Methodological Considerations to Investigate Dosage Parameters of Intensive Upper Limb Rehabilitation in Children with Unilateral Spastic Cerebral Palsy: A Scoping Review of RCTs

Dev Neurorehabil. 2020 Jul;23(5):309-320. doi: 10.1080/17518423.2019.1687599. Epub 2019 Nov 11.

Abstract

Purposes: To identify and synthesize RCTs on the isolated effect of dosage parameters of upper limb Intensive Motor Rehabilitation Treatments (IMRT) of children with Unilateral Spastic Cerebral Palsy (USCP); to identify the most frequent methodological weaknesses.

Methods: Searches were conducted until September 2018 in gray and published literature databases and supplemented by exploring the identified studies' references. Inclusion criteria applied: RCT; children aged 1.5 to 19 years with USCP; upper limb IMRT differing only from ≥1/4 dosage parameters between groups. Literature analyses conducted: qualitative and descriptive.

Results: We identified 461 studies. Seventeen were included: three presented a rehabilitation dosage distinction between groups in Frequency-Time, four in Intensity-Progressivity, three in Intensity-Restraint, two in Intensity-Environment and five presented ≥3 distinctions above.

Conclusions: Inconsistencies were noted between USCP lifelong issues, and the short follow-ups and lack of participation assessments. Confounding factors and misstatements in Intent To Treat (ITT) analyses were identified. A meta-analysis was considered irrelevant.

Abbreviations: USCP, CP: Unilateral Spastic Cerebral Palsy, Cerebral Palsy; RCT: Randomized Controlled Trial; IMRT: Intensive Motor Rehabilitation Treatment.

Keywords: Cerebral palsy; critical thinking; dosage parameter; intensive motor rehabilitation; pediatrics.

Publication types

  • Review

MeSH terms

  • Adolescent
  • Cerebral Palsy / physiopathology
  • Cerebral Palsy / rehabilitation*
  • Child
  • Child, Preschool
  • Humans
  • Randomized Controlled Trials as Topic
  • Treatment Outcome
  • Upper Extremity / physiopathology*