Just how internationally relevant can evidence‐based cerebral palsy clinical practice guidelines be?

Abstract

This commentary is on the clinical practice guide by Jackman et al. on pages 536–549 of this issue.

Best evidence for improving function in children with cerebral palsy: Success is within reach

“…McEwan et al 2016; n = 5912; Cohen's d = 0.6). 5 With respect to the issue of guideline applicability in low-and middle-income countries (LMICs), 6 we agree confounders exist: (1) most CP research has been conducted in high-income countries; (2) the burden of severity is higher in LMICs with a greater proportion in Gross Motor Function Classification System (GMFCS) level V; and (3) little is published about improving function in GMFCS level V, as by definition compensatory adaptive equipment and technology are required over habilitation. The panel minimized recommendations involving expensive equipment, preferentially recommending lower-cost approaches to promote equity.…”

‘Impairments of the brain’: Global South perspectives on childhood neurodevelopmental disability

“…We can question whether these 'international' definitions are genuinely international and whether they consider different understandings of disability in different cultures. 4 The dominance of theories and power from the Global North can easily create generalized and simplified descriptions of disability experiences [5][6][7][8][9] and can underestimate the importance of cultural…”

“…Most countries in the Global South have adopted impairment and disability definitions through medical training, the ratification of the United Nations Convention of the Right of Persons with Disabilities in 2006, commitment to the United Nations Sustainable Development Goals, 3 as well as the language used in development aid projects. We can question whether these ‘international’ definitions are genuinely international and whether they consider different understandings of disability in different cultures 4 . The dominance of theories and power from the Global North can easily create generalized and simplified descriptions of disability experiences 5–9 and can underestimate the importance of cultural concepts and experiences of disability.…”

“…We can question whether these 'international' definitions are genuinely international and whether they consider different understandings of disability in different cultures. 4 The dominance of theories…”

Guideline to improve physical function in cerebral palsy: too big to succeed

“…The four evidence-based recommendations for gross and fine motor function are generic (goal-directed practice) and are compared mostly to no or low-dose intervention, which is not a real-world comparison (at least in the high-resource settings where these studies occurred). 3 When compared to equal or high dose alternative treatments, most effects were small or trivial, improvements not meeting minimal detectable change or clinically important difference.…”