Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study

Schasfoort, Fabiënne C; Dallmeijer, Annet J.; Pangalila, Robert; Catsman, Coriene; Stam, Henk J.; Becher, Jules G.; Steyerberg, Ewout; Polinder, Suzanne; Bussmann, Johannes B. J.

doi:10.2340/16501977-2267

Cited by 16 publications

(27 citation statements)

References 25 publications

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“…For the effect outcomes, gross motor function, everyday physical activity levels and health-related quality of life, it was found previously that treatment regimes with and without BoNT-A were approximately equally effective (52). For the presently described effect outcomes pain, muscle strength and length, spasticity, walking speed, gait characteristics, proxy-reported overall fun-ctioning and individual goal attainment, the findings at primary end-point in the BoNT-A+CR group were largely in accordance with previously reported findings (11,32,33,(68)(69)(70)(71).…”

Section: Discussionmentioning

confidence: 78%

“…A total of 757 children were assessed for study eligibility between October 2009 and September 2013. Of these, 634 did not meet the inclusion criteria regarding their GMFCS level or age (see figure in Schasfoort et al 2017 (52)). Of 123 families who were asked to participate, 65 had their child enrolled in our partly randomized study.…”

Section: Resultsmentioning

confidence: 99%

“…In the SPACE BOP study, the added value of BoNT-A treatment preceding a period of comprehensive rehabilitation (CR) was determined in an ambulatory group of 65 children with spastic CP in the age range 4-12 years, who were equally distributed across GMFCS levels I-III. Differences in treatment effects (and costs, as described previously (52)) were studied between a group of 41 children receiving BoNT-A+CR and a group of 24 children receiving only-CR. One full treatment cycle per child was followed, with a large number of outcome measures across ICF categories: pain, muscle strength and length, spasticity, walking speed, gait characteristics, proxy-reported overall functioning, individual goal attainment, gross motor function, everyday physical activity levels, and health-related quality of life.…”

Section: Discussionmentioning

confidence: 99%

“…To enable a fair comparison of both costs (see (52)) and effects between the 2 intervention groups, BoNT-A treatment plans were made for each child. The need for serial casting and prescription or (re)alignment of AFOs was also determined.…”

Section: Methodsmentioning

confidence: 99%

“…The study design, inclusion criteria and procedures have been described previously (52). This methods section provides only summary data.…”

Section: Study Design Participants and Enrolmentmentioning

confidence: 99%

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Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy

Schasfoort¹,

Pangalila²,

Sneekes³

et al. 2018

J Rehabil Med

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Section: Discussionmentioning

confidence: 78%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

“…The study design, inclusion criteria and procedures have been described previously (52). This methods section provides only summary data.…”

Section: Study Design Participants and Enrolmentmentioning

confidence: 99%

See 3 more Smart Citations

Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy

Schasfoort¹,

Pangalila²,

Sneekes³

et al. 2018

J Rehabil Med

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Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy

Makoshi,

Islam,

McKinney

et al. 2024

Acta Neurochir

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Background Cerebral palsy (CP) is the most cause of motor dysfunction in children. Selective dorsal rhizotomy (SDR) plays a major role in long term spasticity control. However, limited data exists on the effect of SDR on postoperative spasticity treatment requirements and supraspinal effects, and the stimulation responses of dorsal nerve roots in those with CP. Methods The current study included the outcome for 35 individuals undergoing SDR for motor functional outcome, spasticity, baclofen dose changes, botulinum toxin injection frequency, and spasticity related orthopedic procedures. We also report on the stimulation responses in 112 individuals who underwent SDR at our institution. Results There was a significant difference in gross motor function measures (GMFM)-66 scores at last follow up that remained present when considering only ambulatory children but not with non-ambulatory children. Ashworth scores were significantly decreased for both upper and lower extremities after SDR at all follow up points. There was a significant decrease in Baclofen dose and botulinum toxin injections requirements after SDR, but no significant difference in the need for orthopedic intervention. A total of 5502 dorsal nerve roots were tested showing a decrease in stimulation intensity and increase in grade on the right side and for descending lumbosacral levels. Conclusions SDR improves gross motor scores during short term follow up but has additional benefits in decreasing baclofen dosing and botulinum toxin injections requirements after surgery. They stimulation responses of sectioned dorsal nerve roots adds to the limited available data and our understanding of the pathological changes that occur in CP.

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Barriers to recruitment of children with cerebral palsy in a trial of home-based training

Beckers

Rameckers

Smeets

et al. 2019

Contemporary Clinical Trials Communications

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Many trials fail to include the targeted number of participants, causing scientific and ethical problems. The COAD trial of home-based training programs (HBTPs) for children with unilateral cerebral palsy (CP) encountered recruitment problems, even though the parent-delivered home-based approach complies with recent health-care developments in the Netherlands. The current project aimed to identify the barriers to recruitment in the COAD trial. This summative, multidimensional evaluation comprised informal conversational interviews in which stakeholders who had been involved reflected on the factors that impeded successful recruitment of participants into the COAD trial. Barriers to implementation and recruitment were clustered according to the constructs of the Consolidated Framework for Implementation Research (CFIR). Member checking validated the findings. A total of 41 stakeholders contributed to the evaluation. Barriers to the implementation of the HBTPs were identified within every domain of the CFIR (intervention characteristics, outer setting, inner setting, characteristics of individuals, and process). Parent-delivered home-based training was perceived as highly complex and in conflict with the pressures on and the needs of parents. Many parents preferred the alternative center-based group interventions. The involvement of a resonance group was highly valued, and opportunities for further enhancements emerged. Additionally, the importance of research consortia was emphasized. The appropriateness of the RCT as the study design was criticized. The findings of this study are summarized in a tool which provides a dozen directions for the successful recruitment of participants in pediatric rehabilitation research.

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Value of botulinum toxin injections preceding a comprehensive rehabilitation period for children with spastic cerebral palsy: A cost-effectiveness study

Cited by 16 publications

References 25 publications

Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy

Intramuscular botulinum toxin prior to comprehensive rehabilitation has no added value for improving motor impairments, gait kinematics and goal attainment in walking children with spastic cerebral palsy

Postoperative outcomes and stimulation responses for sectioned nerve roots during selective dorsal rhizotomy in cerebral palsy

Barriers to recruitment of children with cerebral palsy in a trial of home-based training

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