Table K.9.5Evidence profile for lower extremity SEMLS and intensive therapy versus multilevel botulinum toxin injections and casting in children and young people with unilateral or bilateral spasticity and generalised joint impairments

Quality assessmentSummary of findings
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsSoft tissue surgeryBotulinum toxin (BoNT)Relative (95% CI)Absolute (95% CI)
Mean change hip migration percentage at least at 18 months (Better indicated by lower values)
1 study (Yang 2008)observational studyno serious limitations1no serious inconsistencyno serious indirectnessserious2none603654-MD 1.7 lower (4.26 lower to 0.86 higher)*5Very low
Mean change hip migration percentage per year - all children (Better indicated by lower values)
1 study (Yang 2008)observational studyno serious limitations1no serious inconsistencyno serious indirectnessserious2none606657-MD 0.9 lower (2.83 lower to 1.03 higher)*5Very low
Mean change hip migration percentage per year - High functioning children gross motor function classification system (GMFCS) levels I and II (Better indicated by lower values)
1 study (Yang 2008)observational studyno serious limitations1no serious inconsistencyno serious indirectnessserious2none28 legs840 legs9-MD 1 lower (3.4 lower to 1.4 higher)*10Very low
Mean change hip migration percentage per year - Low functioning children GMFCS levels III and IV (Better indicated by lower values)
1 study (Yang 2008)observational studyno serious limitations1no serious inconsistencyno serious indirectnessserious2none72 legs1190 legs12-MD 1 lower (2.71 lower to 0.71 higher)*10Very low

CI confidence interval, MD mean difference

*

Calculated by the NCC-WCH

1

Retrospective study

2

Total population is less than 400, 95% confidence interval crosses null effect and is wide

3

Change from baseline Mean (standard deviation; SD) = -3.3 (6.1)

4

Change from baseline Mean (SD) = -1.6 (8.4)

5

p=NS reported

6

Change from baseline Mean (SD) = -1.6 (4.4)

7

Change from baseline Mean (SD) = -0.7 (6.5)

8

Change from baseline Mean (SD) = -3.4 (4.8)

9

Change from baseline Mean (SD) = -2.4 (5.2)

10

Significance test not reported

11

Change from baseline Mean (SD) = -1.0 (4.1)

12

Change from baseline Mean (SD) = 0.0 (6.9)

From: Appendix K, GRADE tables

Cover of Spasticity in Children and Young People with Non-Progressive Brain Disorders
Spasticity in Children and Young People with Non-Progressive Brain Disorders: Management of Spasticity and Co-Existing Motor Disorders and Their Early Musculoskeletal Complications.
NICE Clinical Guidelines, No. 145.
National Collaborating Centre for Women's and Children's Health (UK).
London: RCOG Press; 2012 Jul.
Copyright © 2012, National Collaborating Centre for Women's and Children's Health.

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