A systematic review of interventions for children with cerebral palsy: state of the evidence

Abstract

Aim The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy ( CP ). Method This study was a systematic review of systematic reviews. The following databases were searched: CINAHL , C ochrane L ibrary, DARE , EMBASE , G oogle S cholar MEDLINE , OTS eeker, PED ro, Psyc BITE , P syc INFO , and speech BITE . Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP . Interventions were coded using the O xford L evels of E vidence; GRADE ; E vidence A lert T raffic L ight; and the I nternational C lassification of F unction, D isability and H ealth. Results Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint‐induced movement therapy, context‐focused therapy, diazepam, fitness training, goal‐directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red). Interpretation Evidence supports 15 green light interventions. All yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.