Review for Responsiveness of the ACTIVLIM-CP questionnaire: measuring global activity performance in children with cerebral palsy (CP)”
Citation: Paradis J, Arnould C, Thonnard J, et al. Responsiveness of the ACTIVLIM‐CP questionnaire: Measuring global activity performance in children with cerebral palsy. Developmental medicine and child neurology. 2018;60(11):1178-1185. https://onlinelibrary.wiley.com/doi/abs/10.1111/dmcn.13927. doi: 10.1111/dmcn.13927.
The study “Responsiveness of the ACTIVLIM-CP questionnaire: measuring global activity performance in children with cerebral palsy (CP)” is an investigation aimed at evaluating the responsiveness of the ACTIVLIM-CP in two evidence-based therapeutic interventions in children with CP: motor-skill learning-intensive intervention targeting upper extremities and lower extremities (HABIT-ILE) or botulinum neurotoxin-A (BoNT-A) injection with conventional physiotherapy. Additionally, this study aimed to determine differences in the responsiveness of the ACTIVLIM-CP among different levels of the baseline gross motor function level of the participants. Overall, this study included 87 children who had a CP diagnosis, were levels I to IV on the Gross Motor Function Classification System (GMFCS), completed the assessment times, and were ages 6 to 18 years old. The participants received one of two interventions (HABIT-ILE, n-50 or BoNT-A, n=37), as determined by their physician, to be the most appropriate therapeutic intervention. Each participant was assessed with the ACTIVLIM-CP at baseline (T0), at the time where changes were typically expected to be seen for each intervention (T1), and 3-4 months after completion of each intervention (T2). For comparison, each participant has also assessed with the PEDI, ABIL-HAND-Kids, and ABILOCO-Kids outcome measures.
The study’s findings show significant improvements in ACTIVLIM-CP scores from T0 to T1 but not T1-T2 for the HABIT-ILE group. No significant changes were observed in the BoNT-A group between any of the assessment periods. When analyzed based on a subgroup (GMFCS level), children with GMFCS levels III and IV had greater observed significant changes from T0-T1 for the HABIT-ILE intervention. No significant differences were observed among subgroups for the BoNT-A intervention or T1-T2 for the HABIT-ILE intervention. Based on the findings, the authors concluded that the ACTIVLIM-CP outcome measures demonstrated high responsiveness after HABIT-ILE intervention, suggesting this outcome measure may be appropriate for evaluating global activity performance in clinical trials evaluating interventions improving daily life activities. One limitation of this study is the relatively low sample size for the BoNT-A intervention group, especially for children with GMFCS levels III and IV. Additionally, the observed lack of significant improvements with the ACTIVLIM-CP following the BONT-A injection intervention may be confounded by the combination of conventional physiotherapy, and the different results may be observed when combined with intensive goal-oriented motor-skill learning interventions.
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