Evaluation of group versus individual physiotherapy following lower limb intra-muscular Botulinum Toxin-Type A injections for ambulant children with cerebral palsy: A single-blind randomized comparison trial

• This randomized controlled trial compared group versus individually delivered physiotherapy following lower limb injections of Botulinum Toxin-Type A for ambulant children with cerebral palsy.
• Group and individually delivered physiotherapy following lower limb BoNT-A injections achieved similar improvements in occupational performance.
• Six hours of physiotherapy, augmented by a home programme, was inadequate to drive meaningful changes in lower limb motor outcomes.
• Group physiotherapy was acceptable to children and families and feasible to deliver by physiotherapists.

This study aimed to evaluate efficacy of group (GRP) versus individual (IND) physiotherapy rehabilitation following lower limb intramuscular injections of Botulinum Toxin-Type A (BoNT-A) for ambulant children with cerebral palsy (CP). Following lower limb BoNT-A injections, 34 children were randomly allocated to GRP (n = 17; mean age 7y8m SD 2.0; 13 males; Gross Motor Function Classification System (GMFCS) I = 5, II = 8, III = 4) or IND physiotherapy (n = 17; mean age 8y7m SD 2.0; 11 males; GMFCS I = 9, II = 5, III = 3). Primary outcomes were the Canadian Occupational Performance Measure (COPM) and Edinburgh Visual Gait Score (EVGS) assessed at baseline, 10 and 26 weeks post intervention. There were no baseline differences between groups. GRP intervention had greater, but not clinically meaningful, improvement in COPM satisfaction (estimated mean difference EMD 1.7, 95% CI 0.4–3.1; p < 0.01) at 26 weeks. Both groups demonstrated clinically significant improvements in COPM performance and satisfaction, but minimal change in quality of gait (EVGS). Six hours of direct physiotherapy (either GRP or IND) with an additional indirect dose (median 16 episodes) of individualized home programme activities following lower limb BoNT-A injections, however, was inadequate to drive clinically meaningful changes in lower limb motor outcomes.