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Effectiveness of physical therapy interventions for children with cerebral palsy: a systematic review
Heidi Anttila1, Ilona Autti-Rämö, Jutta Suoranta
1Finnish Office for Health Technology Assessment (FinOHTA), at the National Research and Development Centre for Welfare and Health (STAKES), PO Box 220, FIN-00531 Helsinki, Finland. heidi.anttila@stakes.fi
Insights
Physical therapy (PT) interventions show moderate evidence of effectiveness for upper extremity function in children with cerebral palsy (CP). However, more high-quality trials are needed to confirm benefits for other functional areas.
Area of Science:
- Pediatrics
- Rehabilitation Medicine
- Neurology
Background:
- Cerebral palsy (CP) is a complex developmental disorder affecting movement and posture.
- Physical therapy (PT) plays a crucial role in managing functional deficits in children with CP.
- Assessing the evidence-based effectiveness of various PT interventions is vital for optimizing care.
Purpose of the Study:
- To systematically review randomized controlled trials (RCTs) evaluating PT interventions for children with CP.
- To assess the impact of these interventions on various aspects of functioning.
Main Methods:
- Comprehensive literature search of major databases (Medline, Cinahl, PEDro, Cochrane Library) from 1990 to 2007.
- Inclusion of only RCTs focusing on PT interventions in diagnosed pediatric CP cases.
- Data extraction and methodological quality assessment by two independent reviewers, with outcomes classified using the International Classification of Functioning, Disability and Health (ICF).
Main Results:
- Twenty-two RCTs were identified, categorized into eight intervention types.
- Moderate evidence supports the effectiveness of upper extremity treatments (including prehensile hand treatment and neurodevelopmental therapy) and constraint-induced therapy for specific functional gains.
- Moderate evidence indicated ineffectiveness of strength training for walking speed and stride length, with conflicting results for gross motor function.
Conclusions:
- Limited high-quality evidence exists for most PT interventions in pediatric CP due to methodological limitations and study variations.
- Moderate evidence supports the effectiveness of certain upper extremity training approaches.
- Further well-designed RCTs are essential to establish robust evidence for targeted PT interventions in children with CP.
Background:
To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).
Methods:
A 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).
Results:
Twenty-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.
Conclusion:
Due 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.
