Application Of Different Exercise Therapy In Children With Cerebral Palsy And Survey Of Evidence-based Practice Program Readiness

Objective: To analyze the effect of main exercise interventions for children with cerebral palsy,help healthcare professionals select exercise interventions and guide clinical practice.This study firstly collected the clinical practice guidelines（CPGs）that have been published and included exercise interventions recommendations for children with cerebral palsy,and comprehensively analyzed the exercise interventions recommendations from different CPGs and their consistency.Secondly,the Network Meta-analysis method was used to evaluate the effect of main exercise therapy for children with cerebral palsy,and to rank their curative effect.Finally,investigate the evidence-based practice readiness of evidence application projects,identify possible influencing factors during the implementation process,and promote evidence transformation.Methods: 1. Comparison and analysis of CPGs recommendations: We searched major Chinese and foreign databases（Pub Med,EMBASE,Cochrane library,Web of science,China National Knowledge Infrastructure,Wanfang Database and Chinese Biomedicine Literature Database）,guideline websites（International Guideline Collaboration Network,UK National Institute of Health and Clinical Excellence,Scottish Inter-Hospital Guidelines Network,World Health Organization）and Children’s Health Association/Society website to include CPGs including exercise interventions recommendations for children with cerebral palsy,and analyzing the recommendations of different CPGs;2. Network Meta-Analysis of the effects of main exercise interventions: Major databases（Wanfang Database,and Chinese Biomedical Literature Database,etc.）and published systematic reviews/meta-analyses were searched to collect randomized controlled trials（RCTs）on exercise interventions for children with cerebral palsy.The search period is from inception to July 2021.Two researchers independently screened the literature,used the Cochrane bias risk assessment tool to assess the methodological quality of the included studies.R studio and Stata16.0 software were used to conduct Bayesian network meta-analysis and ranking of the effects of different exercise interventions.The outcome indicators included: The self-selected walking speed,the D dimension（standing）score and the E dimension（walking,running and jumping）score of the Gross Motor Function（GMFM）scale.3. Survey on the Evidence-Based Nursing Practice Readiness: Convenient sampling method was adopted,using the General Information Questionnaire and the Clinical Readiness of Evidence-based Nursing Assessment（CREBNA）to assess the readiness of rehabilitation,pediatric and neurology nurses in ten hospitals,conducted a questionnaire to evaluate the readiness for evidence-based practice of the "resistance training and aerobic exercise" program to identify possible barriers during the implementation of the program.Results: 1.Comparison and analysis of CPGs recommendations: A total of six CPGs were included,from China（2 CPGs）,the United Kingdom（1CPGs）,Australia（1 CPGs）,the Netherlands（1 CPGs）,and Slovakia（1 CPGs）.Five CPGs of them reported grades of evidence,and four of the CPGs reported grades of the strength of recommendation.A total of 11 main recommendations are extracted from the 6 CPGs.There were inconsistencies in the contents of the recommendations,and 2 of them recommended the intensity and time of exercise.2.Network Meta-Analysis of the effects of main exercise interventions: A total of36 RCTs were included,involving 3 types of exercise interventions and conventional rehabilitation.The results of network meta-analysis showed that resistance training was superior to conventional rehabilitation in improving walking speed in children with cerebral palsy [MD=3.55,95%CI（0.614,6.65）].In improving the D dimension of gross motor function measure（GMFM）,aerobic exercise is superior to conventional rehabilitation [MD=9.05,95%CI（1.11,17.0）];in improving the E dimension of GMFM,aerobic exercise is superior to Conventional rehabilitation therapy[MD=9.06,95%CI（1.15,17.0）].3.Survey on the Evidence-Based Nursing Practice Readiness: A total of 306 valid questionnaires were collected.The average total score of the CREBNA scale was 141.51±5.33,the average total score of the evidence subscale was 52.64±2.78,the average total score of the organizational environment subscale was 42.04±1.88,and the average total score of the facilitator subscale was46.84±2.58.the average score of each item on the scale is between 3.56-4.88.The results of the univariate analysis showed that there were statistically significant differences in the total scores of the CREBNA scale for different educational backgrounds and different levels of understanding of the evidence-based nursing practice.Multiple linear stepwise regression analysis showed that education background was the main factor affecting readiness for evidence-based nursing practice.Conclusion: At present,the number of CPGs that contain recommendations for exercise interventions for children with cerebral palsy is small,and the recommendations are not uniform.Resistance training has the most advantages in improving the walking speed of children with cerebral palsy,and aerobic exercise has the most advantages in improving the gross motor function of standing,walking,running and jumping in children with cerebral palsy.The current evidence-based nursing practice program of "resistance training and aerobic exercise" is well prepared and feasible.