Efficacy of Early Intervention for Infants With Cerebral Palsy in an LMIC: An RCT.

Journal: Pediatrics

Volume: 153

Issue: 4

Year of Publication: 2024

Affiliated Institutions:  Queensland Cerebral Palsy and Rehabilitation Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia. Menzies Health Institute Queensland, Griffith University, Brisbane, Australia. Indian Institute of Cerebral Palsy, Kolkata, India. Asha Bhavan Centre, Uluberia, India. Dr B.C. Roy Post Graduate Institute of Paediatric Sciences, Kolkata, India. Bangladesh Protibhondi Foundation, Dhaka, Bangladesh. Children's Nutrition Research Centre, Child Health Research Centre, The University of Queensland, Brisbane, Australia. Queensland Paediatric Rehabilitation Service, Queensland Children's Hospital, Brisbane, Australia. Princess Margaret Hospital, Perth, Australia. Child Development Centre, Apollo Gleneagles Hospital, Kolkata, India. School of Tropical Medicine, Calcutta Medical College, Kolkata, India. Cerebral Palsy Alliance Research Institute, Specialty of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.

Abstract summary 

To test efficacy of a parent-delivered multidomain early intervention (Learning through Everyday Activities with Parents [LEAP-CP]) for infants with cerebral palsy (CP) compared with equal-dose of health advice (HA), on (1) infant development; and (2) caregiver mental health. It was hypothesized that infants receiving LEAP-CP would have better motor function, and caregivers better mental health.This was a multisite single-blind randomized control trial of infants aged 12 to 40 weeks corrected age (CA) at risk for CP (General Movements or Hammersmith Infant Neurologic Examination). Both LEAP-CP and HA groups received 15 fortnightly home-visits by a peer trainer. LEAP-CP is a multidomain active goal-directed intervention. HA is based on Key Family Practices, World Health Organization. Primary outcomes: (1) infants at 18 months CA: Pediatric Evaluation of Disability Inventory-Computer Adaptive Test (PEDI-CAT mobility); and (2) caregiver: Depression Anxiety and Stress Scale.Of eligible infants, 153 of 165 (92.7%) were recruited (86 males, mean age 7.1±2.7 months CA, Gross Motor Function Classification System at 18 m CA: I = 12, II = 25, III = 9, IV = 18, V = 32). Final data were available for 118 (77.1%). Primary (PEDI-CAT mobility mean difference = 0.8 (95% CI -1.9 to 3.6) P = .54) and secondary outcomes were similar between-groups. Modified-Intention-To-Treat analysis on n = 96 infants with confirmed CP showed Gross Motor Function Classification System I and IIs allocated to LEAP-CP had significantly better scores on PEDI-CAT mobility domain (mean difference 4.0 (95% CI = 1.4 to 6.5), P = .003) compared with HA.Although there was no overall effect of LEAP-CP compared with dose-matched HA, LEAP-CP lead to superior improvements in motor skills in ambulant children with CP, consistent with what is known about targeted goal-directed training.

Authors & Co-authors:  Benfer Whittingham Ware Ghosh Chowdhury Moula Samanta Khan Bell Oftedal Bandaranayake Salt Bhattacharya Maiti Tripathi Morgan Novak Boyd

Study Outcome 

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Statistics
Citations : 
Authors :  18
Identifiers
Doi : e2023063854
SSN : 1098-4275
Study Population
Male
Mesh Terms
Male
Other Terms
Study Design
Randomized Control Trial
Study Approach
Country of Study
Publication Country
United States