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PICO final

Journal appraisal

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Grace Olaer
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10 views3 pages

PICO final

Journal appraisal

Uploaded by

Grace Olaer
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
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Download as DOCX, PDF, TXT or read online on Scribd
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A Multicentre, Double-Blind, Randomized Controlled Trial on the Effect of

Functional Strength Training on Gross Motor Function among Children with

Spastic Diplegic Cerebral Palsy

Loganathan Gurusamy

Gandhi Karunanithi Balaji

Sahana Agrahara

December 12, 2022

Submitted by:
Mary Sxiane Q. Bag-ao

Submitted to:
Krystal Rae A. Bo, PTRP

August 30, 2024


Participants
The study included 40 participants, aged between 5 and 14 years, including
males and females, who were recruited for the 2-group pretest-posttest randomized
multicentre clinical trial with the simple random sampling technique out of 63 children.
These children were classified by the Gross Motor Function Classification System
(GMFCS) under levels I, II, or III and could follow verbal commands. Then the children
with spastic diplegia CP are divided into two groups, the FST group and the
conventional physiotherapy (CPT) group, by simple randomization.
Interventions
The study implemented two different interventions for the children. One group
underwent Functional Strength Training (FST), a 6-week program involving progressive
resistance exercises designed to improve muscle strength in functional positions. These
sessions were held three times a week for 45-60 minutes. The training sessions begin
with warm-up exercises, including low-intensity stretching for hip flexors, adductors,
hamstrings, and plantar flexors. Each muscle was held in the stretched position for 15-
sec hold x 5-sec rest x 6 reps. Each child performed four different exercises on the 5-
station circuit in the main training phase. The other stations of the circuit were named as
follows: loaded standing on the edge of the block, loaded sit-to-stand, loaded game,
unloaded game, and relax. The training ended with a cool-down period of 5 minutes,
during which muscle stretching exercises and aerobics were performed.
The other group received Conventional Physiotherapy (CPT), which also
spanned six weeks. This program involved routine exercises like stretching, physio-ball,
and lower limb exercises, focusing on improving flexibility, balance, and strength. The
training sessions begin with warm-up exercises, including low-intensity stretching for hip
flexors, adductors, hamstrings, and plantar flexors. Each muscle was held in the
stretched position for 15-sec hold x 5-sec rest x 6 reps. Then, the routine physiotherapy
sessions began with active exercises for the lower limbs. Active exercises included
bilateral weight shifts (x 10 on each side), holding the couch, and weight-bearing
position like a quadruped, with half kneeling and kneeling position encouraged. Each
position was x 10-sec, hold x 5-sec, rest x 10 reps. Physio-ball exercises were added,
which included bridging (x 10-sec hold x 5-sec rest x 10 reps); weight shifts: side to side
and anteroposterior weight shifts were encouraged on the ball for balance and
proprioception in the lower extremity; both shifts were applied ten times with a rest of 5
minutes in between in supine position. The training ended with a cool-down period of 5
minutes, during which muscle stretching exercises and aerobics were performed.
Comparison
Functional Strength Training (FST) is a 6-week program involving progressive
resistance exercises to improve muscle strength in functional positions. Also, the FST
has a station circuit, which is 5, and each station has its training volume (combination of
load, repetitions, sets, and rest) with which the exercise was performed. Conventional
Physiotherapy (CPT) also spanned six weeks. This program involved routine exercises
like stretching, physio-ball, and lower limb exercises, focusing on improving flexibility,
balance, and strength.
Outcome
The study compared the effectiveness of FST and CPT by measuring the
outcomes using the Gross Motor Function Measure (GMFM-88). The result indicated
that the FST led to significant improvements in gross motor function among children
with spastic diplegic cerebral palsy. The gains in muscle strength during the intervention
translated into better functional performance in daily activities, which persisted after the
intervention; specifically, the FST group showed significant progress in GMFM-88
dimensions D (standing), E (walking, running, jumping), and overall goal total score. In
contrast, while CPT also showed improvements, they were less pronounced,
demonstrating that FST was more effective in enhancing motor skills and functional
abilities in these children.
Reflection
The study proved that Functional Strength Training is more effective than
Conventional Physiotherapy, which is an excellent contribution to the physical therapy
management for children with spastic diplegia CP in terms of gross motor functions
such as standing, walking, running, and jumping. However, this training does not apply
to all CP because it only applies to children who can follow verbal commands and are
strict with the children to follow the treatment. How about the other children outside the
criteria, like CP with ASD or who have a visual or intellectual impairment? Although CPT
is less effective than FST, it can still be used. The study has also proven that it can
improve motor function, which is more applicable to other populations of CP, for it can
be considered a play.

Reference
Gurusamy, L., Balaji, G., & Agrahara, S. (2022). A multicenter, double blind, randomized
controlled trial of functional strength training on gross motor function among children
with spastic diplegic cerebral palsy. Physiotherapy Quarterly, 30(4), 52-58.

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