{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:07:36Z","timestamp":1760144856993,"version":"build-2065373602"},"reference-count":39,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T00:00:00Z","timestamp":1716768000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Background\/Objectives: To determine whether a sitting position with the femoral heads centered into the acetabulum is more effective than the usual sitting position in preventing migration percentage progression in non-ambulatory children with bilateral cerebral palsy. Methods: This was a multicenter, randomized controlled trial. Inclusion criteria: spastic or dyskinetic cerebral palsy, Gross Motor Function Classification System level IV-V, age 1\u20136 years, migration percentage &lt;41%, and informed consent. Exclusion criteria: contractures affecting the hip, anterior luxation, previous hip surgery, and lumbar scoliosis. The treatment group sat with their hips significantly abducted to reduce the head into the acetabulum in a customized system for at least five hours\/day for two years. Controls sat with the pelvis and lower limbs aligned but the hips less abducted in an adaptive seating system. The primary outcome was migration percentage (MP) progression. Health-related quality of life and family satisfaction were among the secondary outcomes. The study was approved by the local ethics board and conducted in accordance with CONSORT reporting guidelines. ClinicalTrials.gov ID: NCT04603625. Results: Overall median MP progression was 1.6 after the first year and 2.5 after the second year. No significant differences were observed between the groups. MP exceeded 40% and 50% in 1.8% and 0% of the experimental group and 5.4% and 3.6% of controls in years 1 and 2, respectively. Both groups expressed satisfaction with the postural system and stable health-related quality of life. Conclusions: MP remained stable over the two-year period in both groups. Considering outliers which progressed over 50%, a more protective trend of the hip-centering sitting approach emerged, but this needs to be confirmed in a final, larger dataset.<\/jats:p>","DOI":"10.3390\/jcm13113129","type":"journal-article","created":{"date-parts":[[2024,5,27]],"date-time":"2024-05-27T09:33:31Z","timestamp":1716802411000},"page":"3129","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Sitting Postural Management to Prevent Migration Percentage Progression in Non-Ambulatory Children with Cerebral Palsy: Randomized Controlled Trial Preliminary Data"],"prefix":"10.3390","volume":"13","author":[{"given":"Silvia","family":"Faccioli","sequence":"first","affiliation":[{"name":"Pediatric Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS of Reggio Emilia, 42122 Reggio Emilia, Italy"},{"name":"PhD Program in Clinical and Experimental Medicine, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Irene","family":"Maggi","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS of Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5933-5636","authenticated-orcid":false,"given":"Emanuela","family":"Pagliano","sequence":"additional","affiliation":[{"name":"Neurodevelopmental Unit, Fondazione IRCCS Istituto Neurologico Carlo Besta, 20133 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Claudia","family":"Migliorini","sequence":"additional","affiliation":[{"name":"Rehabilitation Department, AULSS 9 Scaligera, 37122 Verona, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8959-7154","authenticated-orcid":false,"given":"Arianna","family":"Michelutti","sequence":"additional","affiliation":[{"name":"Scientific Institute IRCCS E. Medea, 33037 Pasian di Prato (UD), Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliana","family":"Guerra","sequence":"additional","affiliation":[{"name":"Pediatric Neuropsychiatric Unit, Azienda Unit\u00e0 Sanitaria Locale Modena, 41122 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3291-5075","authenticated-orcid":false,"given":"Anna","family":"Ronchetti","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Unit, IRCCS Istituto Giannina Gaslini, 16147 Genoa, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5021-7799","authenticated-orcid":false,"given":"Giovanna","family":"Cristella","sequence":"additional","affiliation":[{"name":"IRCCS Don Carlo Gnocchi Foundation, 50143 Florence, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nicoletta","family":"Battisti","sequence":"additional","affiliation":[{"name":"Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Institute of Neurological Sciences, 40124 Bologna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lara","family":"Mancini","sequence":"additional","affiliation":[{"name":"Physical Medicine and Rehabilitation Unit, Santa Maria delle Croci Hospital, Azienda Unit\u00e0 Sanitaria Locale Romagna, 48100 Ravenna, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0420-0048","authenticated-orcid":false,"given":"Odoardo","family":"Picciolini","sequence":"additional","affiliation":[{"name":"Pediatric Physical Medicine and Rehabilitation Unit, IRCCS Ca\u2019 Granda Ospedale Maggiore Polyclinic Hospital, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Silvia","family":"Alboresi","sequence":"additional","affiliation":[{"name":"Pediatric Rehabilitation Unit, Azienda Unit\u00e0 Sanitaria Locale IRCCS of Reggio Emilia, 42122 Reggio Emilia, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Antonio","family":"Trabacca","sequence":"additional","affiliation":[{"name":"Unit for Severe Disabilities in Developmental Age and Young Adults, Scientific Institute IRCCS E. Medea, 72100 Brindisi, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1166-2961","authenticated-orcid":false,"given":"Shaniko","family":"Kaleci","sequence":"additional","affiliation":[{"name":"Surgical Medical and Dental Department of Morphological Sciences Related to Transplant, Oncology and Regenerative Medicine, University of Modena and Reggio Emilia, 41125 Modena, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,5,27]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1111\/j.1469-8749.2008.03129.x","article-title":"A classification system for hip disease in cerebral palsy","volume":"51","author":"Robin","year":"2008","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"951","DOI":"10.1111\/j.1469-8749.2012.04385.x","article-title":"The natural history of hip development in cerebral palsy","volume":"54","author":"Terjesen","year":"2012","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"129","DOI":"10.1007\/s11832-014-0570-7","article-title":"Hip displacement in relation to age and gross motor function in children with cerebral palsy","volume":"8","author":"Larnert","year":"2014","journal-title":"J. Child. Orthop."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1302\/0301-620X.96B11.34385","article-title":"Prevention of dislocation of the hip in children with cerebral palsy: 20-year results of a population-based prevention programme","volume":"96-B","author":"Wagner","year":"2014","journal-title":"Bone Joint J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"319","DOI":"10.1097\/MRR.0000000000000545","article-title":"Hip subluxation in Italian cerebral palsy children and its determinants: A retrospective cohort study","volume":"45","author":"Faccioli","year":"2022","journal-title":"Int. J. Rehabil. Res."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"808","DOI":"10.1111\/dmcn.12754","article-title":"Australian hip surveillance guidelines for children with cerebral palsy: 5-year review","volume":"57","author":"Wynter","year":"2015","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_7","unstructured":"AACPDM Care Pathways (2020, May 26). Hip Surveillance Care Pathway Team. Hip Surveillance: Bottom Line \u2018Evidence-Informed\u2019 Recommendations for the Hip Surveillance in Individuals with Cerebral Palsy. September. Available online: https:\/\/www.aacpdm.org\/UserFiles\/file\/hip-surveillance-care-pathway.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"495","DOI":"10.1080\/17453674.2019.1627116","article-title":"Primary surgery to prevent hip dislocation in children with cerebral palsy in Sweden: A minimum 5-year follow-up by the national surveillance program (CPUP)","volume":"90","author":"Kiapekos","year":"2019","journal-title":"Acta Orthop."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1302\/1863-2548.13.190064","article-title":"Migration percentage and odds of recurrence\/subsequent surgery after treatment for hip subluxation in pediatric cerebral palsy: A meta-analysis and systematic review","volume":"13","author":"Agarwal","year":"2019","journal-title":"J. Child. Orthop."},{"key":"ref_10","unstructured":"National Institute for Health and Care Excellence (2023, September 14). Spasticity in under 19s: Management. Clinical Guideline [CG145]. Available online: https:\/\/www.nice.org.uk\/guidance\/cg145."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"411","DOI":"10.1302\/0301-620X.103B2.BJJ-2020-1528.R1","article-title":"Hip displacement in children with cerebral palsy","volume":"103-B","author":"Wordie","year":"2021","journal-title":"Bone Joint J."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"227","DOI":"10.1177\/18632521221106361","article-title":"A retrospective cohort study about the hip luxation in non-ambulatory cerebral palsy patients: The point of no return","volume":"16","author":"Faccioli","year":"2022","journal-title":"J. Child. Orthop."},{"key":"ref_13","first-page":"682","article-title":"Can we prevent hip dislocation in children with cerebral palsy? Effects of postural management","volume":"52","author":"Picciolini","year":"2016","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1130","DOI":"10.1111\/dmcn.13480","article-title":"Prevention of hip displacement in children with cerebral palsy: A systematic review","volume":"59","author":"Miller","year":"2017","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1097\/PEP.0000000000000488","article-title":"Effects of Postural Management on Hip Migration in Children With Cerebral Palsy: A Systematic Review","volume":"30","author":"Ketelaar","year":"2018","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1016\/j.apmr.2018.07.423","article-title":"Are Seating Systems With a Medial Knee Support Really Helpful for Hip Displacement in Children With Spastic Cerebral Palsy GMFCS IV and V?","volume":"100","author":"Kim","year":"2019","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"23","DOI":"10.2106\/JBJS.F.01416","article-title":"Does botulinum toxin a combined with bracing prevent hip displacement in children with cerebral palsy and \u201chips at risk\u201d? A randomized, controlled trial","volume":"90","author":"Boyd","year":"2008","journal-title":"J. Bone Joint Surg. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"743","DOI":"10.1111\/j.1469-8749.2012.04340.x","article-title":"The impact of botulinum toxin A and abduction bracing on long-term hip development in children with cerebral palsy","volume":"54","author":"Willoughby","year":"2012","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1097\/PEP.0000000000000789","article-title":"Abducted Standing in Children With Cerebral Palsy: Effects on Hip Development After 7 Years","volume":"33","author":"Martinsson","year":"2021","journal-title":"Pediatr. Phys. Ther."},{"key":"ref_20","doi-asserted-by":"crossref","unstructured":"Schulz, K.F., Altman, D.G., Moher, D., and CONSORT Group (2010). CONSORT 2010 Statement: Updated guidelines for reporting parallel group randomised trials. BMC Med., 8.","DOI":"10.1186\/1741-7015-8-18"},{"key":"ref_21","first-page":"37","article-title":"La luxation post\u00e9ro-externe de la hanche chez l\u2019enfant IMC ou polyhandicap\u00e9","volume":"12","author":"Lespargot","year":"1991","journal-title":"Mot. C\u00e9r\u00e9brale"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content validity of the expanded and revised Gross Motor Function Classification System","volume":"50","author":"Palisano","year":"2008","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_23","unstructured":"R Core Team (2022). R: A Language and Environment for Statistical Computing, R Foundation for Statistical Computing. Available online: https:\/\/www.R-project.org\/."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1111\/j.1469-8749.2006.tb01227.x","article-title":"Caregiver Priorities & Child Health Index of Life with Disabilities: Initial development and validation of an outcome measure of health status and well-being in children with severe cerebral palsy","volume":"48","author":"Narayanan","year":"2006","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"651","DOI":"10.23736\/S0026-4806.19.06072-5","article-title":"Italian translation and cross-cultural adaptation of the questionnaire for the assessment of quality of life in children with cerebral palsy: Caregiver priorities and child health index of life with disabilities","volume":"112","author":"Sproccati","year":"2021","journal-title":"Minerva Med."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1080\/10400435.2000.10132015","article-title":"Item analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology (QUEST)","volume":"12","author":"Demers","year":"2000","journal-title":"Assist. Technol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1080\/07380577.2018.1522682","article-title":"Exploring Validity, Reliability, and Factor Analysis of the Quebec User Evaluation of Satisfaction with Assistive Technology in an Italian Population: A Cross-Sectional Study","volume":"32","author":"Galeoto","year":"2018","journal-title":"Occup. Ther. Health Care"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"57","DOI":"10.1111\/dmcn.13166","article-title":"MRI classification system (MRICS) for children with cerebral palsy: Development, reliability, and recommendations","volume":"59","author":"Himmelmann","year":"2017","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"821","DOI":"10.1097\/PHM.0000000000001818","article-title":"Disrupted Access to Therapies and Impact on Well-Being During the COVID-19 Pandemic for Children With Motor Impairment and Their Caregivers","volume":"100","author":"Sutter","year":"2021","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"e536","DOI":"10.1097\/BPO.0000000000001318","article-title":"CHOP Investigative Team. Reliability of Radiographic Assessments of the Hip in Cerebral Palsy","volume":"39","author":"Shore","year":"2019","journal-title":"J. Pediatr. Orthop."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1111\/dmcn.13171","article-title":"Hip health at skeletal maturity: A population-based study of young adults with cerebral palsy","volume":"58","author":"Wawrzuta","year":"2016","journal-title":"Dev. Med. Child. Neurol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"829","DOI":"10.1097\/BPO.0000000000000577","article-title":"Risk Factors for Hip Displacement in Children With Cerebral Palsy: Systematic Review","volume":"36","author":"Pruszczynski","year":"2016","journal-title":"J. Pediatr. Orthop."},{"key":"ref_33","doi-asserted-by":"crossref","unstructured":"Bertoncelli, C., Altamura, P., Vieira, E.R., Bertoncelli, D., and Solla, F. (2021). Predicting hip dysplasia in teenagers with cerebral palsy in order to optimize prevention and rehabilitation. A longitudinal descriptive study. Dev. Neurorehabil., 24.","DOI":"10.1080\/17518423.2020.1819459"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"23094990211001196","DOI":"10.1177\/23094990211001196","article-title":"Risk factors for hip dislocation in dyskinetic cerebral palsy","volume":"29","author":"Okuno","year":"2021","journal-title":"J. Orthop. Surg."},{"key":"ref_35","doi-asserted-by":"crossref","unstructured":"H\u00e4gglund, G. (2020). Association between pelvic obliquity and scoliosis, hip displacement and asymmetric hip abduction in children with cerebral palsy: A cross-sectional registry study. BMC Musculoskelet. Disord., 21.","DOI":"10.1186\/s12891-020-03484-y"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1080\/17453674.2016.1262685","article-title":"Severe hip displacement reduces health-related quality of life in children with cerebral palsy","volume":"88","author":"Ramstad","year":"2017","journal-title":"Acta Orthop."},{"key":"ref_37","doi-asserted-by":"crossref","unstructured":"Marcstr\u00f6m, A., H\u00e4gglund, G., and Alriksson-Schmidt, A.I. (2019). Hip pain in children with cerebral palsy: A population-based registry study of risk factors. BMC Musculoskelet. Disord., 20.","DOI":"10.1186\/s12891-019-2449-8"},{"key":"ref_38","first-page":"93","article-title":"Range of hip abduction after preventive and reconstructive surgery in cerebral palsy: A longitudinal registry study of 307 children","volume":"93","author":"Wagner","year":"2022","journal-title":"Acta Orthop."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"131","DOI":"10.3389\/fphys.2020.00131","article-title":"Stretching Interventions in Children With Cerebral Palsy: Why Are They Ineffective in Improving Muscle Function and How Can We Better Their Outcome?","volume":"11","author":"Kalkman","year":"2020","journal-title":"Front. Physiol."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/11\/3129\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T14:49:23Z","timestamp":1760107763000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/13\/11\/3129"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2024,5,27]]},"references-count":39,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2024,6]]}},"alternative-id":["jcm13113129"],"URL":"https:\/\/doi.org\/10.3390\/jcm13113129","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2024,5,27]]}}}