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Phys. Ther. Korea 2024; 31(2): 131-141

Published online August 20, 2024

https://doi.org/10.12674/ptk.2024.31.2.131

© Korean Research Society of Physical Therapy

Evidence-based Clinical Guidelines for Optimizing the Use of Standing Frame: A Systematic Review of Dosing Recommendations Among Cerebral Palsy

Changho Kim1 , PT, PhD, Hyunsuk Park2 , PT, MPH

1Yonsei Child Development Center, Yongin, 2Rehabilitation Team, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea

Correspondence to: Changho Kim
E-mail: workffid@hanmail.net
https://orcid.org/0000-0001-5627-0243

Received: April 4, 2024; Revised: May 3, 2024; Accepted: May 3, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Standing frames are a common intervention for children with cerebral palsy (CP), yet there is a lack of standardized dosing recommendations, impeding the enhancement of treatment outcomes in this population.
Objects: This paper aims to optimize dosing strategies for standing frame programs in children with CP. It evaluates effective durations and frequencies for using standing frames to improve gait, hip joint integrity, functional activities, joint range of motion, and muscle tone. The goal is to provide evidence-based clinical recommendations to guide practitioners in treating pediatric CP patients.
Methods: A comprehensive research was conducted across seven databases, yielding 23 studies meeting inclusion criteria. Strength of evidence was assessed using established tools. Clinical recommendations were formulated based on the amalgamation of existing evidence.
Results: The paucity of evidence-based dosing recommendations for children with CP supported standing device is highlighted in this review. Key findings suggest that standing frames implemented 5 days per week demonstrate positive effects on gait (45 minutes/day, 3 times/ week), hip joint integrity (60 minutes/day), functional activities (60 minutes/day in 30° to 60° of bilateral hip abduction), joint range of motion (60 minutes/day), and muscle tone (30 minutes/day).
Conclusion: This systematic review of the treatment regimens for children with CP is providing useful insights to the dosing strategies of standing frames. The evidence supports a 30–60 minutes per day and 3–5 days a week intervention with specified durations for optimal outcomes. In enhancing the effectiveness of standing frames, as well as promoting evidencebased practices in the management of children with CP, these clinical recommendations offer guidance for practitioners.

Keywords: Cerebral palsy, Physical therapy modalities, Systematic review

Article

Original Article

Phys. Ther. Korea 2024; 31(2): 131-141

Published online August 20, 2024 https://doi.org/10.12674/ptk.2024.31.2.131

Copyright © Korean Research Society of Physical Therapy.

Evidence-based Clinical Guidelines for Optimizing the Use of Standing Frame: A Systematic Review of Dosing Recommendations Among Cerebral Palsy

Changho Kim1 , PT, PhD, Hyunsuk Park2 , PT, MPH

1Yonsei Child Development Center, Yongin, 2Rehabilitation Team, The Catholic University of Korea, Incheon St. Mary’s Hospital, Incheon, Korea

Correspondence to:Changho Kim
E-mail: workffid@hanmail.net
https://orcid.org/0000-0001-5627-0243

Received: April 4, 2024; Revised: May 3, 2024; Accepted: May 3, 2024

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Standing frames are a common intervention for children with cerebral palsy (CP), yet there is a lack of standardized dosing recommendations, impeding the enhancement of treatment outcomes in this population.
Objects: This paper aims to optimize dosing strategies for standing frame programs in children with CP. It evaluates effective durations and frequencies for using standing frames to improve gait, hip joint integrity, functional activities, joint range of motion, and muscle tone. The goal is to provide evidence-based clinical recommendations to guide practitioners in treating pediatric CP patients.
Methods: A comprehensive research was conducted across seven databases, yielding 23 studies meeting inclusion criteria. Strength of evidence was assessed using established tools. Clinical recommendations were formulated based on the amalgamation of existing evidence.
Results: The paucity of evidence-based dosing recommendations for children with CP supported standing device is highlighted in this review. Key findings suggest that standing frames implemented 5 days per week demonstrate positive effects on gait (45 minutes/day, 3 times/ week), hip joint integrity (60 minutes/day), functional activities (60 minutes/day in 30° to 60° of bilateral hip abduction), joint range of motion (60 minutes/day), and muscle tone (30 minutes/day).
Conclusion: This systematic review of the treatment regimens for children with CP is providing useful insights to the dosing strategies of standing frames. The evidence supports a 30–60 minutes per day and 3–5 days a week intervention with specified durations for optimal outcomes. In enhancing the effectiveness of standing frames, as well as promoting evidencebased practices in the management of children with CP, these clinical recommendations offer guidance for practitioners.

Keywords: Cerebral palsy, Physical therapy modalities, Systematic review

Fig 1.

Figure 1.Flow chart of study selection.
Physical Therapy Korea 2024; 31: 131-141https://doi.org/10.12674/ptk.2024.31.2.131

Table 1 . Summary of findings (included studies, best available evidence levels).

AuthorOCEBM Levels of EvidenceDosage usedParticipant
Gibson et al. [13] 2 1 hour/day, 5 days/week, 6 weeks5 nonambulatory children with CP
Martinsson and Himmelmann [14]230–90 minutes (60 minutes worked best), 5 times/week for 1 year97 children with CP, 2–6 years old, GMFCS levels 3-5
Salem et al. [15]245 minutes/day, 3 times/week in prone stander, 9 sessions6 children with CP, GMFCS levels 2 and 3
Tremblay et al. [16]2 One session, 30 minutes, tilt table with ankle dorsiflexioned 22 children with CP
Rapson et al. [17]260 minutes, 5 times a week25 children with CP, 1–12 years old, GMFCS levels 3–5
Lauruschkus et al. [18]230–90 minutes, daily20 children with CP, 5–17 years old, GMFCS levels 4 or 5
Hägglund et al. [19] 3 No dosing information provided in this study212 children followed until 9–16 years of age
Noronha et al. [20]3One session10 children with spastic diplegic CP
Rauf et al. [21]324 hours positioning in specific seats, night positioning and standing frames for 6 months74 children with quadriplegic CP aged 3 to 8 years
Martinsson and Himmelmann [22]310 hours/week, every week, for 8 months to 7 years269 children with CP were studied for more than 7 years in 2 case-control groups, GMFCS levels 4 or 5
Gudjonsdottir and Stemmons Mercer [23]430 minutes a day, 5 days a week for 8 weeks4 children of preschool age with severe CP
Stark et al. [24]4Total program included 6 months78 children with bilateral CP
Pountney et al. [25]430 minutes/day, Prone standers used daily for an average59 children with bilateral CP
Pountney et al. [26]43 years of daily use of prone stander39 children with bilateral CP
Dalén et al. [27]440 minutes/day (range 4–164 minutes/day)11 boys and 7 girls, median age 10.5 years, with severe CP
Wilmshurst et al. [28]4Regularly weight bearing in a frame9 girls and 18 boys with CP aged 5 to 14 years
Miedaner and Finuf [29]41 session12children, 17 to 58 months of age, with a diagnosis of spastic quadriplegia or diplegia
Rivi E et al. [30]430–60 minutes of verticalization per day for 5 days a week1 child with quadriplegia, GMFCS level 5
Goodwin et al. [31]430–60 minutes, 3 times a week on average12 young people with CP
Barbier et al. [32]4Standing frame for an average of 30 minutes/day24 children with severe CP, GMFCS levels 4 and 5
Macias [33]555°–70° of abduction, 45 minutes a day at home until the age of 514 children with diagnosis of CP, spastic diplegia
Rauch [34]5Standing frame with whole-body vibration,twice per week over a 6-month period4 children with CP
Ruys [35]5Long leg abduction brace when standing on a prone board, 20 minutes/day1 boy 12 years of age with hypotonic athetosis and severe acetabular dysplasia

OCEBM, Oxford Centre for Evidence-Based Medicine; CP, cerebral palsy; GMFCS, gross motor function classification system..


Table 2 . Assessment of methodological quality using the PEDro scale.

Tremblay et al. [16]Gibson et al. [13]Salem et al. [15]Martinsson and Himmelmann [14]Rapson et al. [17]Lauruschkus et al. [18]
Randomization of participantsYNNNYY
Concealed allocationYNYNYY
Groups similar at baselineYYYYYY
Blinding of participantsNNNNNN
Blinding of therapistsNNNNNN
Blinding of assessorsNNNNYNA
More than 85% follow-up of participants in at least one of key outcomesYYYYYY
Intention to treat analysisNYYYYN
Statistical comparisons between groupYYYYYY
Point estimate of at least one of the key outcomesYYYYYY
Total score6/105/106/105/108/106/10

PEDro, Physiotherapy Evidence Database; Y, yes; N, no; NA, not applicable..