Verbesserung der Lebensqualität von Menschen mit Zerebralparese: eine systematische Übersicht und Metaanalyse physiotherapeutischer Interventionen

Summary

Background

Cerebral palsy (CP) is one of the most common motor disorders in pediatrics [1]. CP is defined as a non-progressive disorder in the developed fetal or infantile brain [2]. It presents a multifactorial picture in which movement and posture control are impaired, resulting in restricted physical activity [3]. Depending on the severity of CP, patients suffer from a reduced quality of life, as their mobility and self-care abilities are impaired, for example [4].

In recent years, systematic reviews have focused on the effects of physiotherapy interventions on CP symptoms at the functional, structural and activity levels [5] [6] [7] [8]. With the introduction of the International Classification of Functioning, Disability and Health (ICF) by the World Health Organization in 2001, focus shifted to the biopsychosocial situation of people with health problems as well as their quality of life and their environment [9].

Objective

The aim of the systematic review by Passos et al. was to investigate the effectiveness of physiotherapy interventions with regard to the quality of life of people with CP.

Methods

The review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. For the research, 5 databases (PEDro, PubMed, Web of Science, Scopus, and Google Scholar) were searched up to February 12, 2024.

The review included all randomized controlled trials (RCTs) that examined physiotherapy interventions and their impact on the quality of life of patients with CP. Studies involving physiotherapeutic interventions in conjunction with dietary supplements or medication, or in combination with surgical procedures, were excluded. The studies were selected by 2 independent reviewers. The PEDro scale was used for statistical description and to assess the methodological quality of the studies. The meta-analysis was conducted using random effects models that consider physiotherapy interventions and their effects on quality of life.

Results

The review included 37 studies that examined the quality of life of people with CP at all levels of the Gross Motor Function Classification System (GMFCS), aged between 18 months and 53 years (n = 1541). The included studies showed considerable differences in terms of scales, duration, therapy methods and the number of physiotherapy sessions. A wide variety of tools were used to assess quality of life in the included studies. For this reason, a universal quality of life index was calculated.

Whenever there were signs of bias, 2 meta-analyses were performed: the first included all available studies, while the second included only those studies with a low risk of bias, so that 2 different comparisons between different scenarios were analyzed:

• Conventional physiotherapy vs. alternative physiotherapy

• No therapy vs. alternative therapy

The review counted the following measures and approaches among the alternative physiotherapy methods, for example: task-oriented training, constraint-induced movement therapy, bimanual exercises, dual-task training as well as specialized methods such as inspiratory muscle training or manipulation of connective tissue.

The meta-analysis showed a statistically significant effect of alternative physiotherapy interventions on quality of life compared to conventional therapy (standardized mean difference (SMD): –0.61; 95 % confidence interval (CI) [–1.20–0.03]; p = 0.040).

No significant difference was found when comparing no therapy vs. alternative therapy. It was also found that physiotherapy measures offered at a higher frequency and intensity had a positive effect on quality of life.

Commentary

The review presented by Passos et al. highlights a possible improvement in the quality of life of people with cerebral palsy (CP) through alternative physiotherapy interventions compared to conventional physiotherapy. However, the paper has limitations in some areas.

The age of the study participants in the included studies ranged from 18 months to 53 years. 57 percent of the studies included children, and only 5 percent of the studies focused exclusively on adults. No study included participants from birth to middle adulthood. Most studies focused on the first years of life.

Although the included studies had participants at all GMFCS levels, individuals with GMFCS levels IV and V were underrepresented at 14 percent. In 7 of the included studies, 17 percent of participants did not undergo gross motor classification, even though this is a key factor in assessing the severity of the clinical picture.

The quality of the studies was assessed using the PEDro scale (0–10 points), which revealed differences in methodological quality. 11 of 37 studies only achieved a score of 5 (satisfactory) or lower. In these studies, neither the participants nor the therapists were blinded, and assessors were only blinded in a few cases. This may lead to a distortion of results, which was taken into account in the analysis by subsequently excluding individual studies.

The authors criticized the fact that 10 different assessment tools were used in the RCTs to assess quality of life, which made comparisons difficult. For example, questionnaires for parents were used in the case of infants and toddlers, while older adolescents and adults answered questionnaires themselves. A common index was therefore created for the review to make the data comparable.

75 percent of the included studies had a small sample size (n < 50), 22 percent had a medium sample size (50–99 participants), and 3 percent had a large sample size (n ≥ 100). Small sample sizes are a common problem in physiotherapy research and are not unusual, but they do affect the statistical significance of the results.

The work of Passos et al. makes an important contribution to the physiotherapeutic treatment of people with CP. In everyday therapeutic practice, the focus of physiotherapeutic measures should always be on improving health and the associated increase in quality of life. The results of the review show that physiotherapists should prioritize the use of alternative interventions in their daily practice when treating people with CP.

To better document treatment outcomes, it would be desirable in the future to establish a uniform assessment tool (gold standard) for quality of life in practice and in studies. This would not only facilitate the comparison of outcomes, but also enable practical recommendations for the selection of suitable forms of therapy. Evidence-based assessment tools for the quality of life of people with CP include KID-SCREEN-10 and CP QOL-Child, the use of which depends, among other things, on the target group, context and time resources. In addition, future studies should focus more specifically on certain GMFCS levels and age groups to enable differentiated statements about the effectiveness of individual measures, for example in the context of early childhood support or for older children and adolescents with an increasing need for independence.

Finally, from a therapeutic perspective, it is also evident that higher training intensity and longer therapy duration can lead to better results. In order for these aspects to be effectively implemented into practice, clearly structured, easily comprehensible therapy protocols are required that can be applied in research and everyday clinical practice.

Publikationsverlauf

Artikel online veröffentlicht:
08. Dezember 2025

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