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Single-event multilevel surgery for children with cerebral palsy: a systematic review
Jennifer L McGinley1, Fiona Dobson, Rekha Ganeshalingam
1Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia.
Insights
Single-event multilevel surgery (SEMLS) for children with cerebral palsy shows promising gait improvements, but evidence quality varies. More rigorous research, including randomized trials, is needed for definitive conclusions on SEMLS efficacy.
Area of Science:
- Orthopedic Surgery
- Pediatric Rehabilitation
- Cerebral Palsy Research
Background:
- Single-event multilevel surgery (SEMLS) is a complex orthopedic intervention for children with cerebral palsy.
- Evaluating the evidence quality for SEMLS is crucial for guiding clinical practice and future research.
- The International Classification of Functioning, Disability and Health (ICF) provides a framework for assessing outcomes in rehabilitation.
Purpose of the Study:
- To systematically review studies on single-event multilevel surgery (SEMLS) in children with cerebral palsy.
- To assess the methodological quality of existing SEMLS research.
- To develop recommendations for future research in this field.
Main Methods:
- Systematic literature search of Medline, EMBASE, CINAHL, and Cochrane databases.
- Inclusion criteria focused on SEMLS in cerebral palsy affecting multiple anatomical levels and reporting ICF domains.
- Study quality appraised using the Methodological Index for Non-Randomized Studies (MINORS) and Oxford Centre for Evidence-Based Medicine scale.
Main Results:
- Thirty-one studies published between 1985 and 2010 met the inclusion criteria.
- Significant variation in study quality was observed, though recent studies show improved reporting and ICF domain inclusion.
- A trend towards favorable gait outcomes was noted, but interpretation requires caution due to study limitations and potential overestimation of efficacy in uncontrolled studies.
Conclusions:
- Study design and reporting for SEMLS are improving, reflecting advances in multidisciplinary care and ICF frameworks.
- The current evidence base for SEMLS is limited by a lack of randomized clinical trials.
- Further high-quality research, particularly randomized controlled trials, is essential to establish the definitive efficacy of SEMLS compared to other interventions like selective dorsal rhizotomy.
Aim:
To conduct a systematic review of single-event multilevel surgery (SEMLS) for children with cerebral palsy, with the aim of evaluating the quality of the evidence and developing recommendations for future research.
Method:
The systematic review was conducted using standard search and extraction methods in Medline, EMBASE, CINAHL, and Cochrane electronic databases. For the purposes of this review, SEMLS was defined as two or more soft-tissue or bony surgical procedures at two or more anatomical levels during one operative procedure, requiring only one hospital admission and one period of rehabilitation. Studies were included if: (1) the primary focus was to examine the effect of SEMLS in children with cerebral palsy; (2) the results focused on multiple anatomic levels and reported findings of one or more World Health Organization International Classification of Functioning, Disability and Health (ICF) domains. Studies that focused on a single intervention or level, or on the utility of a specific outcome measure were excluded. Study quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. The review also examined the reporting of surgery, adverse events, and rehabilitation.
Results:
Thirty-one studies fulfilled the criteria for inclusion, over the period 1985 to October 2010. The MINORS score for these studies varied from 4 to 19, with marked variation in the quality of reporting. Study quality has improved over recent years. Valid measures of gait and function have been introduced and several of the most recent studies have addressed multiple dimensions of the ICF. A statistical synthesis of the outcome data was not conducted, although a trend towards favourable outcomes in gait was evident. Caution is advised with interpretation owing to the variable study quality. Uncontrolled studies may have resulted in an overestimation of treatment efficacy.
Interpretation:
The design and reporting of studies of SEMLS are improving with the development of multidisciplinary teamwork and frameworks such as the ICF. However, the evidence base is limited by the lack of randomized clinical trials, especially when compared with other surgical interventions such as selective dorsal rhizotomy.
