Table K.4.7Evidence profile for child-focused intervention compared with context-focused intervention in children with spasticity; functioning assessment

Quality assessmentSummary of findings
No. of patientsEffectQuality
No. of studiesDesignLimitationsInconsistencyIndirectnessImprecisionOther considerationsChild-focused interventionContext-focused interventionRelative

(95% CI)
Absolute
Pediatric evaluation of disability inventory (PEDI) Self care Functional skills at 6 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 2.49 higher (3.25 lower to 8.23 higher)*Low
PEDI Self care Functional skills at 9 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 0.11 higher (6.22 lower to 6.44 higher)*Low
PEDI Mobility Functional skills at 6 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 1.17 higher (7.27 lower to 9.61 higher)*Low
PEDI Mobility Functional skills at 9 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 1.52 higher (7.26 lower to 10.3 higher)*Low
PEDI Self care Caregiver assistance at 6 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 0.58 lower (9.2 lower to 8.04 higher)*Low
PEDI Self care Caregiver assistance at 9 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 1.28 higher (7.78 lower to 10.34 higher)*Low
PEDI Mobility Caregiver assistance at 6 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2None7157-MD 0.42 higher (9.64 lower to 10.48 higher)*Low
PEDI Mobility Caregiver assistance at 9 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 3.18 higher (7.25 lower to 13.61 higher)*3Low
Gross motor function measure (GMFM)-66 overall at 6 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 1.17 higher (3.64 lower to 5.98 higher)*Low
GMFM-66 overall at 9 months (final score) (Better indicated by higher values)
1 study (Law 2011)randomised trialsserious1no serious inconsistencyno serious indirectnessserious2none7157-MD 2.73 higher (2.33 lower to 7.79 higher)*Low

CI confidence interval, MD mean difference

*

Calculated by the NCC-WCH

1

Due to insufficient recruitment and loss to follow up this study was underpowered and the sizes of treatment groups were unbalanced.

2

Total population less than 400

3

The study authors reported a small but unquantified statistically significant change from baseline to 9 months, reflecting an increase in the child-focused group and a decrease in the context-focused group at 9-months' follow-up

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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