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21/22 Stretching programme for ambulant children with cerebral palsy commissioning brief




The aim of the Health Technology Assessment (HTA) Programme is to ensure that high quality research information on the clinical effectiveness, cost-effectiveness and broader impact of healthcare treatments and tests are produced in the most efficient way for those who plan, provide or receive care from NHS and social care services. The commissioned workstream invites applications in response to calls for research on specific questions which have been identified and prioritised for their importance to the NHS, patients and social care.

Research question

Does a dynamic stretching programme for ambulant children with cerebral palsy improve outcomes?

  • Intervention: A dynamic stretching programme alongside child’s usual activity and participation (applicants to define and justify, including how the stretching is delivered, by whom, and the duration of the intervention). 
  • Patient group: Ambulant children (e.g. 4-11 years) with cerebral palsy (applicants to define and justify their eligibility criteria, including age).
    Applications are encouraged which include recruitment from geographic populations with high disease burden which have been historically underserved by research activity in this field.
  • Setting: Clinical/community setting.
  • Comparator: Child’s usual activity and participation programme with no specific stretch exercise.
  • Study design: A randomised controlled trial with an internal pilot phase to test key trial processes such as recruitment and adherence. Clear stop/go criteria should be provided to inform progression from pilot to full trial.
  • Important outcomes: Activities of daily living; gross motor function; range of movement.
  • Other outcomes: Patient and carer acceptability; treatment fidelity; adherence; educational outcomes; quality of life; adverse effects.
    Where established Core Outcomes exist they should be included amongst the list of outcomes unless there is good reason to do otherwise.
  • Minimum duration of follow-up: Six months.
  • Longer-term follow up: If appropriate, researchers should consider obtaining consent from participants to allow potential future follow up through efficient means (such as routine data) as part of a separately funded study.


Cerebral palsy (CP) is a lifelong condition affecting movement and co-ordination. It is caused by a problem with the brain that occurs before, during, or shortly after birth, such as a reduction in oxygen supply. It is estimated to affect one in every 400 children in the UK.

Physiotherapy is one of the most important treatments for children with CP and involves exercises to maintain and hopefully improve movement. Stretching exercises aim to improve muscle length and joint range of motion (ROM), therefore improving the child’s ability to participate in daily activities. These exercises may also delay the development of contractures (where the joint ROM is limited and muscles appear ‘short’) and the need for surgical intervention.

Dynamic stretches involve moving a joint through its full range of motion without holding the stretch position and are potentially important for improving physical skills such as running. Static stretches involve lengthening a muscle, such as the calf muscle, and holding in position for a certain length of time. Despite stretching exercises being common for children with CP, there is inconsistent evidence as to how effective dynamic stretches are. Stretching exercises can cause discomfort as well as being time consuming: either with parents at home, or within school time. This may involve a significant time commitment away from usual activity, and it is important that children and their parents are using their time in the most beneficial way.

As such, the British Academy of Childhood Disability Strategic Research Group in conjunction with the Castang Foundation identified this as one of the top research priorities to address the number one uncertainty identified by the James Lind Alliance Childhood Disability Research Priority Setting Partnership. Applications should be co-produced, demonstrating an equal partnership with service commissioners, providers and service users (including carers) in order to provide evidence and actionable findings of immediate utility to decision-makers, should be embedded throughout the life cycle of the project from application to completion. Applicants may wish to consult the NIHR guidance on co-producing research.

A separate call is available for a strengthening programme for ambulant adolescents with cerebral palsy: applicants should consider whether synergies between the two calls offer opportunities for efficiency, and we would welcome applicants to propose shared infrastructure between the two calls.

Additional commissioning brief background information

A background document is available that provides further information to support applicants for this call. It is intended to summarise what prompted the call and the existing evidence base, including relevant work from the HTA and wider NIHR research portfolio. It was researched and written on the basis of information from a search of relevant sources and databases, and in consultation with a number of experts in the field. If you would like a copy please email

Making an application

If you wish to submit a Stage 1 application for this call, the online application form can be found on the funding opportunities page. To select this call, use the filters on the right of the screen or search using the call name and/or number.

Your application must be submitted on-line no later than 1pm on the 28 July 2021. Applications will be considered by the HTA Funding Committee at its meeting in September 2021.

Guidance notes and supporting information for HTA Programme applications are available by clicking the links.

Important: Shortlisted Stage 1 applicants will be given eight weeks to submit a Stage 2 application. The Stage 2 application will be considered at the Funding Committee in January 2022.

Applications received electronically after 1300 hours on the due date will not be considered.

For commissioned topics, the Programme strongly discourages the practice of the same co-applicant joining more than one competing team. There may be unusual circumstances where the same person could be included on more than on application eg a lead from a named charity or a unique national expert in a condition.

For such exceptions (i) each application needs to state the case as to why the same person is included (ii) the shared co-applicant should not divulge application details between teams and (iii) both teams should acknowledge in their application that they are aware that one of their co-applicants is part of a competing application and that study details have not been shared.

Should you have any queries please contact us at