AACPDM systematic review of the effectiveness of therapy for children with cerebral palsy after botulinum toxin A injections

The aim of this review was to assess the effectiveness of therapy interventions on improving outcomes in children with cerebral palsy (CP) who have received botulinum toxin A (BTX-A) injections to either upper or lower limb muscles. We searched: the Cochrane Central Register of Controlled Trials; the electronic databases Medline, EMBASE, CINAHL, PEDro, SCI, and SSCI; websites of professional associations; and reference lists in trial reports and other relevant articles. We used studies on the effect of therapy on motor control, functional abilities, contracture, spasticity, and/or pain as the selection criteria. Methodological quality and the strength of evidence was assessed systematically by three independent raters using American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines. Twenty-four papers met the criteria for inclusion in the content analysis of evidence. Of these, only one randomized controlled trial was available, with results demonstrating that electrical stimulation postinjection did not enhance the effects of BTX-A on gait improvement (insufficient data provided to report size of effect). Remaining papers were of level II evidence (n=2), Level IV evidence (n=5), and level V evidence (n=14). We conclude that there is insufficient evidence to either support or refute the use of therapy interventions after BTX-A injections in children with CP.