The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis

Milne, Nikki; Miao, Michelle; Beattie, Emma

doi:10.1186/s12887-020-02122-9

Table 3 Effects of lower limb serial casting (inclusive of additional therapeutic interventions): a meta-synthesis of findings from individual investigations reported in fair to good methodological quality studies

From: The effects of serial casting on lower limb function for children with Cerebral Palsy: a systematic review with meta-analysis

Outcomes relevant to lower-limb function.	Authors (reference no.) and Investigation Methods Relevant to the Effect of Serial Casting		Percentage of investigations showing a significant effect from serial casting n/N (%)	Summary Effect (+,-,0,?)
Outcomes relevant to lower-limb function.	Significant Effect (n)	Non-Significant Effect		Summary Effect (+,-,0,?)
Lower Limb Passive Range of Motion
Ankle Dorsiflexion with Knee Flexed (KPF)	• Cameron (45) - (SC + T + A) 1mo (+) • Cameron (45) - (SC + T + A) 4 mo (+) • Kelly (52) - (SC + P) IP (+) • Kelly 2018 (60) - (SC + P) IP (+) • Kelly 2018 (60) - (SC + P) 1 mo (+) • Kelly 2018 (60) - (SC + P) 2 mo (+) • McNee (39) - (SC) 2-3wk (+) • McNee (39) - (SC) 9-10wk (+)	• Corry (46) - (SC + T) 2wk (0) • Corry (46) - (SC + T) 3mo (+) • Kelly 2018 (60) - (SC + P) 6 mo (+)	8/11 = 72.72%	(+)
Ankle Dorsiflexion with Knee Position Extended (KPE)	• Cameron (45) - (SC + T + A) 1mo (+) • Cameron (45) - (SC + T + A) 4 mo (+) • Corry (46) - (SC + T) 2wk (+) • Kay (31) - (SC + A) 8wk (+) • Kay (31) - (SC + P + A) 8wk (+) • Kelly (52) - (SC + P) IP (+) • Kelly 2018 (60) - (SC + P) IP (+) • Kelly 2018 (60) - (SC + P) 1 mo (+) • Kelly 2018 (60) - (SC + P) 2 mo (+) • McNee (39) - (SC) 2-3wk (+)	• Corry (46) - (SC + T) 3mo (0) • McNee (39) - (SC) 9-10wk (−) • Kelly 2018 (60) - (SC + P) 6 mo (+)	10/13 = 76.92%	(+)
Ankle Dorsiflexion with Knee Position Unspecified (KPU)	• Boyd (15) - (SC + P + T + A) 22wk (+) • Brouwer 1998 (44) - (SC) IP (+) • Brouwer 1998 (44) - (SC) 6wk (+) • Dursun (11) - (SC + P + T) IP (+) • Dursun (11) - (SC + P + T) 9wk (+) • Flett (22) - (SC + A) 1mo (+) • Flett (22) - (SC + A) 3mo (+) • Flett (22) - (SC + A) 5mo (+) • Glanzman (16) - (SC) PE (+) • Glanzman (16) - (SC + P) PE (+) • Newman (53) - (Immediate serial casting after BTXA) (SC + P + T) 3mo (+) • Newman (53) - (Delayed serial casting after BTXA) (SC + P + T) 3mo (+) • Newman (53) - (Delayed serial casting after BTXA) (SC + P + T) 6mo (+) • Yap (58) - (SC + P + T) ~2mo (+) • Booth (28) - (SC) 3.5 wk. (+) • Booth (28) - (SC + P) 2 wk. (+)	• Boyd (15) - (SC + P + T + A) 10wk (+) • Newman (53) - (Immediate serial casting after BTXA) (SC + P + T) 6mo (+)	16/18 = 88.89%	(+)
Functional Gait
Velocity	• Kelly (52) - (SC+ P) IP (−) • Cameron (45) - (SC + T + A) 4 mo (+)	• McNee (39) - (SC) 2-3wk (+) • McNee (39) - (SC) 9-10wk (−) • Cameron (45) - (SC + T + A) 1mo (−) • Kelly 2018 (60) - (SC + P) 1 mo (+) • Kelly 2018 (60) - (SC + P) 2 mo (+) • Kelly 2018 (60) - (SC + P) 6 mo (+)	1/8 = 12.50%	(0)
Stride Length	• Cameron (45) - (SC + A + T) 4 mo (+)	• Cameron (45) - (SC + T + A) 1mo (+) • McNee (39) - (SC) 2-3wk (+) • McNee (39) - (SC) 9-10wk (+) • Kelly (52) - (SC + P) IP (−)	1/4 = 25.00%	(0)
Observational Gait Scale (OGS)	• Dursun (11) - (SC + P + T) IP (+), • Dursun (11) - (SC + P + T) 9wk (+) • Newman (53) - (Immediate serial casting after BTXA) (SC + P + T) 3mo (+) • Newman (53) - (Delayed serial casting after BTXA) (SC + P + T) 3mo (+) • Newman (53) - (Delayed serial casting after BTXA) (SC + P + T) 6mo (+)	• Newman (53) - (Immediate serial casting after BTXA) (SC + P + T) 6mo (+)	5/6 = 83.33%	(+)
Physicians rating scale (PRS) / modified PRS	• Flett (22) - (SC + A) 1mo (+) (modified PRS) • Flett (22) - (SC + A) 3mo (+) (modified PRS) • Flett (22) - (SC + A) 5mo (+) (modified PRS) • Yap (58) - (SC + P + T) ~2mo (+) (modified PRS)	• Corry (46) - (SC + T) 2wks (+) • Corry (46) - (SC + T) 3mo (+)	4/6 = 66.67%	(+)
Neurological Measures
Modified Ashworth Scale (MAS) Ankle Plantar Flexors / Hamstrings	• Dai (48) - (SC + P + T) IP (+) • Dai (48) - (SC + P + T) 6wk (+) • Dursun (11) - (SC + P + T) IP (+) • Dursun (11) - (SC + P + T) 9wk (+) • Flett (22) - (SC + A) 1mo (+) • Flett (22) - (SC + A) 3mo (+) • Flett (22) - (SC + A) 5mo (+) • Kay (31) - (SC + A + T) 8wk (+) • Kay (31) - (SC + A + T + P) 8wk (+) • Kelly (52) - (SC + P) IP (+) (Ankle Plantar Flexors) • Kelly (52) - (SC + P) IP (+) (Hamstrings) • Kelly 2018 (60) - (SC + P) IP (+) • Kelly 2018 (60) - (SC + P) 1 mo (+) • Kelly 2018 (60) - (SC + P) 2 mo (+) • Yap (58) - (SC + P + T) ~2mo (+)	• Kelly 2018 (60) - (SC + P) 6 mo (+) • Corry 1998 (46) - (SC + T) 2wks (+) • Corry 1998 (46) - (SC + T) 3mo (0)	15/18 = 83.33%	(+)
Modified Tardieu Scale (MTS) (Ankle Plantar Flexors and Hamstrings)	• Kelly (52) - (SC + P) IP (+) in Hamstrings (KE) • Newman (53) - (Immediate serial casting after BTXA) (SC + P + T) 3mo (+) in Ankle Plantar Flexors • Newman (53) - (Delayed serial casting after BTXA) (SC + P + T) 3mo (+) in Ankle Plantar Flexors • Newman (53) - (Delayed serial casting after BTXA) (SC + P + T) 6mo (+) in Ankle Plantar Flexors • Kelly 2018 (60) - (SC + P) IP (+) DF Knee Ext. • Kelly 2018 (60) - (SC + P) 1 mo (+) DF Knee Ext. • Kelly 2018 (60) - (SC + P) 2 mo (+) DF Knee Ext.	• Kelly (52) - (SC + P) IP (+) Ankle Plantar Flexors with KE & KF • Newman (53) - (Immediate serial casting after BTXA) (SC + P + T) 6mo (+) in Ankle Plantar Flexors • Kelly 2018 (60) - (SC + P) 6 mo (+) DF Knee Ext.	7/10 = 70.00%	(+)
Gross Motor Function
GMFM	• Dai (48) - (SC + P+ T) IP (+) • Dai (48) - (SC + P+ T) 6wk (+) • Kelly (52) - (SC + P) IP (+) • Yap (58) - (SC + P + T) ~2mo (+) • Flett (22) - Standing Dimension of GMFM only (SC + A) 1mo (+) • Flett (22) - Standing Dimension of GMFM only (SC + A) 3mo (+) • Flett (22) - Standing Dimension of GMFM only (SC + A) 5mo (+) • Flett (22) – Dynamic Dimension of GMFM only (SC + A) 1mo (+) • Flett (22) – Dynamic Dimension of GMFM only (SC + A) 3mo (+) • Flett (22) - Dynamic Dimension of GMFM only (SC + A) 5mo (+) • Kay (31) - Dimensions C,D,E of GMFM only (SC + A + T) 8wk (−) • Kelly 2018 (60) - (SC + P) 1 mo (+) • Kelly 2018 (60) - (SC + P) 2 mo (+) • Kelly 2018 (60) - (SC + P) 6 mo (+)	• Kay (31) - Dimensions C,D,E of GMFM only (SC + A + T + P) 8wk (+)	14/15 = 93.33%	(+)

Intervention Coding: SC serial casting in isolation, + T plus allied therapies, + A = plus AFO / night splints / other orthotics, + P = plus pharmacology (which in all instances was BTX-A)
Timeframe Coding: IP immediately post-cast removal (within 0–1 weeks); 3mo = 3 months post-cast removal; 6mo = 6 months post-cast removal; 12 mo = 12 months post-cast removal, (time) = 1st post-test if not immediately post, PE peak effect time not stipulated
Individual Investigation Coding: (+) = positive effect; (−) = negative effect; (0) = nil effect
Summary Coding: n/N for Outcome (%): n = number of investigations with a significant positive effect, N = total number of investigations that explore the effect of serial casting on a given outcome. Summary Effect (+,-,0,?): (+) = ≥60% of investigations have a significant positive effect, (−) = ≥60% of investigations have a significant negative effect, (0) = ≥60% of investigations have a non-significant effect

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ISSN: 1471-2431

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