Clinical Rehabilitation http://cre. sagepub. com Occupational therapy for children with cerebral palsy: a systematic review Esther MJ Steultjens, Joost Dekker, Lex M Bouter, Jos CM van de Nes, Brigitte LM Lambregts and Cornelia HM van den Ende Clin Rehabil 2004; 18; 1 DOI: 10.
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Clinical Rehabilitation 2004; 18: 1–14Occupational therapy for children with cerebral palsy: a systematic review Esther MJ Steultjens Netherlands Institute for Health Services Research, Utrecht, Joost Dekker Department of Rehabilitation Medicine and Institute for Research in Extramural Medicine (EMGO-Institute), Lex M Bouter Institute for Research in Extramural Medicine (EMGO-Institute), Jos CM van de Nes University of Professional Education, Brigitte LM Lambregts SPD Amstel en Zaan, Amsterdam and Cornelia HM van den Ende Netherlands Institute for Health Services Research, Utrecht, The Netherlands Received 6th March 2003; returned for revisions 12th May 2003; revised manuscript accepted 20th July 2003. Objective: Occupational therapy (OT) for cerebral palsy focuses on the development of skills necessary for the performance of activities of daily living.The aim of this systematic review was to determine whether OT interventions improve outcome for children with cerebral palsy (CP). Methods: An extensive search in MEDLINE, CINAHL, EMBASE, AMED and SCISEARCH was performed. Studies with controlled and uncontrolled designs were included. Six intervention categories were distinguished and individually analysed using a best-evidence synthesis.
This synthesis is based on the type of design, the methodological quality, the type of outcome measures and the statistical signi cance of the ndings. Results: Seventeen studies were included in this review, seven of which were randomized controlled trials (RCTs). One RCT had a high methodological quality.The analyses resulted in insuf cient evidence of the ef cacy of occupational therapy in all intervention categories, due to the low methodological quality of studies presenting statistically nonsigni cant results. Conclusion: Despite the reasonable number of studies identi ed, the inconclusive ndings regarding the ef cacy of occupational therapy for children with cerebral palsy may be a re ection of the dif culties in ef cacy research in OT for children with CP. Future research should critically re ect on methodological issues. Introduction Cerebral palsy (CP) is a static encephalopathy that can be de ned as a nonprogressive disorder of posture and movement. It is often associated Address for correspondence: Esther MJ Steultjens, Netherlands Institute for Health ServicesResearch, PO Box 1568, 3500 BN Utrecht, The Netherlands.
e-mail: e. [email protected] nl © Arnold 2004 with epilepsy and abnormalities of speech, vision and intellect, resulting from a defect or lesion in the developmental brain. CP is a common disorder with an estimated prevalence of 2/1000 in the general population. 1 A large variety of symptomatology is seen in children with CP.
2 It is also a condition that occurs early in life and is present throughout a person’s lifetime. It can affect all aspects of a person’s development throughout their life. The focus for treatment should be on 10. 1191/0269215504cr697oa Downloaded from http://cre. sagepub.
com by Farhan Khan on February 12, 2007 © 2004 SAGE Publications.All rights reserved. Not for commercial use or unauthorized distribution. 2 EMJ Steultjens et al. ical and rehabilitation literature (Dutch National Institute Allied Health Professions (NPI), Netherlands Institute for Health Services Research (NIVEL)).
The computerized search strategy used in PubMed was: ‘Cerebral Palsy’[MESH]) AND (‘occupational therapy’[MESH] OR ‘activities of daily living’[MESH] OR ‘exercise therapy’[MESH] OR ‘splints’[MESH] OR ‘selfhelp devices’[MESH] OR ‘Early Intervention (Education)’[MESH] OR (‘parents/education’ [MESH] OR ‘parents/psychology’[MESH]) OR ‘professional family relations’[MESH] OR ‘play and playthings’[MESH]) Limits: Human.The search strategy was adapted by an experienced medical librarian to make it applicable to the other databases. In addition, the reference lists of all studies identi ed were scanned and the corresponding authors of papers eligible for inclusion were contacted by mail to identify further studies. The inclusion of articles was assessed by two independent reviewers (EMJS, CHME), rst on the basis of the title and abstract. The article was read in the event of uncertainty. Disagreements were resolved by discussion. 14 All four inclusion criteria had to be met: (1) ef cacy studies with either a controlled design or a design other than controlled (ODs) such as pre–post tests or timeseries; (2) evaluating OT interventions in children (