Article

AIM: To conduct a systematic review of single-event multilevel surgery (SEMLS)
for children with cerebral palsy, with the aim of evaluating the quality of the
evidence and developing recommendations for future research. METHOD: The
systematic review was conducted using standard search and extraction methods in
Medline, EMBASE, CINAHL,
and Cochrane electronic databases. For the purposes of
this review, SEMLS was defined as two or more soft-tissue or bony surgical
procedures at two or more anatomical levels during one operative procedure,
requiring only one hospital admission and one period of rehabilitation. Studies
were included if: (1) the primary focus was to examine the effect of SEMLS in
children with cerebral palsy; (2) the results focused on multiple anatomic levels
and reported findings of one or more World Health Organization International
Classification of Functioning, Disability and Health (ICF) domains. Studies that
focused on a single intervention or level, or on the utility of a specific
outcome measure were excluded. Study quality was appraised with the
Methodological Index for Non-Randomized Studies (MINORS) and the Oxford Centre
for Evidence-Based Medicine scale. The review also examined the reporting of
surgery, adverse events, and rehabilitation. RESULTS: Thirty-one studies
fulfilled the criteria for inclusion, over the period 1985 to October 2010. The
MINORS score for these studies varied from 4 to 19, with marked variation in the
quality of reporting. Study quality has improved over recent years. Valid
measures of gait and function have been introduced and several of the most recent
studies have addressed multiple dimensions of the ICF. A statistical synthesis of
the outcome data was not conducted, although a trend towards favourable outcomes
in gait was evident. Caution is advised with interpretation owing to the variable
study quality. Uncontrolled studies may have resulted in an overestimation of
treatment efficacy. INTERPRETATION: The design and reporting of studies of SEMLS
are improving with the development of multidisciplinary teamwork and frameworks
such as the ICF. However, the evidence base is limited by the lack of randomized
clinical trials, especially when compared with other surgical interventions such
as selective dorsal rhizotomy.
CI - (c) The Authors. Developmental Medicine & Child Neurology (c) 2011 Mac Keith
Press.

Langue : ANGLAIS