Efectividad del uso de bipedestadores en la prevención de la luxación de cadera en niños y adolescentes con parálisis cerebral espástica, GMFCS III, IV y V. Revisión sistemática / Effectiveness of the use of standing devices in the prevention of hip dislocation in children and adolescents with spastic cerebral palsy, GMFCS III, IV and V. A systematic review

Los bipedestadores se usan como terapia preventiva de la luxación de cadera en pacientes con parálisis cerebral. Esta revisión busca evaluar la efectividad de estos en la prevención de la luxación de cadera de pacientes menores de 18 años con diagnóstico de parálisis cerebral espástica, GMFCS III-V. Se realizó una búsqueda sistemática en 10 bases de datos biomédicas, seleccionando ensayos clínicos aleatorios, cuasiexperimentales y estudios de cohorte. Se comparó el uso de bipedestadores con terapia física, ortesis y/o cirugías de tejido blando. Se consideró al porcentaje de migración de la cabeza femoral como resultado principal. Se evaluó el riesgo de sesgo mediante las pautas Rob 2.0 y Robins I. Como resultado del análisis de 6 estudios primarios, se obtiene que el uso de bipedestación mantuvo el porcentaje de migración de la cabeza femoral dentro de límites normales (MP: 13-23%; p<0,01), aumentó la densidad mineral ósea volumétrica trabecular vertebral (8,16mg/cm3; p=0,01), contenido mineral óseo (p=0,010) y longitud muscular de isquiotibiales (fase B1 p<0,01 y B2 p=0,03). Sin embargo, el riesgo de sesgo de estos estudios se categorizó como de alguna preocupación a moderado. Como conclusión se declara que existe evidencia limitada de la efectividad del uso de bipedestadores en la prevención de la luxación de cadera en la población de estudio, debido a la heterogeneidad metodológica y riesgo de sesgo de los estudios incluidos. Se requiere un mayor número de estudios con nivel de evidencia alto para poder generar una recomendación de su uso. Registro en PROSPERO: CRD42018087641

The standing devices are used as a preventive therapy for hip dislocation in patients with cerebral palsy. This review seeks to assess the effectiveness of standing devices in the prevention of hip dislocation of patients under 18 years old with a diagnosis of spastic cerebral palsy, GMFCS III-V. A systematic search was conducted in 10 biomedical databases, selecting randomized, quasi-experimental clinical trials and cohort studies. The use of standing devices with physical therapy, orthosis and/or soft tissue surgeries was compared. The percentage of migration of the femoral head was considered as the main result. The risk of bias was assessed using the Rob 2.0 and Robins I guidelines. As a result of the analysis of 6 primary studies, it is obtained that the use of standing devices maintained the percentage of migration of the femoral head within normal limits (MP:13-23%, p<.01), increased vertebral trabecular volumetric bone mineral density (8.16mg/cm3, p=.01), bone mineral content (p=.010) and hamstring muscle length (phase B1 p<.01 and B2 p=.03). However, the risk of bias in these studies was categorized as of some concern to moderate. In conclusion, it is stated that there is limited evidence of the effectiveness of the use of standing devices in the prevention of hip dislocation in the study population, due to the methodological heterogeneity and risk of bias of the included studies. A greater number of studies with a high level of evidence are required in order to generate a recommendation for its use. Registration in PROSPERO: CRD42018087641

[Effectiveness of the use of standing devices in the prevention of hip dislocation in children and adolescents with spastic cerebral palsy, GMFCS III, IV and V. A systematic review]. / Efectividad del uso de bipedestadores en la prevención de la luxación de cadera en niños y adolescentes con parálisis cerebral espástica, GMFCS III, IV y V. Revisión sistemática.

The standing devices are used as a preventive therapy for hip dislocation in patients with cerebral palsy. This review seeks to assess the effectiveness of standing devices in the prevention of hip dislocation of patients under 18 years old with a diagnosis of spastic cerebral palsy, GMFCS III-V. A systematic search was conducted in 10 biomedical databases, selecting randomized, quasi-experimental clinical trials and cohort studies. The use of standing devices with physical therapy, orthosis and/or soft tissue surgeries was compared. The percentage of migration of the femoral head was considered as the main result. The risk of bias was assessed using the Rob 2.0 and Robins I guidelines. As a result of the analysis of 6 primary studies, it is obtained that the use of standing devices maintained the percentage of migration of the femoral head within normal limits (MP:13-23%, p<.01), increased vertebral trabecular volumetric bone mineral density (8.16mg/cm3, p=.01), bone mineral content (p=.010) and hamstring muscle length (phase B1 p<.01 and B2 p=.03). However, the risk of bias in these studies was categorized as of some concern to moderate. In conclusion, it is stated that there is limited evidence of the effectiveness of the use of standing devices in the prevention of hip dislocation in the study population, due to the methodological heterogeneity and risk of bias of the included studies. A greater number of studies with a high level of evidence are required in order to generate a recommendation for its use. Registration in PROSPERO: CRD42018087641.