Abstract
Background
Autism Spectrum Disorder (ASD) is characterized by physical, communication, and behavioral challenges that often require comprehensive interventions. This study aimed to evaluate the combined efficacy of physiotherapy, occupational and speech therapies in improving physical and behavioral outcomes among children with ASD.
Materials and methods
This assessor-blinded randomized clinical trial was conducted at Proyash (Institute of Special Education), Jashore, Bangladesh, involving seventy children with ASD. Outcomes were assessed using the modified SF-36 for physical status and GARS-3 for behavioral status at baseline and after six weeks of intervention. Data were analyzed using SPSS version 25.0, with descriptive statistics (median and IQR) and inferential tests (Mann-Whitney U and Wilcoxon signed-rank), maintaining a 95% confidence level.
Results
The average age of participants was 10.66 ± 3.28 years in Group A and 9.17 ± 2.83 years in Group B. Group A had a higher BMI of 21.86 ± 7.96 kg/m² compared to 19.53 ± 4.85 kg/m² in Group B. Post-intervention analysis revealed significant improvements in both physical and behavioral outcomes. Between-group comparisons yielded p-values < 0.01 for both measures. Within-group analysis showed significant improvements in Group A (p < 0.01), whereas changes in Group B were not statistically significant.
Conclusion
The combined rehabilitation program demonstrated significant improvements in physical and behavioral outcomes and showing greater effectiveness overall. These findings emphasize the importance of customized rehabilitation approaches in enhancing both physical and behavioral health, particularly when tailored to specific participant profiles.
Trial registration
CTRI/2024/07/070209 (Prospectively Registered).
Keywords: Behavioral status, Physical and emotional health, Rehabilitation, Autism spectrum disorder
Introduction
Autism Spectrum Disorder (ASD) is mainly characterized by core features in two areas: social communication and motor behavior with restricted, repetitive sensory behaviors [1]. At the physical level, it can manifest as impaired coordination and balance, potentially leading to postural stability challenges and an increased risk of injury [2]. Autism prevalence is rising and currently lies between 0.9% and 1.5% [3]. Higher prevalence rates are observed in affluent and high-income countries compared to developing nations, where diagnosis rates remain lower [4]. A recent worldwide ASD prevalence estimate of 0.6% falls far below estimates for Western developed societies, likely due to the shortage of diagnostic services rather than a true difference in ASD incidence [5].
The average age of ASD diagnosis (4 years, 10 months) was later than optimal for children to benefit most from early intervention [6]. According to the Centers for Disease Control and Prevention (CDC)’s Autism and Developmental Disabilities Monitoring (ADDM) Network, an estimated 1 in 44 children aged eight years old were diagnosed with ASD in the United States [7]. Previously, in 2016, the estimate was 1 in 54. Worldwide epidemiological surveys emphasize a rising prevalence in ASD diagnosis over recent years [8].
According to the Child Neurodevelopment and Autism Center at Bangabandhu Sheikh Mujib Medical University in Bangladesh, 7.5 out of every 10,000 children are affected by autism [9]. Early diagnosis of ASD is considered best practice, as early intervention for emotional regulation, communication, cognitive development, behaviors, sensory processing, and social skills support provides children with improved educational outcomes and quality of life [10, 11].
Today, early autism diagnosis before a child turns three years old is possible and has increased [12]. Early diagnosis and treatment with evidence-based services, such as early intensive behavioral intervention, may help optimize health for children with autism and their families [13]. Autism severity is classified into three levels - mild, moderate, and severe based on the individual’s ability to perform activities of daily living (ADLs) [14].
The treatment of autism involves a multidisciplinary team composed of professionals such as physiotherapists, occupational therapists, speech therapists, psych ecologists, physicians, and others [15]. Physical therapy should begin early to enhance motor development and daily functional needs [16]. Physical activity can increase aerobic capacity, enhance strength, improve motor control, and improve overall fitness in children with ASD [17]. It can also facilitate routine building, reduce stress and anxiety, increase self-efficacy, and enhance overall psychological well-being [18]. Additionally, participation in activities like jogging, martial arts, and horseback riding has been shown to reduce stereotypical behaviors such as rocking and hand-flapping [19]. Hippo-therapy helps in developing muscle strength, motor coordination, postural correction, and balance, promoting the physical and emotional well-being of children with autism [20]. Hydrotherapy through the physical principles of water, hydrotherapy contributes to motor stimulation, social behavior, sensory development, confidence, self-control, and muscle strengthening [21]. It also helps improve mood, motivation, and reduces autistic movement challenges [22]. Play Therapy is a therapeutic practice that promotes communication, motor coordination, cognitive abilities, and emotional expression in children with ASD [23]. Studies have shown that physical activity helps improve social interaction, reduces aggressive behavior [24], and reduces stereotypical behavior in children with autism spectrum disorder (ASD) [25]. Integrated physical training in children with ASD increases social skills and changes their repetitive and restricted behavior [26].
To date, no study has directly compared conventional therapies (occupational and speech-language therapy) with a combined approach that includes physiotherapy in improving behavioral, physical, and mental outcomes in children with ASD. This study aimed to evaluate the effectiveness of this combined intervention against standard needs-based therapy involving only occupational and speech-language therapy.
Materials and methods
Study design and settings
This assessor-blinded randomized clinical trial was conducted from October 2024 to January 2025 at the outpatient unit of Proyash, Institute of Special Education, Jashore, Bangladesh. Seventy children with ASD were enrolled. The study design, analysis, and reporting adhered to the 25-item CONSORT checklist (Fig. 1) [27].
Fig. 1.
Consolidated standard of reporting trails (CONSORT) flowchart of this study
Recruitment, randomization and group allocation
The names and contact details of guardians of children with ASD were obtained from the patient data records of the outpatient department at Proyash, which served as the population frame. Subsequently, potential participants were contacted by telephone to invite them to join the study. Those who expressed interest were screened against the inclusion and exclusion criteria using a questionnaire administered over the phone. The inclusion criteria included: (1) age between 3 and 22 years [28], (2) both boys and girls and (3) diagnosed as children with ASD based on Diagnostic and Statistical Manual of Mental Disorders Fifth Edition (DSM-V) criteria [29]. The participants were excluded if they (1) the respondent gave consents but drops out within the first week of enrollment; (2) other neurodevelopmental disorders such as cerebral palsy, down syndrome, and attention deficit/hyperactivity disorder (ADHD) etc.; (3) any self-reported or parent-reported recent (within the past six months) muscle injury or other disease such as muscle sprain, head injury, skin laceration etc [30].
The study samples were chosen through a simple random sampling method, ensuring an unbiased selection process. A secure web-based computerized random assignment sequence was utilized to maintain confidentiality. To further ensure impartial random allocation of participants in either group A or group B, the randomization sequence was generated either by a statistician or through automated technology, preventing any interference from personnel involved in the enrollment process [21].
Sample size
The sample size was determined utilizing ClinCalc software, concentrating on the primary outcome assessed by the Gilliam Autism Rating Scale, Second Edition (GARS – 2) [31]. The sample size was established according to the expected minimum clinically significant differences (MCID) of GARS-2, calculated at 4.7 ± 1.7 (on a 0–10 Hiva scale derived from a 0–126 GARS-2 score). The full sample size, calculated based on a 25% minimum clinical improvement, 1:1 enrollment ratio, 80% power, and an alpha value of 0.05, was 66 [32]. To ensure safety, we recruited 70 children with autism spectrum disorder (ASD), who was divided into two groups, 35 in each group.
Diagnosis of ASD
Screening for autism spectrum disorder (ASD) involves the DSM-5 diagnostic criteria established by the American Psychological Association [33]. The 15-item Childhood Autism Rating Scale (CARS), completed by a licensed psychologist, aids in identifying ASD based on parental descriptions, the Autism Diagnostic Observation Schedule (ADOS), and direct cognitive observations [34]. Key features of ASD include restricted interests, repetitive behaviors, deficits in verbal and nonverbal communication, and challenges in social interaction. These traits appear across socio-economic and cultural contexts, though their expression varies [35]. The severity of symptoms, categorized from Level 1 to Level 3, depends on the degree of hindrance caused by restricted interests and repetitive behaviors [14]. CARS demonstrates high diagnostic accuracy with 98.5% sensitivity and 92% specificity [36].
Intervention
On the first day, an assessor blinded to group assignment conducted additional screening and administered the pre-intervention evaluation. Participants then received multidisciplinary treatment delivered by three postgraduate practitioners from each discipline: physiotherapy, occupational therapy, and speech-language therapy. Each treatment protocol utilized a distinct set of tools and techniques. Each group received interventions three times per week over a six-week period [37].
Group A: Physiotherapy with speech-language and occupational therapy
Physiotherapy intervention
Group A received physiotherapy such as balance training on land and in water for 10 min; coordination training for 3 min; hippo-therapy or therapeutic horseback riding for 3 min; proprioception training for 4 min to improve motor function and lower limb strength for 5 min; aerobic exercise to improve sleep, motor skills and muscle strengthening to enhance higher executive performance for 5 min [38–42]. Physiotherapy interventions were carried out daily for 30 min in 1.5-hour daily sessions.
Occupational therapy intervention
Sensory integration was customized to each child’s unique needs using the ten basic treatment methods outlined in the Credibility Tool [43]. Some of these methods are: (a) arranging space to improve communication; (b) being physically safe; (c) providing alternatives to input sensory; (d) achieving and maintaining proper stimulation levels; (e) providing qualitative challenges by changing activities; (f) ensuring the success of activities; (g) to advise on behavior self-regulation; (h) creating a fun environment; (i) selecting activities together; And (j) Encouraging therapeutic partnership [44]. These ten topics were divided into three main groups: (1) creating sensory opportunities for the child by changing the environment during treatment; (2) providing common challenges and promoting adaptive responses; and (3) Building a rapport between the therapist and the child [45]. Play therapy, balancing training, skill development drills, ball games, pegboard games, and sensory integration exercises are some other interventions that incorporate gross motor function through exercise [46]. Also, cognitive behavioral therapy and community mobility or travel training [47] have been included. Occupational therapy interventions were conducted daily for 30 min in 1.5-hour daily sessions.
Speech and Language therapy interventions
Group A underwent Speech and language therapy (SLT) incorporating methods such as Applied Behavior Analysis (ABA), Applied Behavior Consequences (ABC), Relationship Development Intervention (RDA), Cognitive Behavior Intervention (CBI), Picture Communication Exchange Communication System (PECS), Augmentative and Alternative Communication (AAC), social communication interventions (e.g., social story)and visual schedules [48, 49]. Speech and language therapy interventions were ongoing for 30 min in 1.5-hour daily sessions.
Group B: Only occupational therapy and Speech-Language therapy
This group received the same speech and language therapy and occupational therapy treatment protocol for Group A but the treatment duration was 1.5 h per session, and each therapy intervention lasted 45 min, but they did not receive any physiotherapy.
Outcome measurement
A structured questionnaire was developed to collect sociodemographic data, including age, gender, BMI, residential area, birth order, mother’s education level, annual household income, history of behavioral intervention, maternal complications during pregnancy, labor details, delivery type, and postnatal complications [50].
Gilliam autism rating scale III (GARS-3)
ASD children’s behavior was assessed using the Gilliam Autism Rating Scale (GARS-3), third edition. The 58-item scale measures Restricted/Repetitive Behaviors (13), Social Interaction (14), Social Communication (9), and Emotional Responses (8). Cognitive Style (seven measures) and Maladaptive Speech (seven items) are used for talkative youngsters. The child’s current actions were evaluated with a four-point Likert scale: “not at all like the individual” (0), “not much like the individual” (1), “somewhat like the individual” (2), “very much like the individual” (3), if an item’s evaluation is unclear, extended observation or prior behavioral data should be used. The Autism Index demonstrated high reliability, with Cronbach’s alpha values of 0.94 and 0.93 for the four- and six-subscale versions, respectively [31].
Modified SF-36
The SF-36 questionnaire is a widely-used tool comprising 36 items that yield eight scores, four of which pertain to physical health: general health, role limitations due to physical problems, physical discomfort, and physical functioning [51]. The remaining scores cover vitality, mental health, role limitations due to affective disorders, and social functioning, with each scale ranging from 0 to 100 [52]. The questionnaire demonstrated strong reliability, with Cronbach’s alpha exceeding 0.85 and reliability coefficients above 0.75 across all dimensions [53]. A modified SF-36 was applied to assess activity limitations, physical health challenges, and mental health concerns in children with autism spectrum disorder (ASD) [54].
Data analysis
Parametric tests were applied to analyze interval and ratio data, while non-parametric tests were utilized for nominal and ordinal data. Data normality was assessed using the Kolmogorov-Smirnov test, and a p-value < 0.05 indicated non-normal distribution [25]. Consequently, descriptive statistics, including median and interquartile range (IQR), were employed for sociodemographic analysis. Between-group differences in behavioral and physical performance of ASD children were analyzed using the Mann-Whitney U-test, while within-group analyses for these variables were performed with the Wilcoxon signed-rank test by. The significance level was set at p < 0.05. All statistical analyses were performed using SPSS Statistics version 25 (IBM Corp., Armonk, NY, USA).
Results
Following randomization, 70 patients were assigned to one of two groups: Group A (n = 35) or Group B (n = 35). Each group had equal drops out during the post-assessment period.
Socio-demographic information
The sociodemographic and clinical information are summarized in Table 1. The average age of the participants in Group A was 10.66 ± 3.28 and in Group B 9.17 ± 2.83 years. The body mass index of the participant in Group A was 21.86 ± 7.96 Kg/m2 and in Group B was 19.53 ± 4.85 Kg/m2. In both groups, the male participants number was the maximum, 80% (n = 28) in the Group A and 71.40% (n = 25) in the Group B and female participants number was the maximum, 20% (n = 7) in the Group A and 28.60% (n = 10) in the Group B. Most of the participants lived in the urban areas Group A 74.30% (n = 26) and Group B 82.90% (n = 29) but they were mostly from rural areas Group A 25.70% (n = 9) and Group B 17.10% (n = 6). Regarding mothers’ educational status, most participants 40.00% (n = 14) completed graduation in Group A whereas 34.30% (n = 12) completed up to SSC education in Group B.
Table 1.
Socio-demographic and clinical characteristics of the participants at baseline
| Characteristics | Overall (n = 70) % (n) |
Group A (n = 35) % (n) |
Group B (n = 35) % (n) |
p-value |
|---|---|---|---|---|
|
Age (years) Median (IQR) |
9 (8 to 12) | 10 (8 to 13) | 9 (7 to 12) | 0.07a* |
|
Body Mass Index (Kg/m2) Median (IQR) |
20.15 (16.10 to 23.50) | 20.20 (16.50 to 25.40) | 19.70 (15.30 to 22.70) | 0.27a |
| Gender | ||||
| Male | 75.70 (53) | 80.00 (28) | 71.40 (25) | 0.38b |
| Female | 24.30 (17) | 20.00 (7) | 28.60 (10) | |
| Living area | ||||
| Urban | 78.60 (55) | 74.30 (26) | 82.90 (29) | 0.51b |
| Rural | 21.40 (15) | 25.70 (9) | 17.10 (6) | |
| Mothers’ education | ||||
| Up to SSC | 20.00 (14) | 5.70 (2) | 34.30 (12) | 0.13c |
| HSC | 32.90 (23) | 37.10 (13) | 28.60 (10) | |
| Graduation / Bachelor | 34.30 (24) | 40.00 (14) | 28.60 (10) | |
| Post-graduation | 12.90 (9) | 17.10 (6) | 8.60 (3) | |
| Monthly family income (BDT) Median (IQR) | 45 K (35 K to 60 K) | 45 K (35 K to 70 K) | 40 K (35 K to 50 K) | 0.24a |
| First born child | ||||
| Yes | 60.00 (42) | 65.70 (23) | 54.30 (19) | 0.74b |
| No | 28.00 (28) | 34.30 (12) | 45.70 (16) | |
| Birth term | ||||
| Pre-term baby (Before 37 weeks) | 12.90 (9) | 2.90 (1) | 22.90 (8) | 0.89c |
| Term baby (38–42 weeks) | 77.10 (54) | 88.60 (31) | 65.70 (23) | |
| Post-term baby (After 42 weeks) | 10.00 (7) | 8.60 (3) | 11.40 (4) | |
| Type of delivery | ||||
| Normal delivery | 11.40 (8) | 8.60 (3) | 14.30 (5) | 0.62b |
| C-section delivery | 88.60 (62) | 91.40 (32) | 85.70 (30) | |
| Birth complications | ||||
| Kernicterus | 2.90 (2) | - | 5.70 (2) | 0.53c |
| Birth asphyxia | 11.40 (8) | 8.60 (3) | 14.30 (5) | |
| Microcephaly | 1.40 (1) | 2.90 (1) | - | |
| Low birth weight | 2.90 (2) | - | 5.70 (2) | |
| Pneumonia | 1.40 (1) | - | 2.90 (1) | |
| No | 80.00 (56) | 88.60 (31) | 71.40 (25) | |
| Autism severity level | ||||
| Level 2 | 51.40 (36) | 40.00 (14) | 62.90 (22) | 0.81c |
| Level 3 | 48.60 (34) | 60.00 (21) | 37.10 (13) | |
|
Total GARS-3 Score Median (IQR) |
100 (96 to 112) | 105 (95 to 120) | 97 (96 to 106) | 0.10a |
|
Modified SF-36 Total Score Median (IQR) |
34 (31 to 42) | 32 (30 to 35) | 42 (31 to 42) | 0.28a |
(a, Mann-Whitney U Test; b,Fisher’s Exact Test; c, Pearson Chi-Square Test; *baseline compatible)
The average monthly family income of the participants in Group A was 45 K (35 K to 70 K) BDT and Group B was 40 K (35 K to 50 K) BDT. The firstborn child was Group A 65.70% (n = 23) and Group B 54.30% (n = 19). In both groups, the maximum number of participants was term baby Group A 88.60% (n = 31) and Group B 65.70% (n = 23). Most of the participants were C-section delivery in both groups, 91.40% (n = 32) in Group A and 85.70% (n = 30) in Group B. Regarding clinical characteristics, most of the participants had no birth complications in both groups, 88.60% (n = 31) in the Group A and 71.40% (n = 25) in the Group B. Birth asphyxia was the most common birth complications in both groups, 8.60% (n = 3) in the Group A and 14.30% (n = 5) in the Group B. Autism severity level 3 was the most common 60.00% (n = 21) in Group A and Autism severity level 2 was the most common 62.90% (n = 22) in Group B. The average GARS-3 score of the participants in Group A was 107.09 ± 16.62 and in Group B was 93.80 ± 16.56 and the modified SF-36 total score was 38.66 ± 5.31 in Group A and 42.06 ± 2.41 in Group B.
Physical and behavioral status of the participants
Both group participants were screened for Gilliam Autism Rating Scale scores and Modified SF-36 scores of the participants (Tables 2 and 3). In terms of physical status evaluated by modified SF-36 where the between-group analysis showed significant change was found in between both groups (z value = 5.72, p-value < 0.001). In the case of behavioral status evaluated by GARS-3, also showed significant change was found in between both groups (z value = 3.99, p-value < 0.001). This means physiotherapy combined with occupational and speech & language therapy is more effective than only occupational and speech & language therapy interventions for improving behavioral and physical status of the ASD children.
Table 2.
Intergroup and intragroup analysis of total GARS-3 scores of the participants
| Outcome group | Baseline | After treatment |
Within group change scores | Between group change scores | ||
|---|---|---|---|---|---|---|
| Total GARS-3 score | ||||||
| Group A | Median (IQR) | Median (IQR) | Z | p | Z | p |
| 105 (95 to 120) | 71 (60 to 81) | 5.16 | 0.001** | 5.72 | 0.001** | |
| Group B | 97 (96 to 106) | 95 (83 to 105) | 1.93 | 0.053 | ||
(**Significant at 99% Confidence Level; Within-group analysis: Wilcoxon rank test; between-group analysis: Mann-Whitney U test)
Table 3.
Intergroup and intragroup analysis of modified SF-36 scores of the participants
| Outcome group | Baseline | After treatment |
Within group change scores | Between group change scores | ||
|---|---|---|---|---|---|---|
| Modified SF-36 score | ||||||
| Group A | Median (IQR) | Median (IQR) | Z | p | Z | p |
| 32 (30 to 35) | 43 (41 to 44) | 5.10 | 0.001** | 3.99 | 0.001** | |
| Group B | 38 (29 to 42) | 42 (31 to 42) | 0.93 | 0.354 | ||
(**Significant at 99% Confidence Level; Within-group analysis: Wilcoxon rank test; between-group analysis: Mann-Whitney U test)
In within-group analysis showed significant change in both outcome parameters of only group A, for behavioural status, Z value = 5.16, p-value < 0.001 and for physical status, Z value = 5.10, p-value < 0.001. These results suggest that the addition of physiotherapy contributed to significant improvements in Group A participants with ASD.
Discussion
This study was carried out to determine the efficacy of combination therapy in improving the physical and behavioral status of children with autism spectrum disorder (ASD), addressing a worldwide concern among this population. Multiple studies discussed various therapeutic modalities, including physiotherapy, occupational therapy, and speech and language therapy, to address the physical and behavioral conditions of children with ASD. Nevertheless, no research has directly contrasted the effectiveness of physiotherapy with occupational and speech and language treatment approaches. The study objectives were met, and Group A demonstrated statistically significant improvements across all measured outcomes compared to Group B. The study involved participants from two groups, Group A and Group B, with varying body mass indexes and living conditions. Male participants were the most common, with 80% in Group A and 71.40% in Group B.
In a study by Lins et al. [51] most participants lived in urban areas, while rural areas had a smaller percentage. Most mothers completed graduation in Group A, while in Group B, 34.30% completed up to SSC education. Most participants had no birth complications, with birth asphyxia being the most common. Autism severity level 3 was the most common in both groups. The GARS-3 scores were similar between the two groups. The study’s results correspond with extensive studies on autism prevalence and related demographic patterns. The high proportion of male participants (80% in Group A, 71.4% in Group B) aligns with the commonly noted male-to-female ratio in autism diagnoses, which is frequently described as hereditary and diagnostic influences [44]. The urban concentration of participants aligns with literature suggesting elevated ASD diagnosis rates in metropolitan regions, where healthcare access and knowledge are superior. In contrast, rural areas experience delayed diagnoses due to resource limitations and dependence on schools for screening.
Higher maternal education in Group A compared to Group B underscores the role of socioeconomic factors in early ASD detection and intervention [45]. Despite this, similar GARS-3 scores and autism severity across groups suggest that such factors may not significantly affect severity as assessed by standardized tools [36]. The observed reduction in stereotyped behaviors following exercise aligns with existing evidence supporting the benefits of physical activity on motor function and engagement in children with ASD [29]. The cited study revealed that a 48-week intervention significantly enhanced motor and verbal stereotypes and responsiveness. These findings align with previous research indicating aerobic activities (e.g., running, cycling, and ball sports) [48] and structured regimens such as combination workouts and martial arts techniques (e.g., Kata) significantly diminish stereotyped tendencies. Aerobic and organized exercise therapies seem to modulate sensory reactivity and promote motor coordination, hence improving social engagement and diminishing repeated behaviors [39].
This corresponds with the neurophysiological advantages of exercise, such as enhanced brain plasticity and executive functioning. The results endorse the use of physical activity in therapy interventions for ASD to mitigate both behavioral and motor deficiencies [31]. Bahrami et al. [55] conducted a study examining the impact of an exercise program (Kata methods) on children with ASD, finding a consistent reduction in stereotypic behaviors in 42.54% of individuals within the exercise group.
Ferreira et al. [24] demonstrated that ball training interventions reduced stereotyped behaviors in children with high-functioning ASD. In the present study, participants in Group A; who received combined physiotherapy, occupational, and speech-language therapy showed greater improvement than those in Group B. Physiotherapy targeted balance, coordination, proprioception, lower limb strength, and aerobic fitness. Occupational therapy focused on play-based activities, skill development, sensory integration, cognitive-behavioral training, and community mobility. Speech-language therapy employed methods such as Applied Behavior Analysis, Relationship Development Intervention, PECS, augmentative communication, and social storytelling.
The inclusion of aerobic exercises also promotes overall fitness and may have beneficial effects on both physical health and emotional regulation, which is particularly important given the often-observed comorbidities of ASD, such as anxiety and hyperactivity [56]. Cognitive-behavioral training in the context of occupational therapy has been shown to support emotional regulation and adaptive behaviors, leading to improved participation in daily activities and social interactions [57]. Moreover, the inclusion of social stories in speech-language therapy aims to improve social understanding and interaction, which is often a significant challenge for children with ASD [48].
This study had several strengths, including its focus on a combined intervention of physiotherapy, occupational therapy, and speech therapy, which highlights a holistic approach to addressing physical and behavioral challenges in children with ASD. The use of validated tools like the modified SF-36 and GARS-3 enhances the reliability of the findings, while the assessor-blinded randomized clinical trial design minimizes bias. Furthermore, the statistical rigor with descriptive and inferential analyses supports the credibility of the results, emphasizing the effectiveness of tailored rehabilitation programs.
However, the study has some weaknesses. It was conducted in a single institute, limiting the generalizability of the findings to other geographical or clinical settings. The relatively short intervention period of six weeks may not fully capture long-term developmental or behavioral changes. Additionally, while improvements were significant, details about the specific contribution of each therapy type to the overall outcomes remain unclear, which could have added more depth to the analysis.
Conclusion
This clinical trial examined the significant impact of a comprehensive approach, incorporating physiotherapy, occupational therapy with speech and language therapy, on enhancing the physical and behavioral conditions of children diagnosed with autism spectrum disorder (ASD). The study demonstrated that children with ASD experienced significant improvements in physical outcomes following a six-week physiotherapy-based intervention. Balance, coordination, and motor skills were all improved as a result of the fundamental exercise routine that was followed by the youngsters. According to the findings of the research that was carried out, the fundamental exercise programs produced favorable results in terms of the children’s motor abilities, along with their balance and coordination. As a result of the fact that both of these physical therapy procedures are simple and basic, they can be simply implemented at home, which means that parents may significantly improve their children’s physical well-being. This comprehensive intervention revealed the potential of holistic treatment strategies in managing autism spectrum disorder (ASD) by addressing several developmental aspects. It enhanced motor skills and physical functioning, promoting improved communication and social behaviors.
Acknowledgements
Authors acknowledge the contribution of Col. Monsur Ahmed (BA- 6483, PSC), Chief Co-Ordinator; Mina Sultana, Principal (Acting); Mst. Sumaya Sultana, Clinical Physiotherapist, Proyash Jashore Area, and Nupur Akter (MPT in Gynae-fellow), Department of Physiotherapy and Rehabilitation, Jashore University of Science and Technology, Jashore, Bangladesh for their cordial support in the study process.
Abbreviations
- ASD
Autism Spectrum Disorder
- ABA
Applied Behavior Analysis
- ABC
Applied Behavior Consequences
- DSM – 5
Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition
- GAR – 3
Gilliam Autism Rating Scale – Third Edition
- ICD – 10
International Classification of Diseases, Tenth Revision
- OT
Occupational therapy
- PECS
Picture Communication Exchange Communication System
- PT
Physiotherapy
- RDI
Relationship Development Intervention
- SF – 36
Short Form – 36
- SLT
Speech and Language Therapy
Author contributions
MSH and AHK contributed to finalizing the methodology, overseeing project administration, resource acquisition, software procurement for data analysis, and drafting the original manuscript. MMI and KMAH provided supervision, reviewed, and edited the manuscript. AHK carried out investigations, validated the study, and managed visualization efforts. NA assisted in organizing supplementary files. All authors reviewed and approved the final manuscript.
Funding
University Grant Commission (UGC) of Bangladesh granted a partial fund through the university and department. Grant number: 24-FoHS-1.
Data availability
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.
Declarations
Ethics approval and consent to participate
On May 20, 2024, the Institutional Review Board (IRB) of the Department of Physiotherapy and Rehabilitation at the Jashore University of Science & Technology granted the trial ethical approval (PTR-JUST/IRB/2024/05/222403). On July 8, 2024, the trial was registered prospectively with the Clinical Trial Registry India (CTRI) (CTRI/2024/07/070209). The administrative authority of Proyash Institute of Special Education, Jashore was provided the necessary permission letter to conduct the study in their facility (Ref: 23.01.955.295.04.099.28.11.24). The researcher complied with the ethical principles outlined in the Helsinki Declaration. Informed consent to participate was obtained from the parents or legal guardians of any participant under the age of 16.
Consent for publication
Not applicable.
Competing interests
The authors declare no competing interests.
Footnotes
Publisher’s note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Md. Sherajul Haque, Mohammad Mohinul Islam and Abid Hasan Khan contributed equally as the first author.
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Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
The data that support the findings of this study are not openly available due to reasons of sensitivity and are available from the corresponding author upon reasonable request.