Article

AIM: To assess treatment effects of botulinum toxin type A (BoNT-A) on walking of
children with leg spasticity due to cerebral palsy (CP) compared with usual care.
METHOD: We systematically searched the databases CINAHL, Cochrane, PEDro, EMBASE,
and PubMed from July 1993 until July 2009 and additionally screened reference
lists. Randomized controlled trials assessing functional outcomes on walking of
children with CP were included. The intervention had to contain BoNT-A into the
lower limb and be compared with usual care. The methodological quality and
clinical relevance were independently assessed by two of the authors (UCR, CHGB).
If statistical pooling was not feasible, we performed a best-evidence synthesis.
RESULTS: Eight trials were included. Trials comparing BoNT-A plus usual care or
physiotherapy versus usual care or physiotherapy alone showed moderate evidence
for functional outcomes at 2 to 6, 12, and 24 weeks follow-up in favour of
BoNT-A. Studies comparing BoNT-A versus casting showed strong evidence for no
difference in effects between these interventions. A limitation of our review was
the exclusion of studies not published in English, Dutch, or German. The
heterogeneity of the included studies, especially for outcome measures and
follow-up assessments, prompted us to refrain from statistical pooling, which
might also be considered a limitation. INTERPRETATION: The use of BoNT-A with
usual care or physiotherapy seems to improve walking of children with CP, but
results should be appraised carefully owing to the limited quality of included
trials.
CI - (c) The Authors. Journal compilation (c) Mac Keith Press 2011.

Langue : ANGLAIS