Abstract
Background: Recurrence in cerebral palsy (CP) patients who have undergone operative or non-operative correction varies greatly from one study to another. Therefore, we conducted this meta-analysis to determine the pooled rate of equinus recurrence following its correction either surgically or non-surgically. Methods: Nine electronic databases were searched from inception to 6 May 2021, and the search was updated on 13 August 2021. We included all studies that reported the recurrence rate of equinus following its correction among CP patients. The primary outcome was recurrence, where data were reported as a pooled event (PE) rate and its corresponding 95% confidence interval (CI). We used the Cochrane’s risk of bias (RoB-II) tool and ROBINS-I tool to assess the quality of included randomized and non-randomized trials, respectively. We conducted subgroup analyses to identify the sources of heterogeneity. Results: The overall rate of recurrence was 0.15 (95% CI: 0.05–0.18; I2 = 88%; p < 0.01). Subgroup analyses indicated that the laterality of CP, study design, and intervention type were significant contributors to heterogeneity. The recurrence rate of equinus differed among interventions; it was highest in the multilevel surgery group (PE = 0.27; 95% CI: 0.19–0.38) and lowest in the Ilizarov procedure group (PE = 0.10; 95% CI: 0.04–0.24). Twelve studies had a low risk of bias, eight had a moderate risk, and nine had a serious risk of bias. Conclusion: The recurrence of equinus following its correction, either surgically or non-surgically, in CP patients is notably high. However, due to the poor quality of available evidence, our findings should be interpreted with caution. Future studies are still warranted to determine the actual risk of equinus recurrence in CP.
Highlights
Search Strategy and Study SelectionThis study was carried out in accordance with the PRISMA guidelines for systematic reviews and meta-analyses, where registering a protocol is not considered mandatory [9]
Introduction published maps and institutional affilCerebral palsy (CP) is the result of a non-progressive brain injury which occurs during the early stages of development [1]
We aimed to identify the current gaps in the literature regarding equinus recurrence following its correction
Summary
This study was carried out in accordance with the PRISMA guidelines for systematic reviews and meta-analyses, where registering a protocol is not considered mandatory [9]. The search was originally carried out on 6 May. 2021, and it was later updated on 13 August 2021, yielding no more relevant papers. The following keywords were used when performing the search: (recurrence) AND (equinus) AND (“cerebral palsy”). The search process was conducted in accordance with the PICO framework: participants were patients with equinus who underwent operative or non-operative correction, the intervention was any type of management approach used for the correction of equinus, the comparison was any type of surgery or other treatment approaches (i.e., casting, injection), and recurrence was the outcome of interest. We included all original studies that reported the recurrence of equinus following its correction (surgically or non-surgically), whether there was a comparison group or not.
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