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.
Six scientific databases (Pubmed, EMBASE, Scopus, Web of Science, PEDro, CINAHL),
Google Scholar, guideline databases and professional society websites were searched.
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.
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.
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.
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.