (I&ndash;II vs. IV&ndash;V; OR = 0.189, 95% CI = 0.057&ndash;0.630, P = 0.007; and III vs. IV&ndash;V; OR = 0.095, 95% CI = 0.011&ndash;0.785, P = 0.029) were significantly associated with a poor response. GMFCS level is the most important prognostic factor for the effect of intensive therapy on gross motor function. In addition, age &ge; 36 months, is associated with a poor outcome.

No MeSH data available.