Associations between gait kinematics, gross motor function and physical activity among young people with cerebral palsy: A cross sectional study

INTRODUCTION: The aim of this study was to investigate the association between gait parameters, gross motor function and physical activity (PA) in young people with cerebral palsy (CP). METHODS: Thirty-eight adolescents aged between 10–19 years with spastic CP in GMFCS levels I-III (mean [standard deviation] age 13.7 [2.4] yr; 53%female) were included in this cross-sectional study. Hip, knee and ankle joint excursion and stance time was assessed using 3D gait analysis. Self-selected walking speed was assessed during a timed 10 m overground walk and treadmill walking. Gross motor function was assessed using dimensions D and E of the Gross Motor Function Measure (GMFM-66). Moderate-to-vigorous PA, light PA and step-count were assessed using an accelerometer. Linear regression was used to examine associations. RESULTS: After adjusting for age, sex and GMFCS level, percentage stance time was associated with dimension E of the GMFM-66 (β= –0.29, 95%CI –0.54 to –0.05). There was no evidence that any other gait parameters were associated with GMFM-66 dimensions D or E. There was also no evidence that gait parameters or GMFM-66 dimensions D or E were associated with step-count or time in PA after adjusting for age, sex and GMFCS level. DISCUSSION: The findings provide an insight into the complexity of the relationship between gait quality or ability at the impairment level, function as measured in a controlled environment, and the performance of habitual PA, which is essential for health among children with CP

A preventative lifestyle intervention for older adults (lifestyle matters): a randomised controlled trial

to test whether an occupation-based lifestyle intervention can sustain and improve the mental well-being of adults aged 65 years or over compared to usual care, using an individually randomised controlled trial. 288 independently living adults aged 65 years or over, with normal cognition, were recruited from two UK sites between December 2011 and November 2015. lifestyle Matters is a National Institute for Health and Care Excellence recommended multi-component preventive intervention designed to improve the mental well-being of community living older people at risk of decline. It involves weekly group sessions over 4 months and one to one sessions. the primary outcome was mental well-being at 6 months (mental health (MH) dimension of the SF-36). Secondary outcomes included physical health dimensions of the SF-36, extent of depression (PHQ-9), quality of life (EQ-5D) and loneliness (de Jong Gierveld Loneliness Scale), assessed at 6 and 24 months. data on 262 (intervention = 136; usual care = 126) participants were analysed using intention to treat analysis. Mean SF-36 MH scores at 6 months differed by 2.3 points (95 CI: -1.3 to 5.9; P = 0.209) after adjustments. analysis shows little evidence of clinical or cost-effectiveness in the recruited population with analysis of the primary outcome revealing that the study participants were mentally well at baseline. The results pose questions regarding how preventive interventions to promote well-being in older adults can be effectively targeted in the absence of proactive mechanisms to identify those who at risk of decline. ISRCTN67209155

COVID-19 in congenital heart disease (COaCHeD) study

Background: COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care.// Objective: Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes.// Methods: Multicentre UK study undertaken 1 March 2020–30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation.// Results: There were 405 reported cases (127 paediatric/278 adult). In children (age <16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p<0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p<0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)).// Conclusions: Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD

Acceptability of a progressive resistance training programme for ambulatory adolescents with spastic cerebral palsy in England: a qualitative study

Purpose: The aim of this study was to explore the acceptability of a 10-week progressive resistance training programme from the perspective of ambulatory adolescents with CP and physiotherapists. Material and methods: Semi-structured interviews were conducted with 32 adolescents with spastic CP, aged 10-19 years in Gross Motor Function Classification System (GMFCS) levels I-III, and 13 physiotherapists. Adolescents had completed a 10-week progressive resistance training programme and physiotherapists had delivered the programme. The Framework Method was used to analyse data. Results: The analysis identified four themes. "It's do-able" described the acceptability of the programme structure, including the frequency of sessions and the duration of the programme. "They were difficult but I did it" described the acceptability of the exercises. "It is completely different," explored the experience of using equipment to progress the programme and "I wish I could do it on a permanent basis" discussed continuing to participate in resistance training. Conclusions: Findings suggest that resistance training is largely acceptable to adolescents and physiotherapists. Acceptability was enhanced by having a weekly supervised session and being able to adapt and progress the exercises to meet the individual's ability. However, there are challenges to implementing progressive resistance training as part of routine practice.Clinical trial registration number: ISRCTN90378161

Acceptability of a progressive resistance training programme for ambulatory adolescents with spastic cerebral palsy in England: a qualitative study.

Purpose: The aim of this study was to explore the acceptability of a 10-week progressive resistance training programme from the perspective of ambulatory adolescents with CP and physiotherapists. Material and methods: Semi-structured interviews were conducted with 32 adolescents with spastic CP, aged 10-19 years in Gross Motor Function Classification System (GMFCS) levels I-III, and 13 physiotherapists. Adolescents had completed a 10-week progressive resistance training programme and physiotherapists had delivered the programme. The Framework Method was used to analyse data. Results: The analysis identified four themes. "It's do-able" described the acceptability of the programme structure, including the frequency of sessions and the duration of the programme. "They were difficult but I did it" described the acceptability of the exercises. "It is completely different," explored the experience of using equipment to progress the programme and "I wish I could do it on a permanent basis" discussed continuing to participate in resistance training. Conclusions: Findings suggest that resistance training is largely acceptable to adolescents and physiotherapists. Acceptability was enhanced by having a weekly supervised session and being able to adapt and progress the exercises to meet the individual's ability. However, there are challenges to implementing progressive resistance training as part of routine practice. Clinical trial registration number: ISRCTN90378161.</p

Progressive resistance training for adolescents with cerebral palsy: the STAR randomized controlled trial

© 2020 The Authors. Aim To evaluate the effect of progressive resistance training of the ankle plantar flexors on gait efficiency, activity, and participation in adolescents with cerebral palsy (CP). Method Sixty‐four adolescents (10–19y; 27 females, 37 males; Gross Motor Function Classification System [GMFCS] levels I–III) were randomized to 30 sessions of resistance training (10 supervised and 20 unsupervised home sessions) over 10 weeks or usual care. The primary outcome was gait efficiency indicated by net non dimensional oxygen cost (NNcost). Secondary outcomes included physical activity, gross motor function, participation, muscle strength, muscle and tendon size, and muscle and tendon stiffness. Analysis was intention‐to‐treat. Results Median attendance at the 10 supervised sessions was 80% (range 40–100%). There was no between‐group difference in NNcost at 10 (mean difference: 0.02, 95% confidence interval [CI] –0.07 to 0.11, p =0.696) or 22 weeks (mean difference: –0.08, 95% CI –0.18 to 0.03, p =0.158). There was also no evidence of between‐group differences in secondary outcomes at 10 or 22 weeks. There were 123 adverse events reported by 27 participants in the resistance training group. Interpretation We found that 10 supervised sessions and 20 home sessions of progressive resistance training of the ankle plantar flexors did not improve gait efficiency, muscle strength, activity, participation, or any biomechanical outcome among adolescents with CP.Action Medical Research. Grant Number: GN2340; Chartered Society of Physiotherapy Charitable Trust. Grant Number: GN234

Associations between gait kinematics, gross motor function and physical activity among young people with cerebral palsy: a cross sectional study

INTRODUCTION:The aim of this study was to investigate the association between gait parameters, gross motor function and physical activity (PA) in young people with cerebral palsy (CP).  METHODS: Thirty-eight adolescents aged between 10–19 years with spastic CP in GMFCS levels I-III (mean [standard deviation] age 13.7 [2.4] yr; 53% female) were included in this cross-sectional study. Hip, knee and ankle joint excursion and stance time was assessed using 3D gait analysis. Self-selected walking speed was assessed during a timed 10 m overground walk and treadmill walking. Gross motor function was assessed using dimensions D and E of the Gross Motor Function Measure (GMFM-66). Moderate-to-vigorous PA, light PA and step-count were assessed using an accelerometer. Linear regression was used to examine associations.  RESULTS:After adjusting for age, sex and GMFCS level, percentage stance time was associated with dimension E of the GMFM-66 (β= –0.29, 95%CI –0.54 to –0.05). There was no evidence that any other gait parameters were associated with GMFM-66 dimensions D or E. There was also no evidence that gait parameters or GMFM-66 dimensions D or E were associated with step-count or time in PA after adjusting for age, sex and GMFCS level.  DISCUSSION: The findings provide an insight into the complexity of the relationship between gait quality or ability at the impairment level, function as measured in a controlled environment, and the performance of habitual PA, which is essential for health among children with CP.</p

COVID-19 in congenital heart disease (COaCHeD) study

Background COVID-19 has caused significant worldwide morbidity and mortality. Congenital heart disease (CHD) is likely to increase vulnerability and understanding the predictors of adverse outcomes is key to optimising care.Objective Ascertain the impact of COVID-19 on people with CHD and define risk factors for adverse outcomes.Methods Multicentre UK study undertaken 1 March 2020–30 June 2021 during the COVID-19 pandemic. Data were collected on CHD diagnoses, clinical presentation and outcomes. Multivariable logistic regression with multiple imputation was performed to explore predictors of death and hospitalisation.Results There were 405 reported cases (127 paediatric/278 adult). In children (age &lt;16 years), there were 5 (3.9%) deaths. Adjusted ORs (AORs) for hospitalisation in children were significantly lower with each ascending year of age (OR 0.85, 95% CI 0.75 to 0.96 (p&lt;0.01)). In adults, there were 24 (8.6%) deaths (19 with comorbidities) and 74 (26.6%) hospital admissions. AORs for death in adults were significantly increased with each year of age (OR 1.05, 95% CI 1.01 to 1.10 (p&lt;0.01)) and with pulmonary arterial hypertension (PAH; OR 5.99, 95% CI 1.34 to 26.91 (p=0.02)). AORs for hospitalisation in adults were significantly higher with each additional year of age (OR 1.03, 95% CI 1.00 to 1.05 (p=0.04)), additional comorbidities (OR 3.23, 95% CI 1.31 to 7.97 (p=0.01)) and genetic disease (OR 2.87, 95% CI 1.04 to 7.94 (p=0.04)).Conclusions Children were at low risk of death and hospitalisation secondary to COVID-19 even with severe CHD, but hospital admission rates were higher in younger children, independent of comorbidity. In adults, higher likelihood of death was associated with increasing age and PAH, and of hospitalisation with age, comorbidities and genetic disease. An individualised approach, based on age and comorbidities, should be taken to COVID-19 management in patients with CHD