Randomized controlled trial of web-based multimodal therapy for children with acquired brain injury to improve gross motor capacity and performance

Objective: To compare efficacy of a web-based multimodal training programme, Move it to improve it' (Mitii(TM)), to usual care on gross motor capacity and performance for children with an acquired brain injury. Design: Randomized waitlist controlled trial. Setting: Home environment. Participants: A total of 60 independently ambulant children (30 in each group), minimum 12months post-acquired brain injury were recruited and randomly allocated to receive either 20weeks of Mitii(TM) training (30minutes/day, six days/week, total 60hours) immediately, or waitlisted (usual care control group) for 20weeks. A total of 58 children completed baseline assessments (32 males; age 11years 11months 2years 6months; Gross Motor Function Classification System equivalent I=29, II=29). Intervention: The Mitii(TM) program comprised of gross motor, upper limb and visual perception/cognitive activities. Main measures: The primary outcome was 30-second, repetition maximum functional strength tests for the lower limb (sit-to-stand, step-ups, half-kneel to stand). Secondary outcomes were the 6-minute walk test, High-level Mobility Assessment Tool, Timed Up and Go Test and habitual physical activity as captured by four-day accelerometry. Results: Groups were equivalent at baseline on demographic and clinical measures. The Mitii(TM) group demonstrated significantly greater improvements on combined score of functional strength tests (mean difference 10.19 repetitions; 95% confidence interval, 3.26-17.11; p=0.006) compared with the control group. There were no other between-group differences on secondary outcomes. Conclusion: Although the Mitii(TM) programme demonstrated statistically significant improvements in the functional strength tests of the lower limb, results did not exceed the minimum detectable change and cannot be considered clinically relevant for children with an acquired brain injury.