Effects of Physical Therapist Intervention on Pulmonary Function in Children With Cerebral Palsy: A Systematic Review and Meta-Analysis

Abstract

Objective The purpose of this study was to evaluate the effects of physical therapy on pulmonary function and respiratory muscle strength in children with cerebral palsy (CP). Methods A search of 10 databases was conducted for this systematic review. Initially, there were no language, study design, or time frame restrictions. All studies assessing the effect of physical therapy on the respiratory system in children with CP were included. Two reviewers independently extracted and documented data. The extraction of the data included description of the intervention (duration, therapeutic method) and study results (change of spirometric parameters, respiratory muscle strength). The effects of physical therapist treatment were calculated using software. Results A total of 269 children aged 5 to 18 years from 10 studies were included. The included studies consisted of 5 different therapeutic methods (inspiratory muscle training [IMT], aerobic training, swimming, respiratory exercise, exercise with elastic bands). Physical therapist intervention led to a significant increase in the maximal expiratory pressure (MEP) (I2 = 0%), peak expiratory flow (I2 = 0%), and maximum oxygen consumption (I2 = 37%). A separate analysis of the most frequently used therapy (IMT) showed a positive effect on MEP (I2 = 0%) and maximal inspiratory pressure (I2 = 35%). Conclusions Various forms of physical therapy have potential to demonstrate a positive effect on maximal inspiratory pressure, MEP, and peak expiratory flow in children with CP. There is no possibility to recommend the best method and duration of the physical therapy; however, it can be suggested that physical therapy should be applied for at least 4 weeks and include IMT. Impact CP is one of the most common causes of physical disabilities in children, and pulmonary dysfunction is the leading cause of death in people with CP. Thus, it is warranted to seek different approaches that may improve pulmonary function in people with CP. This review has shown that various forms of physical therapy have potential to improve the pulmonary function of children with CP.

Addition of respiratory exercises to conventional rehabilitation for children and adolescents with cerebral palsy: a systematic review and meta-analysis

“…Pulmonary rehabilitation in children with chronic lung diseases has been extensively studied and points out protocols with respiratory exercises aimed at chest mobility and abdominal muscle strengthening, which lead to improved chest expansion and increased lower thoracic mobility, thus suggesting better diaphragmatic work and increased quality of life and exercise capacity [7][8][9][10][11]. Some of these exercises were also proposed for children with CP [12,13]. However, available rehabilitation strategies to target the respiratory functioning of the population with CP are not addressed in the literature; protocols are not standardized, and there is no consensus on the optimal training modalities.…”

“…Aerobic exercises are commonly performed over a long period of time with light to moderate intensity (e.g., running and cycling), limiting their application. Alternatively, respiratory exercises are increasingly regarded as an essential part of the overall physiotherapy in the management of CP and can be defined as techniques with or without the use of mechanical devices that encourage inspiration (e.g., incentive spirometer) and expiration [e.g., positive expiratory pressure (PEP)] [12,13].…”

Trials and tribulations of transparency related to inconsistencies between plan and conduct in peer‐reviewed physiotherapy publications: A methodology review

“…The primary outcome matched the registration in eight of the MAs (22.2%) 79,89,94,103,107,125,127,131 . The statistical analysis plan was present in the registration and was the same in the publication for 27 cases (75.0%) 79,81,84,85,89,91,94–96,99,101–104,107,109,114,117,120,125,126,128,129,131–133,142 . Thirty‐three MAs (91.7%) 80–82,84,85,87,89,91,95–97,99,101–104,107,109,114,115,117,120,123–129,131–133,142 had discrepancies between the registration and published study.…”

“…A total of 68 SRs were analysed (43 with meta‐analysis; 25 without). Fifty‐seven SRs (83.8%) were registered 79–110 . Refs 8,95,97,112–133 .…”

“…The statistical analysis plan was present in the registration and was the same in the publication for 27 cases (75.0%) 79,81,84,85,89,91,94–96,99,101–104,107,109,114,117,120,125,126,128,129,131–133,142 . Thirty‐three MAs (91.7%) 80–82,84,85,87,89,91,95–97,99,101–104,107,109,114,115,117,120,123–129,131–133,142 had discrepancies between the registration and published study. Of the 33 MAs with discrepancies, only 2 (6.1%) 103,107 addressed all the discrepancies.…”