Relationship between changes in motor capacity and objectively measured motor performance in ambulatory children with spastic cerebral palsy.

This was a secondary analysis of trial data, and all children were treated as one group, so it did not test whether treatment caused change. The original trial was not fully randomized because some parents chose the treatment group they preferred, and only 40% participated with randomization. Children received several treatments together, including physiotherapy, botulinum toxin, serial casting and ankle foot orthoses, so the contribution of any single component cannot be separated. Follow-up was only 12 and 24 weeks, and the authors note that changes in motor performance may take longer. The sample was small, with 65 ambulatory children in GMFCS levels I to III, so it may not apply to more severely affected children. Actigraph measurements had general limitations, including wearing time, inability to measure water activities, seasonal effects, and uncertainty whether the days sampled were representative. The GMFM may have a ceiling effect in ambulatory children with CP.

The only funding statement provided names ZonMW. No other conflicts of interest are given in the supplied text.

Do not read the 24-week strength and walking speed links with less sedentary time as proof that improving capacity changes daily activity. The 12-week primary endpoint showed no association. Children received physiotherapy, and some also received botulinum toxin, serial casting or ankle foot orthoses, so the contribution of any single component cannot be separated.