A systematic review of interventions for children with cerebral palsy: state of the evidence

Abstract

Aim The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP). Method This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health. Results Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint‐induced movement therapy, context‐focused therapy, diazepam, fitness training, goal‐directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). Interpretation Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.

Interventions to Improve or Maintain Lower-Limb Function Among Ambulatory Adolescents with Cerebral Palsy: A Cross-Sectional Survey of Current Practice in the UK

“…Of the interventions identified in this study, a systematic review of interventions for CP found strong evidence that casting improved passive range of motion of the lower limb, botulinum toxin injections reduced lower-limb spasticity, and aerobic exercise improved aerobic fitness (Novak et al, 2013). This study found that 76% of therapists reported using serial casting, 81% reported using botulinum toxin, and 76% reported using cardiovascular exercise with gym equipment at least once in the past year.…”

“…This study found that 76% of therapists reported using serial casting, 81% reported using botulinum toxin, and 76% reported using cardiovascular exercise with gym equipment at least once in the past year. Although these interventions were recommended by Novak et al (2013) to be included in standard care for children with CP, there was insufficient evidence to support the use of casting or aerobic exercise to improve gross motor function and only moderate quality evidence to support the use of botulinum toxin in combination with physiotherapy for improving walking function among children with CP (Novak et al, 2013). Novak et al (2013), also recommended that neurodevelopmental therapy be discontinued from CP care as there was low quality evidence that it did not improve normalized movement, prevent contracture development, improve function, or enhance social emotional and cognitive skills.…”

“…Of the thirty-nine interventions identified in this study only fifteen were included in the review by Novak et al (2013) as there was insufficient research on the effectiveness of the remaining interventions to include them. Of the interventions that were included in the review there was low quality evidence that hydrotherapy, treadmill training, functional training, and strength training using resistance within functional tasks improves gross motor function, moderate quality evidence that hippotherapy improves gross motor function, insufficient evidence to support the use of electrical stimulation, strength training via progressive resistance training or orthotics to improve lower-limb function, and low quality evidence that conductive education does not improve performance of functional activities.…”

“…However, as described above, walking deteriorates for many people with CP from childhood to young adulthood. A wide range of treatments targeted at improving lower-limb function currently exist (Novak et al, 2013), suggesting that the content of physiotherapy for adolescents with CP may vary widely across the UK. A description of current physiotherapy management of adolescents with CP in the UK is required to direct clinical practice, identify areas for further research into the effectiveness of interventions for adolescents with CP, and inform physiotherapy education.…”

Do we really know what they were testing? Incomplete reporting of interventions in randomised trials of upper limb therapies in unilateral cerebral palsy

“…In the last decade, there has been a rapid increase in evidence from clinical trials for a variety of upper limb therapies for children with unilateral cerebral palsy (Novak, McIntyre, Morgan, Campbell, Dark, Morton et al, 2013;. Despite there being over 45 published randomized trials, there is a lag in the uptake of this evidence into clinical practice.…”