The evidence-base for basic physical therapy techniques targeting lower limb function in children with cerebral palsy: A systematic review using the International Classification of Functioning, Disability and Health as a conceptual framework

OBJECTIVE: This systematic review provides an overview of the effectiveness of basic techniques used in lower limb physical therapy of children with cerebral palsy. It aims to support the development of clinical guidelines for evidence-based physical therapy planning for these children. DATA SOURCES AND STUDY SELECTION: A literature search in 5 electronic databases extracted literature published between January 1995 and December 2009. Studies were evaluated using the framework recommended by the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM), which classifies outcomes according to the International Classification of Functioning, Disability and Health. DATA EXTRACTION: Three independent evaluators rated the strength of evidence of the effects according to the AACPDM levels of evidence classification, and the quality of the studies according to the AACPDM conduct score system. DATA SYNTHESIS: A total of 83 studies was selected and divided into categories (stretching, massage, strengthening, electrical stimulation, weight-bearing, balance-, treadmill- and endurance training). Interventions targeting problems at body function and structure level generally influenced this level without significant overflow to activity level and vice versa. CONCLUSION: The more recent studies evaluating strength training mainly demonstrated level II evidence for improved gait and gross motor function. There was limited evidence for specific information on intensity, duration and frequency of training.