Department of Rehabilitation, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Medical Library, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands.
Dev Med Child Neurol. 2020 Jan;62(1):21-27. doi: 10.1111/dmcn.14315. Epub 2019 Jul 23.
To evaluate and synthesize the evidence for effects of upper extremity surgery (UES) on activities and participation of children and adolescents with cerebral palsy (CP).
The databases MEDLINE, Embase, and PsycINFO were searched for publications up to September 2018. Studies included were comparative studies with or without concurrent comparison groups or case series with pretest/posttest outcomes with a minimal sample size of 10 participants; those that reported the effects of UES with a follow-up time of at least 5 months; those including patients diagnosed with CP aged up to 20 years; and those that used a validated activity-based instrument. Risk of bias was assessed using the ROBINS-I (Risk Of Bias In Non-randomised Studies - of Interventions) tool and quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation.
Twelve studies, involving 310 children and adolescents, were included. The ability and perception of the patient to use the hand(s) and perform activities (measured with the Shriners Hospital Upper Extremity Evaluation, Assisting Hand Assessment, and House Functional Classification) improved significantly after UES. The quality of evidence was very low for each of the activity outcomes of interest.
The very low evidence prohibits recommendations on the use of UES to guide clinical practice. More high-quality comparative studies are needed to obtain better insight into the effects of UES on activities and participation.
Low quality of evidence for effects of upper extremity surgery (UES) on activities and participation. Limited evidence for improvement in activities and participation after UES.
评估并综合上肢手术（UES）对脑瘫（CP）儿童和青少年活动和参与能力的影响。
检索 MEDLINE、Embase 和 PsycINFO 数据库，查找截至 2018 年 9 月的文献。纳入的研究为具有或不具有同期对照组的比较研究，或具有预测试/后测试结果的病例系列研究，最小样本量为 10 名参与者；报告了 UES 影响的研究，随访时间至少为 5 个月；包括诊断为 CP 的患者，年龄不超过 20 岁；以及使用经过验证的基于活动的工具的研究。使用 ROBINS-I（非随机干预研究的偏倚风险）工具评估偏倚风险，并使用 Grading of Recommendations Assessment，Development and Evaluation 进行质量评估。
纳入了 12 项研究，涉及 310 名儿童和青少年。手（手）的使用能力和感知能力以及活动能力（用 Shriners 医院上肢评估、辅助手评估和 House 功能分类进行测量）在 UES 后显著改善。每个感兴趣的活动结果的证据质量均为极低。
极低的证据禁止使用 UES 来指导临床实践。需要更多高质量的比较研究来更好地了解 UES 对活动和参与的影响。
上肢手术（UES）对活动和参与能力影响的证据质量低。UES 后活动和参与能力改善的证据有限。
