Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis
Issued Date
2022-12-01
Resource Type
eISSN
1749799X
Scopus ID
2-s2.0-85137653690
Pubmed ID
36076293
Journal Title
Journal of Orthopaedic Surgery and Research
Volume
17
Issue
1
Rights Holder(s)
SCOPUS
Bibliographic Citation
Journal of Orthopaedic Surgery and Research Vol.17 No.1 (2022)
Suggested Citation
Klaewkasikum K., Patathong T., Woratanarat P., Woratanarat T., Thadanipon K., Rattanasiri S., Thakkinstian A. Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis. Journal of Orthopaedic Surgery and Research Vol.17 No.1 (2022). doi:10.1186/s13018-022-03301-3 Retrieved from: https://repository.li.mahidol.ac.th/handle/20.500.14594/85261
Title
Efficacy of conservative treatment for spastic cerebral palsy children with equinus gait: a systematic review and meta-analysis
Other Contributor(s)
Abstract
Background: Comparisons between various conservative managements of spastic equinus deformity in cerebral palsy demonstrated limited evidences, to evaluate the efficacy of conservative treatment among cerebral palsy children with spastic equinus foot regarding gait and ankle motion. Methods: Studies were identified from PubMed and Scopus up to February 2022. Inclusion criteria were randomized controlled trial (RCT), conducted in spastic cerebral palsy children with equinus deformity, aged less than 18 years, compared any conservative treatments (Botulinum toxin A; BoNT-A, casting, physical therapy, and orthosis), and evaluated gait improvement (Physician Rating Scale or Video Gait Analysis), Observational Gait Scale, Clinical Gait Assessment Score, ankle dorsiflexion (ankle dorsiflexion at initial contact, and passive ankle dorsiflexion), or Gross Motor Function Measure. Any study with the participants who recently underwent surgery or received BoNT-A or insufficient data was excluded. Two authors were independently selected and extracted data. Risk of bias was assessed using a revised Cochrane risk-of-bias tool for randomized trials. I2 was performed to evaluate heterogeneity. Risk ratio (RR), the unstandardized mean difference (USMD), and the standardized mean difference were used to estimate treatment effects with 95% confidence interval (CI). Results: From 20 included studies (716 children), 15 RCTs were eligible for meta-analysis (35% had low risk of bias). BoNT-A had higher number of gait improvements than placebo (RR 2.64, 95% CI 1.71, 4.07, I2 = 0). Its combination with physical therapy yielded better passive ankle dorsiflexion at knee extension than physical therapy alone (USMD = 4.16 degrees; 95% CI 1.54, 6.78, I2 = 36%). Casting with or without BoNT-A had no different gait improvement and ankle dorsiflexion at knee extension when compared to BoNT-A. Orthosis significantly increased ankle dorsiflexion at initial contact comparing to control (USMD 10.22 degrees, 95 CI% 5.13, 15.31, I2 = 87%). Conclusion: BoNT-A and casting contribute to gait improvement and ankle dorsiflexion at knee extension. BoNT-A specifically provided gait improvement over the placebo and additive effect to physical therapy for passive ankle dorsiflexion. Orthosis would be useful for ankle dorsiflexion at initial contact. Trial registration PROSPERO number CRD42019146373.