Evidence Based Practice

Evidence Update: New Research Suggests Increasing Pediatric Intervention Frequency

January 02, 2019 by Elena Noble, MPT

A caregiver steers a child in a blue Rifton Adaptive Tricycle.Existing evidence on pediatric therapy dosing is scanty and conflicting, though motor learning theory has long associated increased frequency and repetition of movement and skills with improved outcomes. A new study now appears to bolster this view in the context of school-based intervention.

The study comes out of Norway, where almost all children with cerebral palsy are registered in CP-specific follow-up programs. The researchers studied this clinically obtained data on 442 children between 2 and 12 years of age, focusing on how the frequency of therapy services affected gross motor improvement. They discovered a clear dose response association: children receiving physical therapy 1-2 times a week experienced a mean improvement of 4.2 percentiles on the GMFM-66 and children receiving services 3-5 times a week experienced a mean improvement of 7.1 percentiles compared to less frequent therapies.

This means that therapists should consider increased therapy frequency as a means of improving ambulation and fostering participation in children with cerebral palsy. The researchers also pointed out that addressing or prioritizing contracture management can optimize gross motor improvement.

Although these are already widely acknowledged observations – and indeed, to the lay reader may even seem self-evident – to those of us in pediatric practice any evidence backing pediatric interventions is always welcome. And sound research put into practice is the backbone in bettering the lives of children with disabilities.

Reference

Storvold GV, Jahnsen RB, Evensen KA, Bratberg GH. Is more frequent physical therapy associated with increased gross motor improvement in children with cerebral palsy? A national prospective cohort study. Disabil Rehabil. 2018; 16:1-9.

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Reply by Margaret on January 08, 2019 at 5:52 PM
Yet everywhere around us hours are getting cut and there isn’t enough staff for more. It feels next to impossible to get the equipment needed to make up for it at home. I wish it were easier.
Reply by Janet on January 08, 2019 at 9:35 PM
Thank you for posting this. A prospective cohort study is well-respected, and 442 is a sizeable number of cases. I like your comment that "to the lay reader" this might "seem self-evident", but it's hard to see or to show what WOULD have been lost by lack of PT or OT. This way it is clear that a higher dose of PT causes an improved outcome. Contracture management sometimes seems like a losing battle to teachers and parents: it's good to see that as measurably helpful too.
Reply by Heather on January 10, 2019 at 1:54 AM
I could not access the entire article, but in the abstract I did not see where the authors specifically referenced "school based physical therapy". Motor learning theory certainly supports repetition of activities as promoting progress, but nowhere does it indicate that this repetition has to be performed by a PT every single time it occurs. The potential for progress in the school-based environment is directly linked to training of staff and daily repetition of skills in familiar, routine environments. Let's leave the discussion of physical therapy "dosing" to the outpatient environment and allow school based therapists to practice in the way that research indicates we should.
Reply by Elena on January 11, 2019 at 3:28 PM
Hi Heather, Thank you for your comment. In the article it mentions that "direct contact with a physical therapist" was the criteria for measuring frequency. So kids that saw a PT 3-5x/week showed greatest improvements on the GMFM. However I do agree that other disciplines or trained staff and parents could/should be included in performing skills repetition. I also apologize if the use of "school-based" therapy was misleading. The term was not used in the article. But I do think that many of these kids - with GMFCS levels up to V- would be candidates for school-based therapy services and therefore recieve part, if not most of therapy service frequency in that environment.
Reply by Gaye on March 13, 2019 at 10:15 AM
I also questioned whether it would need to be the direct contact with a PT at this frequency for these gains to be met. We emphasize the importance of activities being carried out for function in the environment daily and assisted by other trained personnel.