Stark Christina, Duran Ibrahim, Martakis Kyriakos, Spiess Karoline, Semler Oliver, Schoenau Eckhard
Department of Pediatrics, University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.
Cologne Centre for Musculoskeletal Biomechanics (CCMB), University of Cologne, Medical Faculty and University Hospital, Cologne, Germany.
Neuropediatrics. 2020 Dec;51(6):407-416. doi: 10.1055/s-0040-1715489. Epub 2020 Oct 16.
The efficacy of interventions for cerebral palsy (CP) has been frequently investigated with inconclusive results and motor function measured by the Gross Motor Function Measure (GMFM-66) is common.
In this observational analysis, we quantify the GMFM-66 change scores of the second and third year of a multimodal rehabilitation program (interval rehabilitation including home-based, vibration-assisted training) in children with CP.
The study was a retrospective analysis of children with CP (2-13 years) participating for a second ( = 262) and third year ( = 86) in the rehabilitation program with GMFM-66 scores at start (M0), after 4 months (M4) of intensive training, and after 8 months of follow-up (M12). A method was previously developed to differentiate between possible treatment effects and expected development under standard of care for GMFM-66 scores using Cohen's d effect size (ES; size of difference).
After the treatment phase of 4 months (M4) in the second year, 125 of 262 children were responder (ES ≥ 0.2) and 137 children nonresponder (ES < 0.2); mean ES for nonresponder was -0.212 (trivial) and for responder 0.836 (large). After M4 in the third year, 43 children of 86 were responder (ES = 0.881 [large]) and 43 nonresponder (ES = -0.124 [trivial]).
Repeated rehabilitation shows a large additional treatment effect to standard of care in 50% of children which is likely due to the intervention, because in the follow-up period (standard of care), no additional treatment effect was observed and the children followed their expected development.
针对脑瘫（CP）的干预措施的疗效已被频繁研究，但结果尚无定论，且通过粗大运动功能测量（GMFM - 66）来测量运动功能较为常见。
在这项观察性分析中，我们对多模式康复项目（包括家庭康复、振动辅助训练的间歇康复）中CP患儿第二年和第三年的GMFM - 66变化得分进行量化。
该研究是对参与康复项目第二年（n = 262）和第三年（n = 86）的CP患儿（2 - 13岁）进行的回顾性分析，记录其GMFM - 66得分，包括开始时（M0）、强化训练4个月后（M4）以及随访8个月后（M12）。之前已开发出一种方法，使用科恩d效应量（ES；差异大小）来区分GMFM - 66得分在标准护理下可能的治疗效果和预期发展。
在第二年4个月的治疗阶段（M4）后，262名患儿中有125名有反应（ES≥0.2），137名无反应（ES < 0.2）；无反应者的平均ES为 - 0.212（微小），有反应者为0.836（大）。在第三年M4后，86名患儿中有43名有反应（ES = 0.881[大]），43名无反应（ES = - 0.124[微小]）。
重复康复对50%的患儿显示出相对于标准护理的较大额外治疗效果，这可能归因于干预措施，因为在随访期（标准护理）未观察到额外治疗效果，患儿遵循其预期发展。
