Overview of Cochrane systematic reviews for rehabilitation interventions in individuals with cerebral palsy: A mapping synthesis

Abstract

AimThis overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for individuals with cerebral palsy (CP) and the quality of the evidence.MethodFollowing the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database that were relevant for individuals with CP were included. A mapping synthesis was used to group outcomes and comparisons of included CSRs indicating the effect of rehabilitation interventions and the certainty of evidence.ResultsA total of eight CSRs were included in the evidence map. The effect of interventions varied across comparisons and the certainty of evidence was inconsistent, ranging from high to very low. The best evidence was found for botulinum neurotoxin A (BoNT‐A) combined with occupational therapy in the management of spasticity. However, the effect of BoNT‐A on drooling and salivation remains unclear. A paucity of randomized controlled trials studying treatments for both dystonia and postural deformities was noted.InterpretationThis review emphasizes the need to further investigate the effectiveness and cost–benefit of rehabilitation interventions for individuals with CP.

Improving the quality of evidence production in rehabilitation. Results of the 5th Cochrane Rehabilitation Methodological Meeting

“…A second set of lessons came to Cochrane Rehabilitation while working with the WHO to identify the evidence to produce the Package of Interventions for Rehabilitation, 8 a tool offered to countries as the minimum rehabilitation services needed to provide to their citizens. One of the main results, published in a series of Overviews of Cochrane Reviews, 9 - 13 was that the evidence from randomised controlled trials (RCTs) was scarce in quantity and often low in quality. This surprising result showed that RCTs currently do not and in all likelihood cannot answer the range of research questions arising from practice information needs to provide all the evidence we need to treat our patients.…”

Overview of Cochrane Systematic Reviews for Rehabilitation Interventions in Individuals with Upper Limb Fractures: A Mapping Synthesis

“…As for previously published paper [ 16 ], we extracted data about each reported outcome related to an intervention from Table of Findings of each CSR. We extracted GRADE judgments within the CSRs when reported; otherwise, we judged the quality of evidence for the primary outcome, using the standard GRADE approach [ 20 , 21 ].…”

“…In previous publications, we detailed the methodology [16] that follows what was established and published by the WHO Rehabilitation Programme and Cochrane Rehabilitation [2] under the guidance of the WHO's guideline review committee. We performed an overview of CSRs reported following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA 2020 statement) [17] and registered on OSF Registries (https://doi.org/10.17605/OSF.IO/9QKYB (accessed on 28 March 2024)).…”

Physical exercise and its effects on people with Parkinson’s disease: Umbrella review

“…AMSTAR 2 is a 16-item, domain-based instrument meant to critically appraise systematic reviews of randomized controlled trials [ 18 ]. Seven domains of the instrument are considered critical to rate the methodological quality of the study, namely protocol registration before commencement of the review, adequacy of the literature search, justification for excluding individual studies, risk of bias from individual studies included in the review, appropriateness of meta-analytical methods, consideration of risk of bias when interpreting the results of the review and assessment of the likely impact of publication bias [ 18 , 19 ]. The identification of weaknesses in these critical domains allows one to correctly interpret the information provided by the systematic reviews, and provides four classification levels: ‘high quality’, ‘moderate quality’, ‘low quality’ and ‘critically low quality’ evidence [ 18 ].…”