Lisa A Harveya, Owen M Katalinic, Robert D Herbert, Anne M Moseley, Natasha A Lannin, Karl Schurr
Question: Is stretch effective for the treatment and prevention of contractures in people with neurological and non-neurological conditions? Design: A Cochrane Systematic Review with metaanalyses of randomised trials. Participants: People with or at risk of contractures. Intervention: Trials were considered for inclusion if they compared stretch to no stretch, or stretch plus co-intervention to co-intervention only. The stretch could be administered in anyway. Outcome measures: The outcome of interestwas joint mobility. Two sets of meta-analyses were conducted with a random-effects model: one for people with neurological conditions and the other for people with non-neurological conditions. The quality of evidence supporting the results of the two sets of meta analyses was assessed using GRADE. Results: Eighteen studies involving 549 participants examined the effectiveness of stretch in people with neurological conditions, and provided useable data. The pooled mean differencewas 2 deg (95% CI 0 to 3) favouring stretch. Thiswas equivalent to a relative change of 2% (95% CI 0 to 3). Eighteen studies involving 865 participants examined the effectiveness of stretch in people with non-neurological conditions, and provided useable data. The pooled standardised mean difference was 0.2 SD (95% CI 0 to 0.3) favouring stretch. This translated to an absolute mean increase of 1 deg (95% CI 0 to 2) and a relative change of 1% (95% CI 0 to 2). The GRADE level of evidencewas high for both sets of meta-analyses. Conclusion: Stretch does not have clinically important effects on joint mobility.
L. Féasson, J. Verney, F. Kadi, V. Gautheron, P. Calmels, G.Y. Millet
Depuis les premiers consensus publiés au début des années 2000, la pratique d’une activité physique adaptée dans le contexte des myopathies a montré son innocuité et son intérêt s’est largement accru à l’image du nombre d’études dédiées à ce thème. Après quelques rappels fondamentaux sur les modalités d’exercice, les contraintes mécaniques qui en résultent et les bénéfices musculaires attendus sont présentés les arguments scientifiques en faveur de la thérapie par l’exercice chez les patients myopathes. Compte tenu de la complexité du sujet, tenant de la diversité des étiologies, de leur rareté mais aussi de la variété des entraînements musculaires, quelques illustrations de modalités d’exercice et de résultats obtenus dans certaines myopathies sont extraites d’études récentes. Enfin, ce travail de synthèse propose une actualisation des recommandations de prescription de la thérapie par l’exercice en pointant les principaux écueils à éviter et en présentant les préconisations utiles aux patients et aux acteurs médicaux et paramédicaux qui l’accompagnent.
r e v u e ne u r o lo g i que 1 6 6 ( 2 0 1 0 ) 26 9 – 27 8
AIM The aim of this study was to describe systematically the best available intervention evidence for children with cerebral palsy (CP).
METHOD This study was a systematic review of systematic reviews. The following databases were searched: CINAHL, Cochrane Library, DARE, EMBASE, Google Scholar MEDLINE, OTSeeker, PEDro, PsycBITE, PsycINFO, and speechBITE. Two independent reviewers determined whether studies met the inclusion criteria. These were that (1) the study was a systematic review or the next best available; (2) it was a medical/allied health intervention; and (3) that more than 25% of participants were children with CP. Interventions were coded using the Oxford Levels of Evidence; GRADE; Evidence Alert Traffic Light; and the International Classification of Function, Disability and Health.
RESULTS Overall, 166 articles met the inclusion criteria (74% systematic reviews) across 64 discrete interventions seeking 131 outcomes. Of the outcomes assessed, 16% (21 out of 131) were graded ‘do it’ (green go); 58% (76 out of 131) ‘probably do it’ (yellow measure); 20% (26 out of 131) ‘probably do not do it’ (yellow measure); and 6% (8 out of 131) ‘do not do it’ (red stop). Green interventions included anticonvulsants, bimanual training, botulinum toxin, bisphosphonates, casting, constraint-induced movement therapy, context-focused therapy, diazepam, fitness training, goal-directed training, hip surveillance, home programmes, occupational therapy after botulinum toxin, pressure care, and selective dorsal rhizotomy. Most (70%) evidence for intervention was lower level (yellow) while 6% was ineffective (red).
INTERPRETATION Evidence supports 15 green light interventions. All yellow light
interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions should be discontinued since alternatives exist.
Developmental Medicine & Child Neurology 2013 (3-26)
K. Desloovere, J. De Cat a,b, G. Molenaers, I. Franki, E. Himpens,H. Van Waelvelde, K. Fagard, C. Van den Broeck
Aim: To distinguish the effects of different physiotherapeutic programs in a post BTX-A
regime for children with Cerebral Palsy (CP).
Design: Retrospective, controlled intervention study.
Participants and interventions: A group of 38 children (X ¼ 7y7m, GMFCS I-III, 27 bilateral, 11
unilateral CP) receiving an individually defined Neurodevelopment Treatment (NDT)
program, was matched and compared to a group of children with the same age, GMFCS and
diagnosis, receiving more conventional physiotherapy treatment. All patients received
selective tone-reduction by means of multilevel BTX-A injections and adequate follow-up
treatment, including physiotherapy.
Outcome measures: Three-dimensional gait analyses and clinical examination was performed
pre and two months post-injection. Treatment success was defined using the Goal
Attainment Scale (GAS).
Results: Both groups’ mean converted GAS scores were above 50. The average converted
GAS score was higher in the group of children receiving NDT than in the group receiving
conventional physiotherapy ( p < 0.05). In the NDT group, overall treatment success was
achieved in 76% of the goals, compared to 67% of the goals defined for the conventional
physiotherapy group. Especially for the goals based on gait analyses ( p < 0.05) and in the
group of children with bilateral CP ( p < 0.05), treatment success was higher in the NDT
Conclusion: In a post-BTX-A regime, the short-term effects of an NDT approach are more
pronouncedthan these from a conventional physiotherapy approach.
europ e an j o u r n a l of p a e d i a t r i c neurology 1 6 ( 2 0 1 2 ) 2 0 e2 8