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Outcomes after scoliosis surgery for children with cerebral palsy: a systematic review
Author(s) -
Toovey Rachel,
Harvey Adrienne,
Johnson Michael,
Baker Louise,
Williams Katrina
Publication year - 2017
Publication title -
developmental medicine and child neurology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.658
H-Index - 143
eISSN - 1469-8749
pISSN - 0012-1622
DOI - 10.1111/dmcn.13412
Subject(s) - cerebral palsy , medicine , cinahl , scoliosis , medline , quality of life (healthcare) , physical therapy , gross motor function classification system , gross motor skill , confidence interval , cobb angle , evidence based medicine , meta analysis , physical medicine and rehabilitation , surgery , motor skill , psychological intervention , psychiatry , nursing , alternative medicine , pathology , political science , law
Aim This study aims (1) to evaluate and synthesize the evidence for the postoperative outcomes after scoliosis surgery for children with cerebral palsy ( CP ), and (2) to identify preoperative risk factors for adverse outcomes after surgery. Method Medline, EMBASE , CINAHL , and PubMed were searched for relevant literature. Included studies were assessed for risk of bias using the Cochrane Effective Practice and Organisation of Care tool. Quality of evidence for overall function, quality of life (QoL), gross motor function, caregiver outcomes, deformity correction, and postoperative complications were assessed using GRADE (Grades of Recommendation, Assessment, Development and Evaluation). Results Fifty‐one studies met inclusion criteria, including 35 case series designs. Risk of bias was high across all studies. On average good deformity correction was achieved, the trend appears positive for caregiver and QoL outcomes, but there was minimal to no change for gross motor or overall function. Inconsistent measurement limited synthesis. A mean overall complication rate of 38.1% (95% confidence interval 27.3–53.3) was found. The quality of evidence was very low across all functional outcomes. Interpretation Limited high‐quality evidence exists for outcomes after scoliosis surgery in children with CP , a procedure associated with a moderately high complication rate. The intervention appears indicated for deformity correction, but currently there is insufficient evidence to make recommendations for this surgery as a way to also improve functional outcomes, caregiver outcomes, and quality of life.