Aim: To systematically review the evidence for intensive mobility training in cerebral palsy (CP) and to determine the minimum effective dose to improve mobility.Method: Randomized controlled trials (RCTs) or quasi‐RCTs that included participants with CP, and which used intensive task‐oriented training (TOT) mobility interventions and reported mobility outcomes, were included. Five databases were searched; two independent reviewers selected studies and extracted data. The Grading of Recommendations Assessment, Development, and Evaluation system and the Cochrane Risk of Bias 2 tool were used to rate the certainty of evidence at the outcomes level and to determine the risk of bias respectively. Meta‐analyses were conducted with clinically homogeneous studies. Threshold dose was analysed through meta‐regression.Results: Forty‐six RCTs with 1449 participants (mean age range 1 year 2 months to 16 years 4 months) were included. TOT had statistically and clinically significant effects on walking speed (p = 0.001), cadence (p = 0.02), gross motor function (p = 0.03), and functional mobility (p = 0.009) compared with control interventions. The threshold dose was undeterminable owing to the high heterogeneity of studies.Interpretation: TOT may improve walking speed, walking endurance, and balance. Studies with homogeneous samples and outcomes are needed to support clinical recommendations for intensive mobility interventions.
16 September 2024 in Developmental Medicine & Child Neurology
Aim: To explore the clinical utility and psychometric properties of standardized tools for the early detection of developmental concerns or disability in young children.Method: Systematic reviews and clinical practice guidelines containing psychometric data on tools appropriate for use with children from birth to 5 years 11 months were searched for in MEDLINE, CINAHL, Embase, and PsycINFO for the years 2000 to 2023, with no language restrictions.Results: Eighty‐six systematic reviews and six clinical practice guidelines guided identification of tools. A total of 246 tools were identified across domains of neurological, motor, cognition, communication/language, social–emotional, sensory processing, and/or specific diagnostic conditions of attention‐deficit/hyperactivity disorder, autism spectrum disorder, cerebral palsy, developmental coordination disorder, and fetal alcohol spectrum disorder. After critical evaluation, 67 tools were included in the recommendations. Recommendations for screening and diagnostic assessment tools were based on best available evidence for predictive and discriminative validity, diagnostic accuracy, together with consideration of resource use and accessibility.Interpretation: This comprehensive scoping review provides recommendations on the best tools for primary care, medical, allied health professionals, nursing, and other health workers to detect and identify developmental concerns or disability in young children using evidence‐based tools.
Aim: To determine reproducibility of the Motor Optimality Score–Revised (MOS‐R) to assess infants at high risk of adverse neurodevelopmental outcomes, including cerebral palsy (CP), autism, and developmental delays.Method: Thirty infants (18 males, 12 females, gestational age mean [range] = 32.5 [23–41] weeks) were randomly selected, according to 2‐year outcome (typically developing; CP; or adverse neurodevelopmental outcome [ad‐NDO]) from a prospective cohort. Participants had two General Movements videos between 12 weeks and 15 + 6 weeks corrected age. Six assessors, masked to history and outcomes, independently scored the MOS‐R from videos. Assessors scored either one (Group 1; n = 3) or two videos for each infant (Group 2; n = 3). Intraclass correlation coefficient (ICC), Gwet's agreement coefficient, and limits of agreement were calculated.Results: Combined interassessor reliability (IRR) over six assessors for total MOS‐R was ‘fair’ (ICC = 0.56, 95% confidence interval [CI] 0.41–0.72), and ‘excellent’ with consensus agreement (ICC = 0.99, 95% CI 0.98–0.99). Analyses demonstrated a mean interrater difference of 0.316 (95% limits of agreement −11.51, 12.14) over 450 comparisons (15 pairs). IRR was ‘moderate’ to ‘almost perfect’ across subcategories, with the highest reliability ‘movement patterns’ (Gwet's agreement coefficient = 0.73–1.00) and the lowest ‘postural patterns’ (0.45–0.73). Assessors who scored two videos (Group 2) demonstrated higher reproducibility. IRR for total MOS‐R was ‘excellent’ when infants were typically developing (ICC = 0.90), and ‘good’ for CP (0.74) and ad‐NDO (0.68).Interpretation: The MOS‐R is a highly reproducible tool for assessing infants at high risk of ad‐NDOs and is feasible for implementation in clinical settings. Reproducibility is best when the tool is used by experienced assessors to gain consensus agreement.