Monday, 12 July 2010

Physiotherapy: a systematic review

Adults with cerebral palsy: predictable findings

From Finland –

Evidence on physiotherapeutic interventions for adults with cerebral palsy is sparse.
A systematic review
Objectives: To identify evidence evaluating the effectiveness of physiotherapy in adolescents (>16 years of age) and adults with cerebral palsy.
Data sources: Systematic literature search from the earliest available time until March 2009. Additional studies were identified through reference and citation tracking.
Review methods: Two reviewers independently agreed on eligibility, methodological quality and quality of evidence assessment. Standard methods were used for quality assessments.
Results: Included were 13 studies, two of which were randomized controlled trials. No article met the criteria for high methodological quality. Evidence of moderate quality was found on gait after strength training. Evidence of low quality was found on balance after strength training and workstation interventions. Low-quality evidence was also found on functionality after strength training in four studies evaluating gross motor capacity. There was very low-quality evidence on increased muscle strength and in outcome measures used to evaluate range of motion.
Conclusion: Evidence for the effect of physiotherapy on adolescents and adults with cerebral palsy is sparse, and therefore there is an urgent need for well-designed physiotherapeutic trials for these people.

Tested and found wanting

Draw your own conclusions. Personally I consider that the evaluative paradigm utilised here might be as inappropriate of some of the interventions studies as they are for Conductive Education. Still, physiotherapists have seemed happy to cleave generally to a health/medical paradigm so presumably they are not surprised to be judged though its prsently dominant evaluative model.

It is a dangerous time for those tested and found wanting. One wonders how long it will be before cost-paring health services, looking to trim back on what they provide at their fringes, will begin to zero in on such evaluative studies and consider letting their physiotherapists go, at least those dealing with developmental conditions of central origin.

In the UK this is the sort of thing that the Budget Challenge might wish to take up.

Luckily CE lives under a different rubric, education/learning, not health/treatment. Let us hope that it can retain a safe distance in these confusing times.

Reference

Jeglinsky I, Surakka J, Brogren Carlberg E, Autti-Rämö I. ( 2010) Evidence on physiotherapeutic interventions for adults with cerebral palsy is sparse. A systematic review. Clinical Rehabilitation, 6.July [Epub ahead of print]
(Abstract only: the complete article will cost you US$32.00.)

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