Feasibility of a Home-Based Occupational Positioning Program for Children With Spastic Cerebral Palsy: A Preliminary Study.

Five children aged 1–7 with spastic cerebral palsy (GMFCS II–IV, no severe intellectual disability) from rehabilitation centres in Tehran completed a 12-week home-based positioning program. There was no control group and no randomisation — it was a single-group pretest-posttest design. Each child received two in-home visits (2.5–3 h each) from an occupational therapist with over 20 years' experience, during which a personalised illustrated booklet was created showing the child's own occupations with positioning strategies. Over the following 12 weeks, parents implemented positioning during daily routines (eating, play, sleep) and attended weekly 30–60 min remote check-in sessions with the therapist. Parents kept a daily log of how long the child spent in each target occupation. All children also continued their usual occupational therapy (at least two sessions per week). Outcomes were the PEDI functional skills subscales (primary), GAS, and GMFM-88, assessed before and after by a separate occupational therapist who was not blinded. No formal power calculation was done; the sample was chosen to test whether the study procedures would work.

The primary aim was feasibility, and it was met: 96.4% of scheduled remote sessions were attended, mean daily dosage was 5.35 h (range 2.45–10.37 h), parental satisfaction was 9.8 out of 10, and there were no adverse events or dropouts. On the secondary exploratory outcomes, all 5 children improved on every measure — PEDI self-care, mobility, and social function; GAS; and GMFM — and the mean change for each surpassed its minimal clinically important difference. The Wilcoxon signed-rank test gave p < 0.05 for all outcomes. The authors stress these are exploratory and do not prove the program works.

This is a feasibility study, not an effectiveness trial, so it does not yet tell you that home-based occupational positioning improves function. What it does tell you is that the model is workable: parents of 5 children with spastic CP (GMFCS II–IV) managed to embed positioning into daily occupations for an average of 5.35 h per day over 12 weeks, with 96.4% attendance at remote check-ins and near-perfect satisfaction. If you are considering a home-based positioning program for your CP caseload, this suggests the logistics are realistic — parents can do it, they will do it, and they will enjoy it. The individualised illustrated booklet showing the child's own activities was a key engagement tool. However, because every child was also receiving at least two weekly sessions of conventional OT, you cannot separate the effect of the positioning program from routine therapy. Wait for the planned RCT before changing your practice.

No control group and no randomisation, so you cannot tell whether the positioning program caused the improvements or whether they came from the concurrent conventional OT the children were already receiving. Only 5 children completed the study, so the results are too small to generalise and the statistical tests have very low power. Outcome assessment was not blinded — the assessor knew the children had received the intervention. No long-term follow-up, so it is unknown whether any gains were maintained after the 12 weeks ended. Intervention fidelity was not formally measured; you do not know how consistently each family actually implemented the positioning strategies between remote sessions. All participants were recruited from rehabilitation centres in Tehran, Iran, which limits generalisability to other settings and populations.

No funding was received and the authors declare no conflicts of interest.

Do not read the significant p-values on PEDI, GAS, and GMFM as proof that the positioning program improves function. The study had no control group, only 5 children, and every child was simultaneously receiving at least two weekly sessions of conventional occupational therapy, so the authors themselves state the improvements cannot be attributed to the positioning program alone. The primary aim was feasibility, and that is the only conclusion the design supports.