Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Naples, Italy.
Arizona State University, School of Social and Behavioral Sciences, Phoenix, AZ, USA.
Dev Med Child Neurol. 2023 Oct;65(10):1280-1291. doi: 10.1111/dmcn.15572. Epub 2023 Mar 12.
This overview of Cochrane systematic reviews (CSRs) reports on current evidence on the effectiveness of rehabilitation interventions for individuals with cerebral palsy (CP) and the quality of the evidence.
Following the inclusion criteria defined by the World Health Organization, all CSRs tagged in the Cochrane Rehabilitation database that were relevant for individuals with CP were included. A mapping synthesis was used to group outcomes and comparisons of included CSRs indicating the effect of rehabilitation interventions and the certainty of evidence.
A total of eight CSRs were included in the evidence map. The effect of interventions varied across comparisons and the certainty of evidence was inconsistent, ranging from high to very low. The best evidence was found for botulinum neurotoxin A (BoNT-A) combined with occupational therapy in the management of spasticity. However, the effect of BoNT-A on drooling and salivation remains unclear. A paucity of randomized controlled trials studying treatments for both dystonia and postural deformities was noted.
This review emphasizes the need to further investigate the effectiveness and cost-benefit of rehabilitation interventions for individuals with CP.
The quality and quantity of evidence on rehabilitation interventions for cerebral palsy is limited worldwide. Botulinum neurotoxin A plus occupational therapy showed robust efficacy for the management of upper-limb spasticity. Evidence on sleep-positioning systems for hip migration and trihexyphenidyl for dystonia is scarce.
本综述汇总了 Cochrane 系统评价报告，旨在评估当前针对脑性瘫痪（CP）患者康复干预措施的有效性证据，并评估证据质量。
根据世界卫生组织定义的纳入标准，纳入所有与 CP 患者相关并在 Cochrane 康复数据库中标记的 CSR。采用映射综合法对纳入 CSR 的结局和比较进行分组，以表明康复干预措施的效果和证据的确定性。
共有 8 项 CSR 被纳入证据图谱。干预措施的效果在不同的比较中存在差异，证据的确定性也不一致，从高到极低不等。在痉挛的管理中，发现肉毒杆菌神经毒素 A（BoNT-A）联合职业疗法的最佳证据。然而，BoNT-A 对流涎和唾液分泌的影响仍不清楚。注意到缺乏研究治疗脑瘫患者的肌张力障碍和姿势畸形的随机对照试验。
本综述强调需要进一步研究 CP 患者康复干预措施的有效性和成本效益。
全球范围内，针对脑性瘫痪康复干预措施的证据在质量和数量上均有限。肉毒杆菌神经毒素 A 联合职业疗法在治疗上肢痉挛方面显示出强大的疗效。关于髋关节移位的睡眠体位系统和治疗肌张力障碍的苯海索的证据稀缺。
