Gross Motor Function Measure – Article Summary
Title: Impact of Resistance Therapy on Motor Function in Children with Cerebral Palsy: A Systematic Review and Meta-Analysis
Authors: Luisa Collado-Garrido, Paula Parás-Bravo, Pilar Calvo-Martín, and Miguel Santibáñez-Margüello
Purpose: The purpose of this article was to identify the effects of resistance training on children with cerebral palsy via a meta-analysis.
Study Population: School-aged children ≤18 years old with cerebral palsy.
Methods: A bibliographic review was performed on articles from PubMed, ISI, and PEDro related to cerebral palsy and resistance training ranged up to 2018. References from the selected articles were also manually reviewed in addition. In total, 1,795 articles were gathered from these sources, narrowed down to 15 articles following inclusion/exclusion criteria. Included articles are of controlled and non-controlled clinical trials of school-aged children (≤18) with CP, focused on resistance training-based intervention, utilizing outcome measures to describe changes in motor function before and after intervention.
Outcome Measures: The Gross Motor Function Measure (GMFM), Lateral Step Up (LSU), Timed Up and Go (TUG), and Mobility Questionnaire (MobQue) were the outcome measures analyzed, using a standardized mean difference (SMD) with a confidence interval of 95%. A sensitivity analysis was used on the GMFM utilizing a mean difference (MD) on a non-standardized scale. 12 of the 15 articles reported data from the GMFM scale, making it the most common outcome measure among the 15 articles reviewed.
Intervention: No intervention was conducted in this study.
Results: Each of the articles selected were given a quality score: two received a score of “excellent”, seven received a score of “good”, four received a score of “fair”, and two received a score of “poor”. Overall, the studies supported the use of resistance training as a treatment method of CP, with treatment sessions of 7-12 weeks in length being more effective than a duration of 6 weeks or less. Furthermore, it was found that sessions lasting less than 30 minutes had a larger effect compared to sessions lasting between 30 and 60 minutes. “Functional training” was found to be more effective compared to “progressive strength training”, “table of resistance exercises”, and using a static bicycle. Regarding the GMFM data, results favored use of resistance training as an effective treatment method.
Strengths: The strengths of this systematic review lie with its inclusionary/exclusionary requirements, which allowed the authors to narrow down the large amount of search results. Additionally, each of the final articles reviewed utilized multiple objective measures, useful for cross-comparison of data.
Weaknesses: The authors noted that publication bias could have played a role in the favorable results seen, where more studies with favorable results are published more frequently. Furthermore, there was a low amount of high-quality studies in the final pool of articles, with 3 of the 15 being non-controlled trials and many of the studies having low sample sizes.
Conclusion: Based on the meta-analysis, resistance training is a favored intervention for the treatment of cerebral palsy in children younger than 18 years. Resistance training may improve both muscular strength and motor function in this population. However, the quality of the studies reviewed and the possibility of publication bias indicate a need for more randomized controlled trials to be published with specific information on intervention methods and clinical relevance.
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