Randomised trial of constraint induced movement therapy and bimanual training: effect on quality of life of school aged children with congenital hemiplegia

Background/Objectives: The aim of this study was to compare the effects of Constraint Induced Movement Therapy (CIMT) and Bimanual Training on the Quality of Life (QOL) of school aged children with congenital hemiplegia. Design: Randomised comparison clinical trial. Participants and Setting: 43 children with congenital hemiplegia, aged between 5 and 17 years were matched for age (mean 11.1 years), gender (21 female) and side of hemiplegia (27 right). Materials/Methods: Each pair was randomly allocated to either CIMT or Bimanual therapy with both interventions delivered using a day camp model with a circus theme for the same duration (2 weeks) and intensity (60 hours over 10 days). QOL were assessed at baseline and again at 3 weeks post-intervention using the CP QOL-Child questionnaire which was completed by all parents and children 9 years or older. Data were compared within each group and also between groups. Paired t-tests were used for the within group analysis and Analysis of Covariance(ANCOVA) for the between group analysis. Results: There were no differences at baseline between the groups for either parent reported (n= 42) or child self-reported (n= 30) QOL. After intervention no statistical difference between the groups was found for the parent-reported data, for the domains of Social Wellbeing (F=1.211, p=0.28), Functioning (F=0.142, p=0.71),Participation(F=0.036, p=0.85), Emotional Wellbeing (F=0.790, p=0.78), Pain(F=0.900, p=0.35), Access (F=1.719, p=0.20) and Family (F=0.008, p=0.93). There was also no statistical difference between the groups for child self-reported QOL for the domains of Social Wellbeing (F=0.121, p=0.73), Functioning (F= 1.264, p=0.27), Participation (F=0.471, p=0.50), Emotional Wellbeing (F=0.421, p=0.42), and Pain(F=0.155, p=0.70). There was a significant improvement within the CIMT group for Social Wellbeing (t=-2.148, p=0.045) and within the Bimanual group for Emotional Wellbeing (t=-2.273, p=0.034) over time. Both groups however had a reduction in the Participation domain on both parent report and child self-report. Conclusions/Significance: An intensive program of novel rehabilitation may lead to improvements in social and emotional wellbeing. Neither method of upper limb intervention produced a superior effect on QOL. The importance of considering QOL in an intervention based trial has been highlighted in this study, which is one of the first to evaluate the QOL of children with congenital hemiplegia in an interventional trial