Early Results of Surgical Intervention for Elbow Deformity in Cerebral Palsy Based on Degree of Contracture

Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review

“…Carlson et al 20 C C S C S S S C Donadio et al 22 C C S C S S S C House et al 23 C C S C S S M C Libberecht et al 18 C C S C S M M C Louwers et al 15 S M S S L M M S Matsou et al 24 C C S C S S S C Matsou et al 25 C C S C S S S C Ponten et al 16 C S S S L S M C Roth et al 21 C C S C S S S C Smitherman et al 17 was critical for the items on selection (owing to lack of allocation concealment, loss to follow-up), confounding (inherently to non-controllable studies, different baseline characteristics), and measurement of outcomes (blinding of outcome assessment). Three studies 14,15,17 were judged to be at serious risk of bias in at least one domain, but not at critical risk of bias in any domain.…”

“…Clinicians evaluated patients' functional performance using an outcome measure including quantifiable tasks in 12 studies. [14][15][16][17][18][19][20][21][22][23][24][25] The perception of patients' abilities to use the hand(s) in task performance was measured with the Canadian Occupational Performance Measure (COPM) in three studies. [14][15][16] Functional performance outcome measures (clinicalbased)…”

“…14,15,[17][18][19] Ten studies included only children and adolescents with CP aged up to 24 years. [14][15][16][17][19][20][21][22][23][24] From the two studies including patients older than 20 years of age, 18,25 the percentage patients to include (>75% of the participants were aged up to 20y) could be derived from the reported mean and range. Four studies included participants with unilateral CP, 14,17,19,21 of which three involved those described as having spastic CP.…”

“…Patients' abilities to handle objects on request (capacity) was evaluated with the Box and Block Test (BBT), 26 the Jebsen-Taylor Hand Function Test (JHFT), 27 and the House Functional Classification 23 in seven studies, 18,[20][21][22][23][24][25] ranging from 0 (no use of the hand) to 8 (complete spontaneous use of the hand). The mean House Functional Classification score changed significantly in the studies, suggesting that the affected arm/hand changed from a (fair) passive assist before surgery to a (fair) active assist after surgery.…”

“…32 Significant improvement on the spontaneous functional use (SHUEE spontaneous functional analysis and AHA) was found in all four studies. [14][15][16][17] For the AHA, a change of five AHA units 19 --0.81 BBT Very low 16 14 2.0 (5.9) À1.85 to 4.65 >0.05 27 15 2.3 (4.9) 0.36-4.13 0.21 HFC Very low 24 20 <0.01 <0.01 20 22 1.95 (1.4) 1.32-2.58 <0.001 56 23 2.7 (1.7) 0.22-2.23 <0.001 15 18 3.0 (-) -0.002 26 25 1.7 (1.7) 0.98-2.35 <0.001 19 24 3.2 (1.2) 2.59-3.70 <0.001 17 21 1.8 (-) -<0.001 SHUEE SFA Very low 40 17 4.0 (-) -<0.001 16 14 6.5 (11.0) 0.37-12.56 <0.05 AHA Very low 18 16 6.2 (3.7) 4.34-8.0 <0.001 16 14 3.1 (5.4) 0.21-5.92 <0.05 31 15 6.7 (4.2) 5.14-8.21 <0.001 COPM-P Very low 35 15 3. or more does (with 95% certainty) reflect a real change exceeding any random measurement error. 33…”