Evaluation Of The Efficacy Of SPR In The Treatment Of Cerebral Palsy Based On A Systematic Review And Literature Analysis

Objective:The results of SPR were evaluated in the control study by systematic evaluation,and the effects of SPR on the improvement of spasticity,gross motor function,gait analysis and joint movement were evaluated.According to the literature analysis,the basic information and main benefit indexes of SPR treatment CP related non-control study were summarized and analyzed statistically.Methods:Literature search was conducted in PubMed,EMBASE,Web of Science,Cochrane Library,CBM,CNKI,Wanfang database and VIP electronic databases from the establishment of the database to August 6,2020.According to the standard,the control study of SPR for CP children was included.At least two reviewers independently extracted data,used Cochrane 5.1.0 bias risk assessment tool to evaluate the quality of included RCTs,and used minors to evaluate the quality of nrcts.Revman 5.3 software(meta analysis)and SPSS 25.0 software(literature analysis)were used for data analysis.Results:Ten studies involving 332 patients with cerebral palsy were included in the meta-analysis.The results showed that SPR improved gross motor function(GMFM total score,GMFM-88 B,C,E score),muscle tone(lower limb muscle tone,adductor tone,hamstring tone,ankle flexor muscle tone),gait analysis(step length),joint movement(knee extension,ankle dorsiflexion,ankle plantar flexion,foot progression angle)better than the control group.Merge results:GMFM total score[SMD=0.35,95%CI(0.07,0.64),P=0.02],GMFM-88-B score[WMD=13.11,95%CI(4.94,21.28),P=0.002],GMFM-88-C score[WMD=7.79,95%CI(1.36,14.22),P=0.02],GMFM-88-E score[WMD=5.47,95%CI(0.41,10.53),P=0.03],lower limb muscle tone[WMD=-1.05,95%CI(-1.28,-0.82),P<0.00001],adductor muscle tone[WMD=-1.17,95%CI(-1.42,-0.92),P<0.00001],hamstring muscle tone[WMD=-0.71,95%CI(-1.20,-0.23),P=0.004],ankle flexor muscle tone[WMD=-1.19,95%CI(-1.67,-0.72),P<0.00001],stride length[SMD=0.59,95%CI(0.17,1.01),P=0.006],knee extension[WMD=-8.88,95%CI(-16.13,-1.62),P=0.02],ankle dorsiflexion[WMD=5.70,95%CI(1.85,9.55),P=0.004],ankle plantar flexion[WMD=14.95,95%CI(10.76,19.10),P<0.00001],foot progression angle[WMD=-9.65,95%CI(-15.65,-3.66),P=0.002].For GMFM-88 A,D score of gross motor function;cadence,velocity of gait analysis;hip flexion/extension,hip extension,knee flexion/extension,knee flexion and swing of joint movement;as well as pelvic tilt angle and pelvic rotation angle;SPR group and control group had no significant difference.Merge results:GMFM-88-A score[WMD=0.01,95%CI(-3.16,3.19),P=0.99],GMFM-88-D score[WMD=1.74,95%CI(-3.51,6.99),P=0.52],cadence[WMD=2.70,95%CI(-9.87,15.27),P=0.67],velocity[WMD=0.11,95%CI(-0.25,0.48),P=0.54],hip flexion/extension[WMD=6.03,95%CI(-1.58,13.64),P=0.12],hip extension[WMD=-4.75,95%CI(-10.52,1.02),P=0.11],knee flexion/extension[WMD=10.91,95%CI(-1.21,23.02),P=0.08],knee flexion swing[WMD=2.45,95%CI(-1.03,5.93),P=0.17],pelvic tilt angle[WMD=0.03,95%CI(-3.59,3.66),P=0.99],pelvic rotation angle[WMD=-1.53,95%CI(-4.03,0.98),P=0.23].A total of 116 articles from 12 countries were included in the literature analysis.The total sample size was 17496.The ratio of male to female was 1.73:1.The average age of operation was 8.09 years.The average follow-up time was 3.4 years.The effective rate was 100%,gross motor function was 88.5%,gait analysis was 80%,and range of motion was 60%.Conclusion:SPR can improve gross motor function,lower limb spasm,gait quality,and kinematic parameters of knee joint and ankle joint in CP children;The long-term effect of SPR in improving gross motor function of CP patients needs further study,and the evidence for improving joint range of motion is insufficient.