Tuesday, 5 January 2010

Research: more systematic review

Give me strength
Balderdash 5

John Russo's critical blog, The C.A.M Report, offers 'an objective and dispassionate source of information on the latest research in complementary and alternative medicine (CAM)'. It has just turned its attention to presumed benefits of 'strength training' in cerebral palsy. Surprise surprise, it reports that a recent review of published research has found that:

...strengthening interventions are neither effective nor worthwhile.

No doubt the strength-trainers will be saying that this conclusion might be based upon some poor old studies. If you really consider this avenue worthwhile, you can check this out for yourself throughthe link that John Russo has provided.

A priori, and out of simple common sense, why bother?

And here too, amongst strange bedfellows...
Conductive Education

John Rosso continues –

In Finland the effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy was reviewed. The high-quality reviews reported some benefit from strength training, constraint-induced movement therapy, or hippotherapy (physical, occupational, and speech therapy that uses equine movement). There was insufficient evidence on comprehensive physiotherapy and occupational therapy interventions.

Only the summary of this Finnish article is available free online, so I cannot see what rubbish went in to this review for such rubbish to come out at the other end. Here, anyway is the formal abstract summary:

We conducted a criteria-based appraisal of systematic reviews on the effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy (CP). Computerized bibliographic databases were searched without language restriction up to August 2007. Reviews on trials and descriptive studies were included. Two reviewers independently identified, selected, and assessed the quality of the reviews using the criteria from the Overview Quality Assessment Questionnaire complemented with decision rules. Twenty-one reviews were included, six of which were of high methodological quality. Altogether, the reviews included 23 randomized controlled trials and 104 observational studies on children with CP. The high-quality reviews found some evidence supporting strength training, constraint-induced movement therapy, or hippotherapy, and insufficient evidence on comprehensive physiotherapy and occupational therapy interventions. Conclusions in the other reviews should be interpreted cautiously, although, because of the poor quality of the primary studies, most reviews drew no conclusions on the effectiveness of the reviewed interventions. Reviews on complex interventions in heterogeneous populations should use rigorous methods and report them adequately, closely following the Quality of Reporting of Meta-Analyses recommendations.

Producing this little gem helped keep four people in employment – at Finnish prices. Nice work I you can get it.

References

Antilla, H., Suoranta, J., Malmivaara, A., Mäkelä,, M., Autti-Rämö, I. (2008) Effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy: a focused review, American Journal of Physical and Medical Rehabilitation, vol. 87, no 6, 478-501

Russo, J. (2010) Any benefits of strength training in cerebral palsy? The C.A.M Report. Complementary and alternative medicine: fair, balanced, and to the point, 3 January

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