Abstract
BackgroundTo assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).MethodsA search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).ResultsTwenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies.ConclusionDue to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.
Highlights
To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP)
Four trials were of high methodological quality
Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use
Summary
To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP). Cerebral palsy (CP) describes "a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to nonprogressive disturbances that occurred in the developing fetal or infant brain. The motor disorders of cerebral palsy are often accompanied by disturbances of sensation, perception, cognition, communication, and behaviour, by epilepsy, and by secondary musculoskeletal problems [1]." The estimated prevalence in the general population is 2/ 1000 [2,3]. The reference lists of the identified studies and reviews were screened for additional references. An experienced medical librarian formulated the search strategy for Ovid Medline (see Additional file 1, Word document: search strategy for Ovid Medline) and adapted it to the other databases. Inclusion criteria Study type Published, full-length articles or full written reports of RCTs since 1990
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