Lower limb contracture definitions in children and adults with cerebral palsy: A systematic review
Andrea Marron1, Jasmine Milnes1, Laura Conry2
1Movement Analysis Laboratory, Central Remedial Clinic, Dublin, Ireland.
Insights
This study found significant variability in how lower limb contractures are defined and measured in people with cerebral palsy (CP). Standardized definitions are proposed to improve future research quality and consistency.
Area of Science:
- Orthopedics
- Pediatric Rehabilitation
- Clinical Measurement
Background:
- Fixed lower limb contractures are common in cerebral palsy (CP).
- Current definitions and prevalence rates of these contractures lack standardization.
- Variability in definitions impacts research quality and clinical comparability.
Purpose of the Study:
- To systematically review quantitative definitions and prevalence rates of lower limb contractures in CP.
- To propose standardized cut-off values for defining contractures to enhance future research.
Main Methods:
- Systematic review adhering to PRISMA guidelines.
- Searched four databases from inception to April 2024.
- Independent screening, data extraction, and quality assessment by two reviewers; descriptive synthesis of data.
Main Results:
- Forty-four studies were included, revealing wide ranges in definitions and prevalence for ankle, knee, and hip contractures.
- Ankle plantarflexion contracture definitions varied, with prevalence from 32-90%.
- Knee and hip flexion contracture definitions also showed significant variability, with prevalence rates differing widely. Hip extension and abduction contractures were rarely defined.
Conclusions:
- Considerable heterogeneity exists in the reported definitions and prevalence of lower limb contractures in CP.
- Proposed standardized definitions include: ankle plantarflexion < 0° dorsiflexion, knee flexion < 0° extension, hip flexion < 0° extension, hip abduction < 30° abduction, and hip extension ≤ 90° flexion range of motion.
- Standardization is crucial for improving the quality and comparability of research on CP-related contractures.
Aim:
To examine the quantitative definitions and prevalence rates of fixed lower limb contractures in people with cerebral palsy (CP). Based on findings, to propose standardized values to define lower limb contractures to improve quality in future research.
Method:
A systematic review was conducted according to PRISMA guidelines using 4 databases from inception to April 2024. Titles, abstracts, and full texts were independently screened. Data were extracted and quality assessed independently by 2 reviewers. Data were synthesized and presented descriptively.
Results:
Forty-four studies were included. Ankle plantarflexion contracture definitions ranged from < 10° dorsiflexion to ≥ 20° plantarflexion, and prevalence rates ranged from 32 % to 90 %. Knee flexion contracture definitions ranged from > 0° to ≥ 30° flexion, and prevalence rates ranged from 19 % to 44 %. Hip flexion contracture definitions ranged from > 0° to ≥ 30° flexion, and prevalence rates ranged from 7 % to 68 %. Hip extension and abduction contractures were seldom defined.
Interpretation:
There is considerable variability in reported contracture definitions and prevalence rates. Based on findings, we propose the following cut-offs for defining contractures; ankle plantarflexion contracture < 0° dorsiflexion, knee flexion contracture < 0° knee extension, hip flexion contracture < 0° hip extension, hip abduction contracture < 30° hip abduction, hip extension contracture ≤ 90° hip flexion range of motion.
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