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Impaired mobility associated with an increased likelihood of death in children: A systematic review
Sally Nissen1, Edward Purssell2, Karen Shaw3
11 Department of Child and Family Health, Florence Nightingale Faculty of Nursing, Midwifery and Palliative Care, King's College London, London, UK.
Insights
Immobility in disabled children is linked to a higher risk of death. Identifying these children can help provide better integrated palliative care services.
Area of Science:
- Pediatric Palliative Care
- Disability Studies
- Prognostic Factor Research
Background:
- Identifying children with increased mortality risk is crucial for timely palliative care.
- Immobility is a significant factor in children with disabilities, but its prognostic value for mortality requires further investigation.
Purpose of the Study:
- To systematically review the association between immobility and the likelihood of death in children with disabilities in high-income countries.
- To identify specific indicators of immobility that predict mortality risk.
Main Methods:
- Systematic literature search of multiple databases (MEDLINE, Embase, Cochrane Library, OpenGrey, Science Citation Index) from 1990-2016.
- Inclusion of studies reporting hazard ratios (HRs) and relative risk for mortality related to impaired mobility.
- Independent review by two researchers to extract data and assess study quality.
Main Results:
- Nine studies were included, with varying measures of mobility and functioning.
- Key prognostic factors for mortality included lack of sitting ability at 24 months (HR 44.4) and Gross Motor Function Classification System (GMFCS) level V (HR 16.3).
- Immobility generally correlated with increased mortality risk, though clinical interpretation was challenging due to differing referent groups.
Conclusions:
- Immobility is a significant indicator of increased mortality risk in children with disabilities.
- Specific functional limitations, such as lack of sitting ability and severe motor impairment (GMFCS V), are strongly associated with higher mortality.
- Findings support using immobility as a criterion for identifying children who could benefit from integrated palliative care.
Abstract:
Improved identification of children with an increased likelihood of death can support appropriate provision of integrated palliative care. This systematic review aims to consider immobility and the associated likelihood of death in children with disabilities, living in high-income countries. Two reviewers independently searched MEDLINE, Embase, Cochrane Library, OpenGrey and Science Citation Index (1990-2016) for studies that reported hazard ratios (HRs) and relative risk for the likelihood of death related to impaired mobility. Nine papers were included. Three studies reported functioning using the Gross Motor Function Classification Scale (GMFCS) and the remaining studies reported measures of functioning unique to the study. The strongest single prognostic factor for the likelihood of death was 'lack of sitting ability at 24 months', HR 44.4 (confidence interval (CI) 6.1-320.8) followed by GMFCS V HR 16.3 (CI 5.6-47.2) and 11.4 (CI 3.76-35.57) and 'not able to cruise by 24 months', HR 14.4 (CI 3.5-59.2). Immobility is associated with an increased risk of dying over study periods, but different referent groups make clinical interpretation challenging. Overall, the quality of evidence is moderate. The findings suggest that immobility can support identification of children who may benefit from integrated palliative care.
