Occupational Therapy and Physical Therapy Dosage for Children with Hemiplegic Cerebral Palsy

Research Objectives: To document the dosage of occupational therapy (OT) and physical therapy (PT) for children with hemiplegic cerebral palsy (HCP) and measure the types of evidence-based interventions used in clinical practice.

Design: Retrospective cohort study.

Setting: Participants received outpatient OT and/or PT sessions at a single large pediatric hospital in the Midwest United States.

Participants: Data were extracted from electronic medical records of 929 visits (421 OT and 508 PT) across 138 participants 0-18 years (mean: 6.3, SD: 4.0) and diagnosed with HCP (Gross Motor Function Classification System [GMFCS]: I-IV). Participants attended at least one OT and/or PT outpatient session in 2019. The majority of participants were male (51%), white (73%), covered by public insurance (50%), and had co-occurring medical conditions (94%).

Interventions: N/A

Main Outcome Measures: Demographic and dosage (frequency, intensity, time, and type) variables were extracted from the electronic health record, including clinical documentation from up to five OT and PT visits per participant. To quantify the specific interventions (type) used by therapists from unstructured fields in the health record, researchers organized interventions into 29 OT and 27 PT treatment type categories.

Results: Of the 138 participants, 94 (68.1%) received OT and 112 (81.2%) received PT, with 68 (49%) receiving both OT and PT in 2019. The most common frequency and intensity for both PT and OT was once per week (59.8% PT, 40.4% OT) for one hour per session (46.1% PT, 54.9% OT). Green light interventions made up 74.3% of all coded PT interventions and 66.8% of all OT interventions. Home programming and task-specific training were the two most commonly coded interventions for both disciplines. Therapists utilized an average of 4.1 (SD=1.5) unique interventions per PT session and 4.9 (SD=1.7) per OT session.

Conclusions: Typical OT and PT dosage for children with HCP at one center consisted of primarily evidence-based interventions. Most children received multiple unique interventions per session and nearly half received both PT and OT concurrently; therefore, future pragmatic clinical trials should encompass multiple interventions to mirror the care provided clinically. Continued investigation of the optimal dose of OT and PT for children with HCP is key to improving outcomes and maximizing their ability to participate in age-appropriate activities.

Author(s) Disclosures: No conflicts of interests to declare.