Parent-reported activity and health-related quality of life after botulinum toxin in spastic cerebral palsy

Objective: This study aimed to investigate changes in activity levels and health-related quality of life (HRQoL) in children with spastic cerebral palsy (CP) before and after botulinum toxin (BTX) injection, based on parental reports within the International Classification of Functioning Disability and Health (ICF) framework.

Methods: This retrospective study included 60 children with spastic CP (20 girls, 40 boys) who underwent BTX injection for spasticity management. The age range was 2-11 years (mean age, 5.44 Å} 2.09 years). Gross motor function level was classified using the Gross Motor Function Classification System–Family Report. Activity was evaluated with the Pediatric Outcome Data Collection Instrumen (PODCI), and HRQoL was assessed using the Pediatric Quality of Life Inventory (PedsQL) before and after BTX injection. Parents completed all questionnaires 6-12 months after BTX injection; pre- and post-injection scores were compared.

Results: The PODCI scores improved significantly after BTX in upper extremity function (P = .001), transfers/basic mobility (P = .005), pain/comfort (P = .009), happiness/satisfaction (P < .001), and global score (P < .001), while the physical function/sports subscale did not change significantly (P = .136). The PedsQL total score improved (P < .001), with significant improvements in daily activities (P < .001), school (P = .034), activity/balance (P < .001), pain/ache (P = .015), fatigue/prostration (P = .002), and nutrition (P = .027); the speech/communication domain showed no significant change (P = .150).

Conclusion: From a parental perspective, BTX injection was associated with improved activity and HRQoL in children with spastic CP, with gains seen across multiple functional and well-being domains. Clinically, these findings support counseling families that BTX within an ICF-oriented rehabilitation approach may translate into meaningful improvements in daily function and overall well-being, although speech-related outcomes may be less responsive.

Cite this article as: Yavuz GK, Yılmaz G, Günel MK. Parent-reported activity and health-related quality of life after botulinum toxin in spastic cerebral palsy. Acta Orthop Traumatol Turc., 2026; 60(2), 0612, doi: 10.5152/j.aott.2026.25612.