Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2025 May 1;6(5):506-516.
doi: 10.1302/2633-1462.65.BJO-2024-0267.

Clinical effectiveness of a child-specific dynamic stretching programme, compared to usual care, for ambulant children with spastic cerebral palsy (SPELL trial): a parallel group randomized controlled trial

Tim Theologis  1 , Daniel C Perry  2 , Ines Rombach  3 , David J Keene  4 , Ioana R Marian  5 , Morag Andrew  6 , Catherine Barry  7 , Loretta Davis  7 , Gregory Firth  8 , Heidi Fletcher  7 , Beth Fordham  7 , Vivi Gregory Osborne  9 , Helen Gregory Osborne  9 , Lesley Katchburian  10 , Joanna O'Mahoney  7 , Jeremy R Parr  6 , Rachel Rapson  11 , Jennifer Ryan  12 , Fema Er  5 , Megan Stone  7 , Helen Wood  5 , Sally Hopewell  5
Affiliations

Clinical effectiveness of a child-specific dynamic stretching programme, compared to usual care, for ambulant children with spastic cerebral palsy (SPELL trial): a parallel group randomized controlled trial

Tim Theologis et al. Bone Jt Open. .

Abstract

Aims: Dynamic muscle stretching exercises are one of the interventions frequently prescribed by physiotherapists for children with cerebral palsy (CP). However, there is wide variability in the exercise regimes used and limited evidence of their effectiveness. The SPELL trial will assess the clinical effectiveness of an individually tailored dynamic stretching programme, compared to usual care for ambulant children with spastic CP.

Methods: We are conducting a multicentre, two-arm, parallel group, superiority randomized controlled trial. We will recruit children aged four to 11 years with a diagnosis of spastic CP (bilateral or unilateral) and Gross Motor Function Classification System (GMFCS) levels I to III who are able to comply with assessment procedures and exercise programme with or without support. Participants will be recruited from at least 12 UK NHS Trust physiotherapy and related services. Participants (n = 334) will be randomized (centralized computer-generated one:one allocation ratio) to either: 1) a dynamic stretching exercise programme, with six one-to-one physiotherapy sessions over 16 weeks; or 2) usual NHS care, with a single physiotherapy session and an assessment, and advice regarding self-management and exercise.

Conclusion: The primary outcome is functional mobility measured using the child-/parent-reported Gait Outcomes Assessment List (GOAL) at six months. Secondary outcomes are: joint range of motion (Cerebral Palsy Integrated Pathway protocol) and motor function (timed up and go test) at six months; functional mobility (GOAL) at 12 months; independence (GOAL subdomain A); balance (GOAL subdomain A, B, D); pain and discomfort (GOAL subdomain C); health-related quality of life (youth version of the EuroQol five-dimension questionnaire (EQ-5D-Y)); educational attendance; exercise adherence; and additional physiotherapy treatment at six and 12 months. The primary analysis will be intention to treat.

PubMed Disclaimer

Conflict of interest statement

M. Andrew, G. B. Firth, V. Gregory Osborne, H. Gregory Osborne, L. Katchburian, D. J. Keene, J.R. Parr, D. C. Perry, R. Rapson, I. Rombach, and J. Ryan are co-applicants on the grant awarded by the National Institute of Health Research (NIHR) Health Technology Assessment (NIHR135131). G. B. Firth reports that as a co-applicant, a small amount of the funding for this study went towards his research department at Maidstone and Tunbridge Wells Trust. D. J. Keene is supported by the NIHR Exeter Biomedical Research Centre. J. Parr reports that his Newcastle University salary was funded by the NIHR in order to work on this study, and being Chair of the British Academy of Childhood Disability Strategic Research Group, whose Priority Setting led to the NIHR funding call for this study. D. C. Perry discloses NIHR Research Professorship funding from the NIHR Academy (NIHR301655).

Figures

Fig. 1
Fig. 1
Study flow diagram for SPELL trial. CP, cerebral palsy; CPIP, Cerebral Palsy Integrated Pathway; GOAL, Gait Outcomes Assessment List; EQ-5D-Y, youth version of the EuroQol five-dimension questionnaire; TUG, Timed Up and Go test.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Rosenbaum P, Paneth N, Leviton A, et al. A report: the definition and classification of cerebral palsy April 2006. Dev Med Child Neurol Suppl. 2007;109:8–14. - PubMed
    1. No authors listed . SCOPE; [10 April 2025]. Cerebral palsy: introduction 2020.https://www.scope.org.uk/advice-and-support/cerebral-palsy-introduction date last. accessed.
    1. Palisano RJ, Rosenbaum P, Bartlett D, Livingston MH. Content validity of the expanded and revised gross motor function classification system. Dev Med Child Neurol. 2008;50(10):744–750. doi: 10.1111/j.1469-8749.2008.03089.x. - DOI - PubMed
    1. Lieber RL, Theologis T. Muscle-tendon unit in children with cerebral palsy. Dev Med Child Neurol. 2021;63(8):908–913. doi: 10.1111/dmcn.14807. - DOI - PubMed
    1. Ostojic K, Paget S, Kyriagis M, Morrow A. Acute and chronic pain in children and adolescents with cerebral palsy: prevalence, interference, and management. Arch Phys Med Rehabil. 2020;101(2):213–219. doi: 10.1016/j.apmr.2019.08.475. - DOI - PubMed