ObjectiveTo assess the feasibility and effectiveness of home-based occupational therapy and physiotherapy programmes in children with cerebral palsy (CP), focusing on the upper extremity and reporting on child-related and/or parent-related outcomes.DesignSystematic review.Data sourcesElectronic searches were performed in MEDLINE, EMBASE, CINAHL, PsycINFO, OTseeker and PEDro, and in ICTRP and CENTRAL trial registers, from inception to 6 June 2019.Eligible criteriaThe review included all types of original studies concerning feasibility or effectiveness of home-based therapy in children aged <18 years with any type of CP. No language, publication status or publication date restrictions were applied.Data extraction and synthesisStudy and intervention characteristics and the demographics of participating children and their parents were extracted. Feasibility was assessed by outcomes related to acceptability, demand, implementation, practicality, adaptation, expansion or integration. Regarding effectiveness, child-related outcome measures related to any level of the International Classification of Functioning, Disability and Health, or parent-related outcomes were investigated. Two authors independently extracted the data. Risk of bias was assessed using the Downs and Black checklist and the Joanna Briggs Institute Critical Appraisal Checklist.ResultsThe search resulted in a total of 92 records: 61 studies and 31 conference abstracts. Feasibility studies reported mainly on acceptability and implementation. Overall compliance to home-based training programmes (implementation) was moderate to high, ranging from 56% to 99%. In the effectiveness studies, >40 different child-related outcome measures were found. Overall, an improvement in arm-hand performance within group across time was shown. Only two studies reported on a parent-related outcome measure. No increase in parental stress was found during the intervention.ConclusionsBased on the results of the included studies, home-based training programmes seem to be feasible. However, conclusions about the effectiveness of home programmes cannot be made due to the large variability in the study, patient and intervention characteristics, comparators, and outcome measures used in the included studies.PROSPERO registration numberCRD42016043743.
Aim: To critically evaluate single-case design (SCD) studies performed within the population of children/ adolescents with cerebral palsy (CP). Methods: A scoping review of SCD studies of children/adolescents with CP. Demographic, methodological, and statistical data were extracted. Articles were evaluated using the Risk of Bias in N-of-1 Trials (RoBiNT) Scale and the Consolidated Standards of Reporting Trials (CONSORT) extension for N-of-1 trials (CENT 2015). Comments regarding strengths and limitations were analyzed. Results: Studies investigated the effects of a wide range of interventions on various outcomes. Most SCD types were adopted in multiple studies. All studies used visual inspection rather than visual analysis, often complemented with basic statistical descriptives. Risk of bias was high, particularly concerning internal validity. Many CENT items were insufficiently reported. Several benefits and limitations of SCD were identified. Conclusions: The quality of evidence from results of SCD studies needs to be increased through risk of bias reduction. ARTICLE HISTORY
BackgroundThe Gross Motor Function Measure-66 (GMFM-66) is an observational clinical measure designed to evaluate gross motor function in children with Cerebral Palsy (CP). It is a shortened version of the GMFM-88. A free computer program, the Gross Motor Ability Estimator (GMAE), is required to calculate the interval level total score of the GMFM-66. The aim of this study was to explore pediatric physiotherapists’ experiences with the GMFM-66 and application of the measure in Dutch clinical practice.MethodsAn explorative cross-sectional survey study was performed. Dutch pediatric physiotherapists were invited to complete an online survey. Data-analysis merely consisted of frequency tables, cross-tabulations and data-driven qualitative analysis.ResultsFifty-six respondents were included in the analysis. In general, the therapists expressed a positive opinion on the GMFM-66, in particular regarding its user-friendly administration and benefits of the GMAE. The majority of questions revealed that therapists deviate from the guidelines provided by the manual to a greater or lesser extent though. The most worrisome finding was that 28.8 % (15/52) of the therapists calculate the total score of the GMFM-66 using the score form of the GMFM-88 instead of the GMAE.DiscussionThe consequences of the high number of therapists who stated that they calculate the total score of the GMFM-66 with the GMFM-88 score form are far-reaching; it has a misleading impact on the opinion of rehabilitation teams and parents on the development of the child, on decision-making in rehabilitation, and ultimately on the development of the child.ConclusionsInformation currently available on psychometric properties, motor growth curves and percentiles cannot be generalized to clinical practice in the Netherlands, as they were generated in highly controlled testing conditions, which do not hold in clinical practice.Electronic supplementary materialThe online version of this article (doi:10.1186/s12887-015-0459-8) contains supplementary material, which is available to authorized users.
AIMTo identify factors other than active disease and anemia that contribute to fatigue in pediatric inflammatory bowel disease (IBD).METHODSWe performed an electronic search in Medline and EMBASE from their inception to May 2017 using the search term “fatigue” or the related keywords “physical impairment” and “inflammatory bowel disease” with the filter “child” (age 0-18 years). Cross-sectional and case-control studies were included. We restricted our search to studies published in English. We used the PRISMA checklist and flow diagram. Duplicate articles were manually deleted in End Note. To identify further relevant studies, we checked the reference lists of the selected articles.RESULTSWe identified 149 papers, of which 19 were retrieved for full text review. Eleven studies were subsequently excluded because fatigue was not evaluated as an outcome measure. Eight papers focused on the desired topic and were discussed in the final analysis. A lack of uniformity of outcome measures made the pooling of data impossible. In all but one study, questionnaires were used to evaluate fatigue. In the remaining study, an accelerometer was used to measure daily activities, sleeping time and their relationships with fatigue in a more quantifiable manner. Adolescents with IBD are significantly more fatigued than healthy controls. In addition to active disease, increased anxiety or depression and disturbed family relationships were frequently reported predictors of fatigue. Quantitative measurement of physical activity in patients with Crohn’s disease showed a reduction in the number of steps per day, and patients with ulcerative colitis had a shorter duration of physical activity during the day.CONCLUSIONFatigue in pediatric IBD is related to a combination of biological, functional and behavioral factors, which should all be taken into account when managing fatigue.
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