Lucas Barbara R, Elliott Elizabeth J, Coggan Sarah, Pinto Rafael Z, Jirikowic Tracy, McCoy Sarah Westcott, Latimer Jane
Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia.
BMC Pediatr. 2016 Nov 29;16(1):193. doi: 10.1186/s12887-016-0731-6.
Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders.
A systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively.
Of 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to -0.5) with "very low quality" GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with "low quality" GRADE ratings. Study limitations included the small number and poor quality of the available trials.
Although we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.
粗大运动技能是儿童发育的基础。目前针对轻度至中度粗大运动障碍儿童的物理治疗方法的有效性尚不清楚。本研究的目的是系统回顾文献，以调查保守干预措施对改善一系列神经发育障碍儿童粗大运动表现的有效性。
进行了一项系统评价并荟萃分析。检索了MEDLINE、EMBASE、AMED、CINAHL、PsycINFO、PEDro、Cochrane协作网、谷歌学术数据库和临床试验注册库。已发表的随机对照试验，纳入3至18岁的儿童，这些儿童患有：（i）发育性协调障碍（DCD）或脑性瘫痪（CP）（粗大运动功能分类系统1级）或发育迟缓或轻度获得性脑损伤或早产（孕周<30周）或胎儿酒精谱系障碍；以及（ii）接受来自卫生专业人员的非药物或非手术干预；以及（iii）使用标准化评估工具获得的粗大运动结果。进行荟萃分析以确定干预对粗大运动功能的综合效应。分别使用PEDro和GRADE方法评估荟萃分析建议的方法学质量和强度。
在2513篇论文中，9篇符合纳入标准，包括患有CP（n = 2）或DCD（n = 7）的儿童接受了11种不同的干预措施。9项试验中只有2项显示出治疗效果。使用最不保守的试验结果，显示出干预有很大的有益效果（标准化均数差：-0.8；95%可信区间：-1.1至-0.5），GRADE评分为“极低质量”。使用最保守的试验结果，没有治疗效果（标准化均数差：-0.1；95%可信区间：-0.3至0.2），GRADE评分为“低质量”。研究局限性包括现有试验数量少且质量差。
虽然我们发现一些以任务为导向框架的干预措施可以改善DCD或CP儿童的粗大运动结果，但这些发现受到现有证据质量极低的限制。迫切需要高质量的干预试验。
