Cerebral Palsy (CP), Home-based Programs, Home-based Rehabilitation, Perceptions, Postural Control, Telerehabilitation
Conditions
Keywords
Cerebral Palsy, Home care services, Motor Skills, Patient adherence, Postural balance, Tele-support therapy, Tele Rehabilitation
Brief summary
The goal of this feasibility study is to evaluate the adherence, parental experiences, and perceptions of a home-based Intensive Segmental Trunk Training (ISTT) program for children aged 4-12 with spastic diplegic cerebral palsy (CP) in Pakistan. The main questions it aims to answer are: What is the rate of caregiver adherence to a home-based ISTT program over 12 weeks? What are the primary barriers, experiences, and perceptions of caregivers implementing the program? What are the preliminary signals of clinical effectiveness on trunk control and gross motor function? Researchers will compare pre- and post-intervention outcomes (baseline vs. week 12) to see if there are statistically significant improvements in trunk control (measured by SATCo) and gross motor function (measured by GMFM-88). Participants (20 primary caregivers and their children) will: Attend an initial in-person orientation session to learn trunk stabilization exercises from a senior pediatric physical therapist Complete a 12-week home-based ISTT program with weekly tele-supervision video calls to monitor progress and address challenges Attend monthly face-to-face monitoring visits at the hospital for clinical assessment and technique reinforcement Complete a KABA (Knowledge, Attitudes, Barriers, and Adherence) survey at baseline and week 12 Participate in a semi-structured interview at the end of the 12-week program to share their experiences.
Detailed description
This single-arm feasibility study was conducted at a hospital in Lahore, Pakistan, to investigate parental experiences and adherence to a home-based Intensive Segmental Trunk Training (ISTT) program for children with spastic diplegic cerebral palsy (CP). Background: Trunk control is a fundamental prerequisite for gross motor function, postural stability, and functional mobility in children with CP. Conventional clinic-based rehabilitation in Pakistan faces significant challenges including transportation barriers, high costs, and limited access to specialized pediatric physical therapy services, resulting in poor adherence and suboptimal outcomes. Home-based, caregiver-delivered programs offer a promising alternative, but evidence is limited on their feasibility and acceptability in low-resource settings. Intervention: The ISTT program is a structured, progressive trunk stabilization protocol targeting segmental control of the cervical, upper thoracic, lower thoracic, and lumbar regions of the spine. The 12-week intervention was delivered through a hybrid model: Week 1: In-person orientation and training session at the hospital, where a senior pediatric physical therapist taught caregivers the exercise protocol, including proper positioning, facilitation techniques, and progression criteria using both verbal instruction and practical demonstration. Weeks 1-12: Daily home-based sessions (approximately 30 minutes), guided by a library of pre-recorded instructional videos and a picture-based manual developed specifically for this program. Exercises progressed from supported to unsupported positions and from static to dynamic tasks. Weekly tele-supervision: Synchronous video calls between the therapist and caregiver to monitor progress, correct technique, address barriers, and adjust exercise difficulty as needed. Monthly in-person visits: Face-to-face monitoring at the hospital for clinical reassessment, technique refinement, and reinforcement of training principles. Participants: Twenty primary caregivers (mothers or fathers) of children aged 4-12 years with a confirmed diagnosis of spastic diplegic CP, classified at Gross Motor Function Classification System (GMFCS) levels II-IV, who were willing to commit to the 12-week program and had access to a smartphone with video-calling capability. Outcome Measures: Primary outcomes: Adherence rate (percentage of prescribed sessions completed over 12 weeks) Caregiver experiences and perceptions (assessed via the KABA \[Knowledge, Attitudes, Barriers, and Adherence\] survey administered at baseline and week 12, and a semi-structured qualitative interview at study completion) Secondary outcomes (pre-post comparison): Trunk control measured by the Segmental Assessment of Trunk Control (SATCo) Gross motor function measured by the Gross Motor Function Measure-88 (GMFM-88)
Interventions
OTHERHome-Based Intensive Segmental Trunk Training (ISTT)
A 12-week structured, progressive trunk stabilization protocol targeting segmental control of the cervical, upper thoracic, lower thoracic, and lumbar regions of the spine. The program consisted of daily home-based sessions (approximately 30 minutes per session), guided by pre-recorded instructional videos and a picture-based manual developed specifically for this study. Exercises progressed from supported to unsupported positions and from static to dynamic tasks. Caregivers received an initial in-person orientation session at a hospital, followed by weekly tele-supervision video calls with a senior pediatric physical therapist to monitor progress, correct technique, address barriers, and adjust exercise difficulty. Monthly face-to-face monitoring visits were conducted at the hospital for clinical reassessment and reinforcement of training principles.
Sponsors
Iqra Khan
University of Lahore
Study design
Allocation
NA
Intervention model
SINGLE_GROUP
Primary purpose
SUPPORTIVE_CARE
Masking
NONE
Masking description
This was an open-label, single-arm feasibility study with no blinding. All participants (caregivers and their children), the care provider (pediatric physical therapist conducting tele-supervision), and the investigator assessing outcomes were aware of the intervention assignment, as the study was designed to evaluate real-world feasibility and caregiver experiences with a home-based program.
Intervention model description
This was a single-arm, open-label feasibility study with no control group or comparator arm. All 20 caregiver-child dyads received the same home-based Intensive Segmental Trunk Training (ISTT) program over 12 weeks. Outcomes were measured at baseline and at the end of the 12-week intervention period (pre-post design). There was no randomization, no parallel group, and no crossover of interventions.
Eligibility
Sex/Gender
ALL
Age
4 Years to 12 Years
Healthy volunteers
No
Inclusion criteria
* Children aged 4-12 years with a confirmed diagnosis of spastic diplegic cerebral palsy * Gross Motor Function Classification System (GMFCS) levels II-IV * Primary caregiver (mother or father) willing to commit to the 12-week program * Caregiver had access to a smartphone with video-calling capability * Caregiver able to understand and follow instructions in Urdu or English
Exclusion criteria
* Children with uncontrolled seizures * Children who had undergone orthopedic surgery or botulinum toxin injections in the lower extremities within the previous 6 months * Children with severe visual or hearing impairments that would interfere with participation * Caregivers with a diagnosed physical or mental health condition that would prevent them from safely delivering the home-based program
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Adherence Rate | Week 12 (end of intervention) | Percentage of prescribed home-based ISTT sessions completed by caregivers over the 12-week intervention period, calculated as (number of sessions completed / number of sessions prescribed) × 100. Adherence was cross-validated through caregiver self-report and observation during weekly tele-supervision video calls. |
| Caregiver Experiences and Perceptions (Qualitative) | Week 12 (semi-structured interview) | Measured using a semi-structured qualitative interview conducted at the end of the intervention to explore caregivers' experiences, challenges, and perceived benefits of the home-based program. |
| Caregiver Knowledge, Attitudes and Barriers | Baseline and Week 12 | Measured using the KABA (Knowledge, Attitudes, Barriers, and Adherence) survey, administered at baseline and Week 12, to assess caregivers' knowledge, attitudes, and perceived barriers to the home-based Intensive Segmental Trunk Training program. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Segmental Assessment Trunk Control (SATCo) | Baseline and Week 12 | Segmental Assessment of Trunk Control (SATCo) evaluates segmental trunk control across cervical, upper thoracic, lower thoracic, and lumbar regions. Scores range from 0 to 20, with higher scores indicating better trunk control. |
| Gross Motor Function Measure-88 (GMFM-88) | Baseline and Week 12 | Gross Motor Function Measure-88, a standardized observational instrument assessing gross motor function across five dimensions (lying and rolling; sitting; crawling and kneeling; standing; walking, running, and jumping). Scores range from 0 to 100, with higher scores indicating better gross motor function. |
Countries
Pakistan
Contacts
STUDY_CHAIRAshfaq Ahmad, PhD
University of Lahore
Outcome results
None listed