Efficacy and threshold dose of intensive training targeting mobility for children with cerebral palsy: A systematic review and meta-analysis.

Autor: Sudati IP; Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil.; Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia., Sakzewski L; Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia., Fioroni Ribeiro da Silva C; Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil., Jackman M; Cerebral Palsy Alliance Research Institute, University of Sydney, Sydney, Australia., Haddon M; Physiotherapy Department, Perth Children's Hospital, Perth, Western Australia, Australia., Pool D; The Healthy Strides Foundation, Perth, Western Australia, Australia., Patel M; Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia., Boyd RN; Queensland Cerebral Palsy and Rehabilitation Research Centre, Faculty of Medicine, Child Health Research Centre, The University of Queensland, Brisbane, Australia., de Campos AC; Physical Therapy Department, Federal University of São Carlos, São Carlos, São Paulo, Brazil.
Jazyk: angličtina
Zdroj: Developmental medicine and child neurology [Dev Med Child Neurol] 2024 Dec; Vol. 66 (12), pp. 1542-1557. Date of Electronic Publication: 2024 Aug 06.
DOI: 10.1111/dmcn.16040
Abstrakt: Aim: To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility.
Method: Randomized controlled trials (RCTs) or quasi-RCTs that included participants with CP, and which used intensive task-oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta-analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta-regression.
Results: Forty-six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed (p = 0.001), cadence (p = 0.02), gross motor function (p = 0.03), and functional mobility (p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies.
Interpretation: TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions.
(© 2024 The Author(s). Developmental Medicine & Child Neurology published by John Wiley & Sons Ltd on behalf of Mac Keith Press.)
Databáze: MEDLINE
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