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Neurodevelopmental Therapy for Cerebral Palsy: A Meta-analysis
Anna Te Velde1,2, Catherine Morgan1, Megan Finch-Edmondson1
1Cerebral Palsy Alliance Research Institute, Specialty of Child & Adolescent Health, Sydney Medical School, Faculty of Medicine & Health, The University of Sydney, Sydney, NSW, Australia.
Insights
Neurodevelopmental therapy (NDT) is not more effective than control for cerebral palsy (CP). Activity-based interventions show superior motor function improvements, suggesting NDT deimplementation in CP care.
Area of Science:
- Pediatric Rehabilitation
- Neurology
- Evidence-Based Practice
Background:
- Bobath therapy, also known as neurodevelopmental therapy (NDT), is a common intervention for cerebral palsy (CP).
- Existing evidence suggests other interventions may be more effective for children with CP.
- The efficacy of NDT in infants and children with CP or at high risk for CP requires thorough evaluation.
Purpose of the Study:
- To determine the effectiveness of neurodevelopmental therapy (NDT) in children and infants diagnosed with or at high risk of cerebral palsy (CP).
- To compare the efficacy of NDT against control interventions and activity-based approaches.
Main Methods:
- A systematic literature search was conducted across major databases (CINAHL, Cochrane Library, Embase, Medline) up to March 2021.
- Included studies were randomized controlled trials comparing NDT with any or no intervention.
- Meta-analysis was performed using standardized mean differences, with study quality assessed using Cochrane Risk of Bias tool-2 and certainty of evidence by Grading of Recommendations Assessment, Development, and Evaluation.
Main Results:
- Analysis of 34 studies involving 1332 participants revealed no significant effect of NDT compared to control (pooled effect size 0.13).
- Activity-based approaches demonstrated a moderate effect (0.76) and body structure/function interventions showed a similar effect (0.77) in improving motor function compared to NDT.
- Higher-dose NDT was not found to be more effective than lower-dose NDT (0.32), and considerable heterogeneity was noted in NDT versus activity-based comparisons.
Conclusions:
- Activity-based and body structure/function interventions are more effective for improving motor function in CP than NDT.
- NDT shows no superior efficacy compared to control interventions for cerebral palsy.
- A strong recommendation is made for the deimplementation of NDT in CP management due to its lack of demonstrated effectiveness.
Background And Objective:
Bobath therapy, or neurodevelopmental therapy (NDT) is widely practiced despite evidence other interventions are more effective in cerebral palsy (CP). The objective is to determine the efficacy of NDT in children and infants with CP or high risk of CP.
Methods:
Cumulative Index to Nursing and Allied Health Literature, Cochrane Library, Embase, and Medline were searched through March 2021. Randomized controlled trials comparing NDT with any or no intervention were included. Meta-analysis was conducted with standardized mean differences calculated. Quality was assessed by using Cochrane Risk of Bias tool-2 and certainty by using Grading of Recommendations Assessment, Development, and Evaluation.
Results:
Of 667 records screened, 34 studies (in 35 publications, 1332 participants) met inclusion. Four meta-analyses were conducted assessing motor function. We found no effect between NDT and control (pooled effect size 0.13 [-0.20 to 0.46]), a moderate effect favoring activity-based approaches (0.76 [0.12 to 1.40]) and body function and structures (0.77 [0.19 to 1.35]) over NDT and no effect between higher- and lower-dose NDT (0.32 [-0.11 to 0.75]). A strong recommendation against the use of NDT at any dose was made. Studies were not all Consolidated Standards of Reporting Trials-compliant. NDT versus activity-based comparator had considerable heterogeneity (I2 = 80%) reflecting varied measures.
Conclusions:
We found that activity-based and body structure and function interventions are more effective than NDT for improving motor function, NDT is no more effective than control, and higher-dose NDT is not more effective than lower-dose. Deimplementation of NDT in CP is required.
