A systematic review finds that methodological quality is better than its reputation but can be improved in physiotherapy trials in childhood cerebral palsy

Kunz, Regina; Autti-Rämö, Ilona; Anttila, Heidi; Malmivaara, Antti; Mākelä, Marjukka

doi:10.1016/j.jclinepi.2006.03.009

Cited by 27 publications

(26 citation statements)

References 34 publications

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“…Only RCTs, which are generally considered to be the criterion standard of effectiveness research, were included in this review. 23 We found significant effects in functional outcomes in favour of BoNT-A treatment combined with usual care or physiotherapy only in Scholtes et al 11,15 at follow-up times of 6 weeks, 15 and 12 and 24 weeks. 11 Results of trials for BoNT-A and casting presented no significant effects for either BoNT-A injections, casting, or a combination of both treatments.…”

Section: Summary Of Evidencementioning

confidence: 62%

Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review

Ryll

Bastiaenen

Bie

et al. 2011

Developmental Medicine &Amp; Child Neurology

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Section: Summary Of Evidencementioning

confidence: 62%

Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review

Ryll

Bastiaenen

Bie

et al. 2011

Developmental Medicine &Amp; Child Neurology

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“…Considering this, the examination of the relations between capacity, capability, and performance for other ICF-YC domains is of interest. Agreement on standard instruments for use in research and its testing is crucial for an adequate comparison of results from trials across studies since, according to Kunz et al,65 the large diversity of instruments is a major barrier to meaningful comparisons across studies.The use of valid and reliable instruments to measure outcomes related to activities and social participation should be encouraged in order to understand the impact of this therapeutic intervention on children's daily lives. …”

mentioning

confidence: 99%

Efficacy of suit therapy on functioning in children and adolescents with cerebral palsy: a systematic review and meta‐analysis

Martins

Cordovil

Oliveira

et al. 2015

Develop Med Child Neuro

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ASTAdeli AIM This systematic review and meta-analysis presents an overview of the efficacy of suit therapy on functioning in children and adolescents with cerebral palsy (CP).METHOD A systematic review with meta-analysis was conducted. A comprehensive search of peer-reviewed articles was performed on electronic databases, from their inception to May 2014. Studies included were rated for methodological quality using the Physiotherapy Evidence Database scale. Effects of suit therapy on functioning were assessed using metaanalytic techniques.RESULTS From the 46 identified studies, four met the inclusion criteria and were included in the meta-analysis. Small, pooled effect sizes were found for gross motor function at posttreatment (g=0.46, 95% confidence interval [CI] 0.10-0.82) and follow-up (g=0.47, 95% CI 0.03-0.90). INTERPRETATIONThe small number of studies, the variability between them, and the low sample sizes are limitations of this review. Findings suggest that to weigh and balance benefits against harms, clinicians, patients, and families need better evidence to examine and prove the effects of short intensive treatment such as suit therapy on gross motor function in children and adolescents with CP. Therefore, more research based on high-quality studies focusing on functioning in all dimensions of the International Classification of Functioning, Disability and Health perspective is necessary to clarify the impact of suit therapy.Cerebral palsy (CP) designates a group of permanent disorders of the development of movement and posture, which causes activity limitations. These disorders are attributed to non-progressive disturbances that occur in the developing fetal or infant brain, and are often accompanied by other conditions such as: (1) disturbances of sensation, perception, cognition, communication, and behaviour; (2) epilepsy; and (3) secondary musculoskeletal problems. 1 In the general population, the estimated prevalence is two in every 1000 live births. 2,3 From an International Classification of Functioning, Disability and Health perspective (ICF), CP affects a person's 'functioning', inclusive of body structures and functions, activities, and participation, which may in turn cause 'disabilities' such as impairments, activity limitations, and participation restrictions. 4 The limitations in activity require individual rehabilitation throughout the lifespan. 5 Rehabilitation in children with CP aims to minimize the effect of physical impairments, promote independence, and improve the quality of life of children and their families who play a major role in the process. 6,7 The process of rehabilitation is influenced by the clinical type and severity of the CP, the existence of additional disabilities (e.g. visual, auditory, or cognitive), emotional problems, the physiological age of the child, and the family's socioeconomic status. 8 The management of motor disability in CP includes physical therapy and a wide spectrum of other therapeutic interventions. 9 Physical therapy focuses on function, movement...

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“…Most studies described the interventions well as reported earlier [30,59]. The detailed intervention descriptions allowed for the identification of the active components in each study thus helping to categorize them.…”

Section: Discussionmentioning

confidence: 99%

“…First, the active components of the intervention may vary notably between individuals. Secondly, as the goal of comprehensive intervention is not targeted at specific functions but more on activity or participation, it is more difficult to control confounders, since performance on these levels is affected also by hobbies or other activities at kindergarten, school, or home [30]. A randomized design can more easily be used to evaluate more narrowly defined interventions, such as strength, aerobic, or balance training, or riding.…”

Section: Discussionmentioning

confidence: 99%

“…Overall, the effectiveness and efficacy of therapeutic interventions for children with CP has been difficult to determine owing to the lack of high-quality research. Siebes et al [29] identified an improvement in the methodological quality of the therapeutic intervention studies during the last decade, and Kunz et al [30] found the quality of PT trials to be better than their reputation.…”

Section: Introductionmentioning

confidence: 99%

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Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review

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2008

Child

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A systematic review finds that methodological quality is better than its reputation but can be improved in physiotherapy trials in childhood cerebral palsy

Cited by 27 publications

References 34 publications

Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review

Effects of leg muscle botulinum toxin A injections on walking in children with spasticity-related cerebral palsy: a systematic review

Efficacy of suit therapy on functioning in children and adolescents with cerebral palsy: a systematic review and meta‐analysis

Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review

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