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Highlights:
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First systematic review of clinical practice guidelines in CP
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Guidelines cover a wide range of categories although majority on body functions
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Surprising lack of guidelines focused on physical or occupational therapies
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Recent evidence and ICF terminology warrant inclusion in new guidelines
Abstract
Objective
World Health Organization’s (WHO) Rehabilitation 2030 initiative is developing a set
of evidence-based interventions selected from clinical practice guidelines for Universal
Health Coverage. As an initial step, WHO Rehabilitation Programme and Cochrane Rehabilitation
convened global content experts to conduct systematic reviews of clinical practice
guidelines for 20 chronic health conditions, including cerebral palsy.
Data Sources
Six scientific databases (Pubmed, EMBASE, Scopus, Web of Science, PEDro, CINAHL),
Google Scholar, guideline databases and professional society websites were searched.
Study Selection
A search strategy was implemented to identify clinical practice guidelines for cerebral
palsy across the lifespan published within 10 years in English. Standardized spreadsheets
were provided for process documentation, data entry and tabulation of the Appraisal
of Guidelines for Research and Evaluation (AGREE II) tool. Each step was completed
by 2 or more group members with disagreements resolved by discussion. Initially, 13
guidelines were identified. Five did not meet AGREE II established threshold or criteria
for inclusion. Further review by WHO eliminated 3 more, with 5 remaining.
Data Extraction
All 339 recommendations from the 5 final guidelines, with type (Assessment, Intervention
or Service), strength and quality of evidence, were extracted and an ICF Functioning
category assigned to each.
Data Synthesis
Most guidelines addressed mobility functions, with comorbid conditions and lifespan
considerations also included; however, most were at the level of Body Functions. No
guideline focused specifically on physical or occupational therapies to improve activity
and participation despite their prevalence in rehabilitation.
Conclusions
Despite the great need for high quality guidelines, this review demonstrated the limited
number and range of interventions and lack of explicit use of the ICF during development
of guidelines identified here. A lack of guidelines however does not necessarily indicate
a lack of evidence. Further evidence review and development based on identified gaps
and stakeholder priorities are needed.
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Article Info
Publication History
Accepted:
November 1,
2020
Received in revised form:
October 29,
2020
Received:
March 31,
2020
Publication stage
In Press Journal Pre-ProofFootnotes
Acknowledgments: We would like to thank Dr. Audrey Thurm and Dr. Jordan WIckstrom at the National Institutes of Health (NIH) for their help in the initial phases of this work and for Jordan Wickstrom at NIH and Tonya Piergies at University of California San Francisco for designing the ICF figure. This work was supported in part by the Intramural Research Program at the NIH Clinical Center.
Identification
Copyright
© 2021 Published by Elsevier Inc. on behalf of the American Congress of Rehabilitation Medicine
