Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis

Abstract

Background Comparisons between various conservative managements of spastic equinus deformity in cerebral palsy demonstrated limited evidences, to evaluate the efficacy of conservative treatment among cerebral palsy children with spastic equinus foot regarding gait and ankle motion. Methods Studies were identified from PubMed and Scopus up to February 2022. Inclusion criteria were randomized controlled trial (RCT), conducted in spastic cerebral palsy children with equinus deformity, aged less than 18 years, compared any conservative treatments (Botulinum toxin A; BoNT-A, casting, physical therapy, and orthosis), and evaluated gait improvement (Physician Rating Scale or Video Gait Analysis), Observational Gait Scale, Clinical Gait Assessment Score, ankle dorsiflexion (ankle dorsiflexion at initial contact, and passive ankle dorsiflexion), or Gross Motor Function Measure. Any study with the participants who recently underwent surgery or received BoNT-A or insufficient data was excluded. Two authors were independently selected and extracted data. Risk of bias was assessed using a revised Cochrane risk-of-bias tool for randomized trials. I2 was performed to evaluate heterogeneity. Risk ratio (RR), the unstandardized mean difference (USMD), and the standardized mean difference were used to estimate treatment effects with 95% confidence interval (CI). Results From 20 included studies (716 children), 15 RCTs were eligible for meta-analysis (35% had low risk of bias). BoNT-A had higher number of gait improvements than placebo (RR 2.64, 95% CI 1.71, 4.07, I2 = 0). Its combination with physical therapy yielded better passive ankle dorsiflexion at knee extension than physical therapy alone (USMD = 4.16 degrees; 95% CI 1.54, 6.78, I2 = 36%). Casting with or without BoNT-A had no different gait improvement and ankle dorsiflexion at knee extension when compared to BoNT-A. Orthosis significantly increased ankle dorsiflexion at initial contact comparing to control (USMD 10.22 degrees, 95 CI% 5.13, 15.31, I2 = 87%). Conclusion BoNT-A and casting contribute to gait improvement and ankle dorsiflexion at knee extension. BoNT-A specifically provided gait improvement over the placebo and additive effect to physical therapy for passive ankle dorsiflexion. Orthosis would be useful for ankle dorsiflexion at initial contact. Trial registration PROSPERO number CRD42019146373.

Perfil Epidemiológico De Pacientes Com Paralisia Cerebral Assistidos Pelo Serviço De Ortopedia Da Oficina Ortopédica Fixa/Ceriii/Ueafto/CCBS/Uepa

“…Atualmente, não há consenso sobre o melhor tipo de AFO para pacientes nessa condição, podendo ser órteses sólidas ou articuladas. Contudo, existem orientações acerca da acomodação do comprimento completo do gastrocnêmio nas AFOs e contraindicação em casos de comprimento e rigidez do gastrocnêmio, tanto em alongamento passivo quanto à hipertonicidade (Klaewkasikum et al, 2022).…”

A bibliometric analysis of cerebral palsy from 2003 to 2022

“…However, Horsch ( 58 ) proposed a clinical cutoff of a ≤5° dorsiflexion as the recommended value for defining functionally relevant equinus foot in patients with CP. Casting, orthoses, and physical therapies, such as shock waves, botulinum toxin, and surgery, are common treatments for the equinus foot in patients with CP ( 59 – 61 ). Horsch evaluated gait outcomes and strength following different surgical procedures of the equinus foot in two groups of patients with CP and found that the Strayer procedure and Achilles tendon lengthening showed higher postoperative dorsiflexion.…”

The efficacy of curcumin in relieving osteoarthritis: A meta‐analysis of meta‐analyses

“…The most common cause of ankle OA is previous trauma, unlike knee OA, which occurs as a result of the primary OA. Thus, ankle OA patients are usually younger than knee OA patients (Boffa et al, 2021; Ding et al, 2023; Laohajaroensombat et al, 2023). Treatments that are considered for OA of the knee, depending on the severity of the deterioration, include pharmacological treatment, physiotherapy, bracing, prolotherapy, and surgical operation (Hsiao et al, 2021).…”