Effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy: a focused review.

We conducted a criteria-based appraisal of systematic reviews on the effectiveness of physiotherapy and conductive education interventions in children with cerebral palsy (CP). Computerized bibliographic databases were searched without language restriction up to August 2007. Reviews on trials and descriptive studies were included. Two reviewers independently identified, selected, and assessed the quality of the reviews using the criteria from the Overview Quality Assessment Questionnaire complemented with decision rules. Twenty-one reviews were included, six of which were of high methodological quality. Altogether, the reviews included 23 randomized controlled trials and 104 observational studies on children with CP. The high-quality reviews found some evidence supporting strength training, constraint-induced movement therapy, or hippotherapy, and insufficient evidence on comprehensive physiotherapy and occupational therapy interventions. Conclusions in the other reviews should be interpreted cautiously, although, because of the poor quality of the primary studies, most reviews drew no conclusions on the effectiveness of the reviewed interventions. Reviews on complex interventions in heterogeneous populations should use rigorous methods and report them adequately, closely following the Quality of Reporting of Meta-Analyses recommendations.