Evaluation of single event multilevel surgery and rehabilitation in children and youth with cerebral palsy – A 2-year follow-up study

Åkerstedt, Anita; Risto, Olof; Ödman, Pia; Öberg, Birgitta

doi:10.3109/09638280903180171

Cited by 26 publications

(35 citation statements)

References 50 publications

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“…Patient‐reported outcomes have only recently been introduced in orthopaedic studies in general and SEMLS studies in particular. Recent studies have reported outcomes using the CHQ, 46 the PODCI, 33,47 and/or the Pediatric Quality of Life Inventory (PedsQL) 33,47 …”

Section: Resultsmentioning

confidence: 99%

Single‐event multilevel surgery for children with cerebral palsy: a systematic review

McGinley

Dobson

Ganeshalingam

et al. 2011

Develop Med Child Neuro

195

187

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AIM To conduct a systematic review of single-event multilevel surgery (SEMLS) for children with cerebral palsy, with the aim of evaluating the quality of the evidence and developing recommendations for future research.METHOD The systematic review was conducted using standard search and extraction methods in Medline, EMBASE, CINAHL, and Cochrane electronic databases. For the purposes of this review, SEMLS was defined as two or more soft-tissue or bony surgical procedures at two or more anatomical levels during one operative procedure, requiring only one hospital admission and one period of rehabilitation. Studies were included if: (1) the primary focus was to examine the effect of SEMLS in children with cerebral palsy; (2) the results focused on multiple anatomic levels and reported findings of one or more World Health Organization International Classification of Functioning, Disability and Health (ICF) domains. Studies that focused on a single intervention or level, or on the utility of a specific outcome measure were excluded. Study quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. The review also examined the reporting of surgery, adverse events, and rehabilitation.RESULTS Thirty-one studies fulfilled the criteria for inclusion, over the period 1985 to October 2010. The MINORS score for these studies varied from 4 to 19, with marked variation in the quality of reporting. Study quality has improved over recent years. Valid measures of gait and function have been introduced and several of the most recent studies have addressed multiple dimensions of the ICF. A statistical synthesis of the outcome data was not conducted, although a trend towards favourable outcomes in gait was evident. Caution is advised with interpretation owing to the variable study quality. Uncontrolled studies may have resulted in an overestimation of treatment efficacy.INTERPRETATION The design and reporting of studies of SEMLS are improving with the development of multidisciplinary teamwork and frameworks such as the ICF. However, the evidence base is limited by the lack of randomized clinical trials, especially when compared with other surgical interventions such as selective dorsal rhizotomy.

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Section: Resultsmentioning

confidence: 99%

Single‐event multilevel surgery for children with cerebral palsy: a systematic review

McGinley

Dobson

Ganeshalingam

et al. 2011

Develop Med Child Neuro

195

187

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“…Cerebral palsy (CP) is the most common reason for motor impairment in children (Åkerstedt Risto, Ødman, & Øberg, 2010). Conditions which result from spasticity such as scoliosis, hip dysplasia, ankle deformities, and joint contractures are frequented treated by orthopedic procedures (Knaus & Terjesen, 2009; McKearnan, Kieckhefer, Engel, Jensen, Labyak, 2004; Murphy et al 2006).…”

mentioning

confidence: 99%

At the edge of vulnerability—lived experience of parents of children with cerebral palsy going through surgery

Iversen

Graue

Råheim

2013

International Journal of Qualitative Studies on Health and Well

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This study explored the experiences of parents of children with cerebral palsy undergoing surgery as they describe them from a lived experience perspective. When children undergo surgical procedures, they have to stay at hospital for a long time, which represents a great challenge for the children as well as their parents. We collected data by using open-ended interviews with 12 parents of 9 children and analyzed these data in accordance with Max van Manen's methodological themes. Based on the parents’ stories, the essential theme is: At the edge of vulnerability—being parents at hospital to a child with CP undergoing surgery, which consisted of three subthemes: establishing trust, awareness of a child who cannot speak, and sensing bodily reactions. Parents experienced demanding challenges as they entered the hospital, in a situation that meant both familiarity and unfamiliarity. Judgments about how to care for the child relied on what they normally did. Sitting bedside for hours and days, thoughts about the legitimacy of letting their child go through the suffering surgery were tormenting the parents. They felt vulnerable and very much dependent on health care workers’ competence and at the same time doubting them in seeing and taking care of their child's specific needs. It was experienced as an ambivalent situation, and even more so for the parents of a child without speech. The findings indicate that establishing trust implies being met at an existential level and a deeply felt need for health care workers that are really engaged in taking care of their child and their parents.

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“…Design type Statistical approach(es) Akerstedt et al 21 (2010) A-B design Angelo 22 (1992) Alternating-treatments design Kruskal-Wallis test Angelo 23 (1993) Alternating-treatments design Barbosa et al 24 (2008) Withdrawal/reversal (A-B-A) design: A-B-C-A Celeration Line (CL) Two-standard deviation band method Beauregard et al 25 (1998) Withdrawal/reversal (A-B-A) design Celeration line Brien et al 26 (2010) Multiple-baseline design Visual analysis of graphed data Statistical analysis using the two-standard deviation band method Analysis of clinical significance Brien et al 27 (2011) A-B design (including follow-up) Autocorrelation coefficient to determine serial dependency Visual inspection: summarizing patterns of data on the basis of trend, level, and variability Two-standard deviation band method Computation of the differences between the mean scores at baseline and the mean scores at intervention and follow-up Chen et al 28 (2007) A-B design (including follow-up) Autocorrelation coefficient to determine serial dependency Two-standard deviation band method Analysis of clinical significance Coker et al 29 (2009) Withdrawal/reversal (A-B-A) design: A-B-A-B Corn et al 30 (2003) A-B design Linear regression models to determine the line of best fit T-values (difference between the slope of the baseline data and the slope of the intervention and intercept between the last baseline value and the first intervention value (effect)) Costigan et al 31…”

Section: Studymentioning

confidence: 99%

Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review

Beckers

Stal

Smeets

et al. 2019

Developmental Neurorehabilitation

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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

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Evaluation of single event multilevel surgery and rehabilitation in children and youth with cerebral palsy – A 2-year follow-up study

Abstract: Self-reported walking ability improved after multilevel surgery and intensive rehabilitation. This result was partly supported by lower energy cost and improved HRQOL. Expectations and satisfaction were fulfilled for the majority of children.

Cited by 26 publications

References 50 publications

Single‐event multilevel surgery for children with cerebral palsy: a systematic review

Single‐event multilevel surgery for children with cerebral palsy: a systematic review

At the edge of vulnerability—lived experience of parents of children with cerebral palsy going through surgery

Single-case Design Studies in Children with Cerebral Palsy: A Scoping Review

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