Systematic review of clinical guidelines related to care of individuals with cerebral palsy as part of the World Health Organization efforts to develop a global Package of Interventions for Rehabilitation

Published:January 12, 2021DOI:https://doi.org/10.1016/j.apmr.2020.11.015
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      Highlights:

      • First systematic review of clinical practice guidelines in CP
      • Guidelines cover a wide range of categories although majority on body functions
      • Surprising lack of guidelines focused on physical or occupational therapies
      • 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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