Comparison of outcome between operative treatment and constraint-induced movement therapy for forearm and wrist deformities in cerebral palsy. A randomized controlled trial
Issued Date
2022-04-01
Resource Type
ISSN
24681229
eISSN
24681210
Scopus ID
2-s2.0-85124666410
Pubmed ID
35124285
Journal Title
Hand Surgery and Rehabilitation
Volume
41
Issue
2
Start Page
258
End Page
264
Rights Holder(s)
SCOPUS
Bibliographic Citation
Hand Surgery and Rehabilitation Vol.41 No.2 (2022) , 258-264
Suggested Citation
Tawonsawatruk T. Comparison of outcome between operative treatment and constraint-induced movement therapy for forearm and wrist deformities in cerebral palsy. A randomized controlled trial. Hand Surgery and Rehabilitation Vol.41 No.2 (2022) , 258-264. 264. doi:10.1016/j.hansur.2021.12.012 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/86001
Title
Comparison of outcome between operative treatment and constraint-induced movement therapy for forearm and wrist deformities in cerebral palsy. A randomized controlled trial
Author(s)
Author's Affiliation
Other Contributor(s)
Abstract
Several treatment strategies for upper extremity deformities in cerebral palsy have been studied for their effectiveness in terms of function and quality of life. There are a few comparative studies between nonoperative and operative management for upper extremity deformities. This study aimed to compare the outcomes between conservative methods using constraint-induced movement therapy (CIMT) and operative methods using pronator teres rerouting, flexor carpi ulnaris transfer to extensor carpi radialis brevis (FCU transfer to ECRB) and fractional lengthening in cerebral palsy patients with forearm pronation and wrist flexion contracture. A total of 19 participants aged 7-15 years were randomized to either CIMT or surgery. The primary endpoint was changes in Shriners Hospital Upper Extremity Evaluation (SHUEE) functional score. Secondary endpoints comprised range of motion, Volkmann's angle, and the Pediatric Outcomes Data Collection Instrument (PODCI). At 1-year follow-up, there was no significant difference between the nonoperative and operative groups in any SHUEE dimensions, range of motion or PODCI. However, there was significant improvement in Volkmann's angle in the operative group compared to the CIMT group: CIMT = 11.11 ± 9.92, surgery = -13.00 ± 4.72: p = 0.04 (95% CI = 1.68-46.54). Operative treatment provided more improvement in wrist posture, represented by Volkmann's angle, in cerebral palsy patients. However, SHUEE, range of motions and PODCI were comparable between the CIMT and operative groups.