PTOTSystematic ReviewDevelopmental medicine and child neurology2020

Effects of upper extremity surgery on activities and participation of children with cerebral palsy: a systematic review.

Annoek Louwers, Jessica Warnink-Kavelaars, Joost Daams and 1 others

PMID 31334566

WHAT IT FOUND

Children with cerebral palsy improved in hand use and perceived performance after upper extremity surgery, but evidence quality was very low.

No improvements were found in speed or capacity. Surgeons cannot recommend this procedure based on current data.

Key findings

01The quality of evidence for all postoperative activity outcomes was very low.

02Improvements were reported in functional performance and self-perception, but not in speed or capacity.

03Clinical recommendations on the effect of surgery cannot be made due to the very low quality of evidence.

STILL TO COME

How it was doneWhat they foundWhat it means for PTsWhat it means for OTs

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What it does not show

Most included studies were retrospective case series, which inherently carry a high risk of bias. There was no blinding of outcome assessment in the included studies. The studies used different outcome measures, making it impossible to pool data or perform a meta-analysis. Many potentially relevant studies were excluded because they used non-validated or qualitative outcome measures.

The easy way to misread this

Do not interpret the reported improvements in hand use as proof that surgery is effective. The evidence quality is very low, and the review explicitly states that no clinical recommendations can be made based on these findings.

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