{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,18]],"date-time":"2025-10-18T20:57:40Z","timestamp":1760821060597,"version":"3.37.3"},"reference-count":25,"publisher":"BMJ","issue":"6","funder":[{"name":"Gait and Motion Outcomes Fund of the Gillette Children\u2019s Foundation"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2019,5,7]]},"published-print":{"date-parts":[[2019,6]]},"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>Spasticity is one of the primary pathologies associated with cerebral palsy (CP), yet no definitive evidence exists to guide the appropriate level of spasticity management for an individual. Spasticity management strategies often differ by center. On one end of this strategy spectrum is a highly-interventional approach, characterized by treatments such as a selective dorsal rhizotomy (SDR), intrathecal baclofen pump (ITB), and anti-spasticity injections and medications. On the other end of the spectrum is a less interventional approach, involving minimal use of these treatments, and no SDR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and analysis<\/jats:title><jats:p>A retrospectively-matched, multi-center study protocol is described that comprehensively compares the long-term outcomes of a highly-interventional versus a minimally-interventional spasticity management strategy. We will analyze two groups of adults with spastic bilateral CP (\u226521 years). In one group are individuals who underwent an SDR between the ages of 4 and 10 years, along with ongoing spasticity management during childhood and adolescence. In the other group are individuals who received minimal spasticity management and did not undergo an SDR. Individuals with prolonged use of an intrathecal baclofen (ITB) pump will be excluded. The two groups will be matched for spasticity and other important clinical characteristics at baseline. This study design improves on many of the limitations found in the existing outcome literature.<\/jats:p><\/jats:sec><jats:sec><jats:title>Ethics and dissemination<\/jats:title><jats:p>This study received necessary approval from the University of Minnesota and Western Institutional Review Boards. Results will be disseminated via peer-reviewed publications and conference presentations.<\/jats:p><\/jats:sec><jats:sec><jats:title>Trial registration number<\/jats:title><jats:p><jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" xlink:href=\"NCT03789786\" ext-link-type=\"clintrialgov\">NCT03789786<\/jats:ext-link>.<\/jats:p><\/jats:sec>","DOI":"10.1136\/bmjopen-2018-027486","type":"journal-article","created":{"date-parts":[[2019,6,21]],"date-time":"2019-06-21T10:16:38Z","timestamp":1561112198000},"page":"e027486","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":13,"title":["Comparing the effects of two spasticity management strategies on the long-term outcomes of individuals with bilateral spastic cerebral palsy: a multicentre cohort study protocol"],"prefix":"10.1136","volume":"9","clinical-trial-number":[{"clinical-trial-number":"nct03789786","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9859-6572","authenticated-orcid":false,"given":"Meghan E","family":"Munger","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1651-4503","authenticated-orcid":false,"given":"Brian Po-Jung","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Bruce A","family":"MacWilliams","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark L","family":"McMulkin","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael H","family":"Schwartz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"239","published-online":{"date-parts":[[2019,6,20]]},"reference":[{"key":"2024052012043544000_9.6.e027486.1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440-1754.2005.00687.x"},{"key":"2024052012043544000_9.6.e027486.2","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1111\/dmcn.12268","article-title":"Prevalence of cerebral palsy, co-occurring autism spectrum disorders, and motor functioning - Autism and Developmental Disabilities Monitoring Network, USA, 2008","volume":"56","author":"Christensen","year":"2014","journal-title":"Dev Med Child Neurol"},{"key":"2024052012043544000_9.6.e027486.3","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1111\/j.1469-8749.2008.03031.x","article-title":"Comprehensive short-term outcome assessment of selective dorsal rhizotomy","volume":"50","author":"Trost","year":"2008","journal-title":"Dev Med Child Neurol"},{"key":"2024052012043544000_9.6.e027486.4","doi-asserted-by":"crossref","first-page":"484","DOI":"10.1111\/dmcn.12665","article-title":"A prospective cohort study investigating gross motor function, pain, and health-related quality of life 17 years after selective dorsal rhizotomy in cerebral palsy","volume":"57","author":"Tedroff","year":"2015","journal-title":"Dev Med Child Neurol"},{"key":"2024052012043544000_9.6.e027486.5","first-page":"e1077","article-title":"Beneficial effects of childhood selective dorsal rhizotomy in adulthood","volume":"9","author":"Park","year":"2017","journal-title":"Cureus"},{"key":"2024052012043544000_9.6.e027486.6","first-page":"e1256","article-title":"Functional outcomes of childhood selective dorsal rhizotomy 20 to 28 Years Later","volume":"9","author":"Park","year":"2017","journal-title":"Cureus"},{"key":"2024052012043544000_9.6.e027486.7","doi-asserted-by":"crossref","first-page":"180","DOI":"10.3171\/PED\/2008\/1\/3\/180","article-title":"A prospective gait analysis study in patients with diplegic cerebral palsy 20 years after selective dorsal rhizotomy","volume":"1","author":"Langerak","year":"2008","journal-title":"J Neurosurg Pediatr"},{"key":"2024052012043544000_9.6.e027486.8","doi-asserted-by":"publisher","DOI":"10.1016\/j.ejpn.2009.05.002"},{"key":"2024052012043544000_9.6.e027486.9","doi-asserted-by":"crossref","first-page":"1196","DOI":"10.1111\/dmcn.13500","article-title":"Long-term outcomes after selective dorsal rhizotomy: a retrospective matched cohort study","volume":"59","author":"Munger","year":"2017","journal-title":"Dev Med Child Neurol"},{"key":"2024052012043544000_9.6.e027486.10","unstructured":"Organization WH. 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