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

Number of studiesNumber of participantsEffectQuality
Soft tissue surgeryBotulinum toxinRelative

(95% CI)
Absolute

(95% CI)
Mean change hip migration percentage at least at 18 months (better indicated by lower values)
1 study (Yang 2008)60a65b-MD 1.7 lower (4.26 lower to 0.86 higher)*cVery low
Mean change hip migration percentage per year, all children (better indicated by lower values)
1 study (Yang 2008)60d65e-MD 0.9 lower (2.83 lower to 1.03 higher)*cVery low
Mean change hip migration percentage per year, high-functioning children (GMFCS level I or II, better indicated by lower values)
1 study (Yang 2008)28 legsf40 legsg-MD 1 lower (3.4 lower to 1.4 higher)*hVery low
Mean change hip migration percentage per year, low functioning children (GMFCS level III or IV, better indicated by lower values)
1 study (Yang 2008)72 legsi90 legsj-MD 1 lower (2.71 lower to 0.71 higher)*hVery low

CI confidence interval, GMFCS Gross Motor Function Classification System, MD mean difference, NS not (statistically) significant, P probability, SD standard deviation

*

Calculated by the NCC-WCH

a

Change from baseline Mean (SD) = -3.3 (6.1)

b

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

c

P = NS reported

d

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

e

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

f

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

g

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

h

Significance test not reported

i

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

j

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

See the complete GRADE Table K.9.5 which accompanies this abbreviated version.

From: 9, Orthopaedic surgery

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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