Effectiveness of physical therapy interventions for children with cerebral palsy: A systematic review
1 Finnish Office for Health Technology Assessment (FinOHTA), at the National Research and Development Centre for Welfare and Health (STAKES), PO Box 220, FIN-00531 Helsinki, Finland
2 The Social Insurance Institute, PO Box 450, 00101 Helsinki, Finland
3 Hospital of Children and Adolescents, University of Helsinki, PO Box 280, 00029 HUS, Finland
4 Tampere School of Public Health, 33014 University of Tampere, Finland
5 Department of General Practice, University of Copenhagen, PO Box 2099, 1014 Copenhagen K, Denmark
BMC Pediatrics 2008, 8:14 doi:10.1186/1471-2431-8-14Published: 24 April 2008
To assess the effectiveness of physical therapy (PT) interventions on functioning in children with cerebral palsy (CP).
A search was made in Medline, Cinahl, PEDro and the Cochrane library for the period 1990 to February 2007. Only randomized controlled trials (RCTs) on PT interventions in children with diagnosed CP were included. Two reviewers independently assessed the methodological quality and extracted the data. The outcomes measured in the trials were classified using the International Classification of Functioning, Disability and Health (ICF).
Twenty-two trials were identified. Eight intervention categories were distinguished. Four trials were of high methodological quality. Moderate evidence of effectiveness was established for two intervention categories: effectiveness of upper extremity treatments on attained goals and active supination, and of prehensile hand treatment and neurodevelopmental therapy (NDT) or NDT twice a week on developmental status, and of constraint-induced therapy on amount and quality of hand use. Moderate evidence of ineffectiveness was found of strength training on walking speed and stride length. Conflicting evidence was found for strength training on gross motor function. For the other intervention categories the evidence was limited due to low methodological quality and the statistically insignificant results of the studies.
Due to limitations in methodological quality and variations in population, interventions and outcomes, mostly limited evidence on the effectiveness of most PT interventions is available through RCTs. Moderate evidence was found for some effectiveness of upper extremity training. Well-designed trials are needed especially for focused PT interventions.