Effectiveness of postural interventions in cerebral palsy: umbrella systematic review

Monica Toohey; Remy Blatch-Williams; Kristian Budini; Astrid Ferreira; Alexandra Griffin; Ashleigh Hines; Michelle Jackman; Karin Lind; Jill Massey; Maria Mc Namara; Jenna Mitchell; Catherine Morgan; Esther Norfolk; Madison CB. Paton; Daniel Polyblank; Sarah Reedman; Iona Novak

doi:10.1016/j.paed.2024.06.003

Effectiveness of postural interventions in cerebral palsy: umbrella systematic review

Monica Toohey, Remy Blatch-Williams, Kristian Budini, Astrid Ferreira, Alexandra Griffin, Ashleigh Hines, Michelle Jackman, Karin Lind, Jill Massey, Maria Mc Namara, Jenna Mitchell, Catherine Morgan, Esther Norfolk, Madison CB. Paton, Daniel Polyblank, Sarah Reedman, Iona Novak

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2 Citations (Scopus)

Abstract

Cerebral palsy is a disorder of posture and movement. Multiple postural management interventions exist to prevent complications and improve outcomes. In this short review we followed a systematic approach to appraise the quality of evidence supporting each intervention and assessed the effectiveness across the International Classification of Functioning, Disability and Health (ICF) outcomes. Evidence-based recommendations are essential for assisting clinicians in selecting and implementing interventions aligned with the individual's goals. This review aims to summarize and evaluate the evidence supporting postural interventions for CP published after Gough's review in 2009. Additionally, it aims to provide clinical bottom lines according to GMFCS or MACS levels. We conducted our search for systematic reviews or population register studies evaluating postural management interventions in people with cerebral palsy using an umbrella systematic review design. We assessed the quality of evidence for each intervention and made recommendations using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) and the Evidence Alert Traffic Light approaches. From a total of 955 citations identified 33 unique studies met our inclusion criteria. The 33 studies included 41 interventions, measuring 22,835 participants, across 207 RCTs and 1 population register study. Of the 41 interventions, 14 were postural control interventions to improve movement; 11 were tone management interventions to improve movement or prevent deformity; 2 were postural management interventions to support upright posture; and 14 were postural management interventions to prevent deformity. Several postural control interventions are effective for improving movement, and several postural management interventions may prevent deformity, with hip surveillance having the best evidence.

Original language	English
Pages (from-to)	257-278
Number of pages	22
Journal	Paediatrics and Child Health
Volume	34
Issue number	8
DOIs	https://doi.org/10.1016/j.paed.2024.06.003
Publication status	E-pub ahead of print - 29 Jul 2024

Keywords

Cerebral palsy
hip surveillance
postural control
postural management

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10.1016/j.paed.2024.06.003

https://www.sciencedirect.com/science/article/pii/S1751722224000805

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Toohey, M., Blatch-Williams, R., Budini, K., Ferreira, A., Griffin, A., Hines, A., Jackman, M., Lind, K., Massey, J., Mc Namara, M., Mitchell, J., Morgan, C., Norfolk, E., Paton, M. CB., Polyblank, D., Reedman, S., & Novak, I. (2024). Effectiveness of postural interventions in cerebral palsy: umbrella systematic review. Paediatrics and Child Health, 34(8), 257-278. Advance online publication. https://doi.org/10.1016/j.paed.2024.06.003

@article{00a1b52d5cfc4688b13ac27b3df20791,

title = "Effectiveness of postural interventions in cerebral palsy: umbrella systematic review",

abstract = "Cerebral palsy is a disorder of posture and movement. Multiple postural management interventions exist to prevent complications and improve outcomes. In this short review we followed a systematic approach to appraise the quality of evidence supporting each intervention and assessed the effectiveness across the International Classification of Functioning, Disability and Health (ICF) outcomes. Evidence-based recommendations are essential for assisting clinicians in selecting and implementing interventions aligned with the individual's goals. This review aims to summarize and evaluate the evidence supporting postural interventions for CP published after Gough's review in 2009. Additionally, it aims to provide clinical bottom lines according to GMFCS or MACS levels. We conducted our search for systematic reviews or population register studies evaluating postural management interventions in people with cerebral palsy using an umbrella systematic review design. We assessed the quality of evidence for each intervention and made recommendations using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) and the Evidence Alert Traffic Light approaches. From a total of 955 citations identified 33 unique studies met our inclusion criteria. The 33 studies included 41 interventions, measuring 22,835 participants, across 207 RCTs and 1 population register study. Of the 41 interventions, 14 were postural control interventions to improve movement; 11 were tone management interventions to improve movement or prevent deformity; 2 were postural management interventions to support upright posture; and 14 were postural management interventions to prevent deformity. Several postural control interventions are effective for improving movement, and several postural management interventions may prevent deformity, with hip surveillance having the best evidence.",

keywords = "Cerebral palsy, hip surveillance, postural control, postural management",

author = "Monica Toohey and Remy Blatch-Williams and Kristian Budini and Astrid Ferreira and Alexandra Griffin and Ashleigh Hines and Michelle Jackman and Karin Lind and Jill Massey and {Mc Namara}, Maria and Jenna Mitchell and Catherine Morgan and Esther Norfolk and Paton, {Madison CB.} and Daniel Polyblank and Sarah Reedman and Iona Novak",

year = "2024",

month = jul,

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doi = "10.1016/j.paed.2024.06.003",

language = "English",

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Toohey, M, Blatch-Williams, R, Budini, K, Ferreira, A, Griffin, A, Hines, A, Jackman, M, Lind, K, Massey, J, Mc Namara, M, Mitchell, J, Morgan, C, Norfolk, E, Paton, MCB, Polyblank, D, Reedman, S & Novak, I 2024, 'Effectiveness of postural interventions in cerebral palsy: umbrella systematic review', Paediatrics and Child Health, vol. 34, no. 8, pp. 257-278. https://doi.org/10.1016/j.paed.2024.06.003

TY - JOUR

T1 - Effectiveness of postural interventions in cerebral palsy

T2 - umbrella systematic review

AU - Toohey, Monica

AU - Blatch-Williams, Remy

AU - Budini, Kristian

AU - Ferreira, Astrid

AU - Griffin, Alexandra

AU - Hines, Ashleigh

AU - Jackman, Michelle

AU - Lind, Karin

AU - Massey, Jill

AU - Mc Namara, Maria

AU - Mitchell, Jenna

AU - Morgan, Catherine

AU - Norfolk, Esther

AU - Paton, Madison CB.

AU - Polyblank, Daniel

AU - Reedman, Sarah

AU - Novak, Iona

PY - 2024/7/29

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N2 - Cerebral palsy is a disorder of posture and movement. Multiple postural management interventions exist to prevent complications and improve outcomes. In this short review we followed a systematic approach to appraise the quality of evidence supporting each intervention and assessed the effectiveness across the International Classification of Functioning, Disability and Health (ICF) outcomes. Evidence-based recommendations are essential for assisting clinicians in selecting and implementing interventions aligned with the individual's goals. This review aims to summarize and evaluate the evidence supporting postural interventions for CP published after Gough's review in 2009. Additionally, it aims to provide clinical bottom lines according to GMFCS or MACS levels. We conducted our search for systematic reviews or population register studies evaluating postural management interventions in people with cerebral palsy using an umbrella systematic review design. We assessed the quality of evidence for each intervention and made recommendations using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) and the Evidence Alert Traffic Light approaches. From a total of 955 citations identified 33 unique studies met our inclusion criteria. The 33 studies included 41 interventions, measuring 22,835 participants, across 207 RCTs and 1 population register study. Of the 41 interventions, 14 were postural control interventions to improve movement; 11 were tone management interventions to improve movement or prevent deformity; 2 were postural management interventions to support upright posture; and 14 were postural management interventions to prevent deformity. Several postural control interventions are effective for improving movement, and several postural management interventions may prevent deformity, with hip surveillance having the best evidence.

AB - Cerebral palsy is a disorder of posture and movement. Multiple postural management interventions exist to prevent complications and improve outcomes. In this short review we followed a systematic approach to appraise the quality of evidence supporting each intervention and assessed the effectiveness across the International Classification of Functioning, Disability and Health (ICF) outcomes. Evidence-based recommendations are essential for assisting clinicians in selecting and implementing interventions aligned with the individual's goals. This review aims to summarize and evaluate the evidence supporting postural interventions for CP published after Gough's review in 2009. Additionally, it aims to provide clinical bottom lines according to GMFCS or MACS levels. We conducted our search for systematic reviews or population register studies evaluating postural management interventions in people with cerebral palsy using an umbrella systematic review design. We assessed the quality of evidence for each intervention and made recommendations using GRADE (Grading of Recommendation, Assessment, Development, and Evaluation) and the Evidence Alert Traffic Light approaches. From a total of 955 citations identified 33 unique studies met our inclusion criteria. The 33 studies included 41 interventions, measuring 22,835 participants, across 207 RCTs and 1 population register study. Of the 41 interventions, 14 were postural control interventions to improve movement; 11 were tone management interventions to improve movement or prevent deformity; 2 were postural management interventions to support upright posture; and 14 were postural management interventions to prevent deformity. Several postural control interventions are effective for improving movement, and several postural management interventions may prevent deformity, with hip surveillance having the best evidence.

KW - Cerebral palsy

KW - hip surveillance

KW - postural control

KW - postural management

U2 - 10.1016/j.paed.2024.06.003

DO - 10.1016/j.paed.2024.06.003

M3 - Article

SN - 1751-7222

VL - 34

SP - 257

EP - 278

JO - Paediatrics and Child Health

JF - Paediatrics and Child Health

IS - 8

ER -

Effectiveness of postural interventions in cerebral palsy: umbrella systematic review

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Keywords

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