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Prevention of hip displacement in children with cerebral palsy: a systematic review
Stacey D Miller1, Maria Juricic1, Kim Hesketh2
1BC Children's Hospital, Vancouver, BC, Canada.
Insights
Evidence for interventions preventing hip displacement in children with cerebral palsy (CP) is low. Current research is insufficient to recommend specific treatments for hip displacement or dislocation in CP.
Area of Science:
- Orthopedics
- Pediatrics
- Neurology
Background:
- Hip displacement is a common complication in children with cerebral palsy (CP).
- Preventive interventions are crucial for improving long-term outcomes in these patients.
Purpose of the Study:
- To systematically review and evaluate the evidence quality for interventions aimed at preventing hip displacement in children with CP.
- To identify effective interventions and guide future research directions.
Main Methods:
- A systematic review was conducted following AACPDM and PRISMA guidelines.
- Searches were performed across seven electronic databases, including studies reporting radiological measures of intervention effectiveness.
- Orthopaedic surgical interventions were excluded from the review.
Main Results:
- Twenty-four studies met the inclusion criteria, encompassing botulinum neurotoxin A, bracing, complementary/alternative medicine, intrathecal baclofen, nerve blocks, positioning, and selective dorsal rhizotomy.
- Significant variability was observed in treatment protocols, patient characteristics, and follow-up durations.
- The overall level of evidence was low, with no intervention demonstrating a large treatment effect on hip displacement.
Conclusions:
- The current evidence base for interventions to prevent hip displacement in children with CP is of low quality.
- Insufficient evidence exists to support or refute the efficacy of identified interventions.
- High-quality, prospective, longitudinal studies are needed to establish effective prevention strategies.
Aim:
To conduct a systematic review and evaluate the quality of evidence for interventions to prevent hip displacement in children with cerebral palsy (CP).
Method:
A systematic review was performed using American Academy of Cerebral Palsy and Developmental Medicine (AACPDM) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) methodology. Searches were completed in seven electronic databases. Studies were included if participants had CP and the effectiveness of the intervention was reported using a radiological measure. Results of orthopaedic surgical interventions were excluded.
Results:
Twenty-four studies fulfilled the inclusion criteria (4 botulinum neurotoxin A; 2 botulinum neurotoxin A and bracing; 1 complementary and alternative medicine; 1 intrathecal baclofen; 1 obturator nerve block; 8 positioning; 7 selective dorsal rhizotomy). There was significant variability in treatment dosages, participant characteristics, and duration of follow-up among the studies. Overall, the level of evidence was low. No intervention in this review demonstrated a large treatment effect on hip displacement.
Interpretation:
The level and quality of evidence for all interventions aimed at slowing or preventing hip displacement is low. There is currently insufficient evidence to support or refute the use of the identified interventions to prevent hip displacement or dislocation in children and young people with CP.
What This Paper Adds:
High-quality evidence on prevention of hip displacement is lacking. No recommendations can be made for preventing hip displacement in children with cerebral palsy because of poor-quality evidence. High-quality, prospective, longitudinal studies investigating the impact of interventions on hip displacement are required.
