Evidence
This page contains a snapshot of featured content which highlights evidence addressing key clinical questions including areas of uncertainty. Please see the main topic reference list for details of all sources underpinning this topic.
BMJ Best Practice evidence tables
Evidence tables provide easily navigated layers of evidence in the context of specific clinical questions, using GRADE and a BMJ Best Practice Effectiveness rating. Follow the links at the bottom of the table, which go to the related evidence score in the main topic text, providing additional context for the clinical question. Find out more about our evidence tables.
This table is a summary of the analysis reported in a guideline (underpinned by a systematic review) that focuses on the above important clinical question.
Confidence in the evidence is very low or low where GRADE has been performed and there may be no difference in effectiveness between the intervention and comparison for key outcomes. However, this is uncertain and new evidence could change this in the future.
Population: Adults aged 16 and over with cerebral palsy
Intervention: Physical activity; strengthening programmes or training; task-orientated upper limb training
Comparison: Each other or usual care
| Outcome | Effectiveness (BMJ rating)? | Confidence in evidence (GRADE)? |
|---|---|---|
Physical activity intervention, before versus after outcomes | ||
Participation (walking efficiency - gait energy expenditure index) | No statistically significant difference | Very Low |
Physical function (Gross Motor Function Measure [GMFM] D [standing] and E [walking, running, and jumping]) | No statistically significant difference | Very Low |
Physical activity interventions versus standard care | ||
Participation (change in maximal gait speed) | Favours intervention | Low |
Physical function (International Classification of Functioning: total score) | Favours intervention | Low |
Independence (functional independence measure) | Favours intervention | Low |
Strengthening or training programmes versus standard care | ||
Participation (change from baseline in 2-min walk test) | No statistically significant difference | Low |
Participation (change from baseline in 6-min walk test) | No statistically significant difference | Low |
Physical function (change from baseline in stair climbing - adapted from GMFM) | No statistically significant difference | Low |
Physical function (change from baseline in GMFM 66) | No statistically significant difference | Low |
Health-related Quality of Life (change from baseline in Assessment of Quality of Life Instrument-6D) | No statistically significant difference | Very Low |
Fatigue (change from baseline in Fatigue Severity Scale) | No statistically significant difference | Very Low |
Falls (change from baseline in Falls Efficacy Scale) | No statistically significant difference | Very Low |
Complications of treatment (participants reporting new soreness) | No statistically significant difference | Low |
Adherence to treatment (number of sessions attended) | No statistically significant difference | Low |
Task-orientated upper limb training versus standard care | ||
Participation (change from baseline in Jebsen Hand Function Test) | No statistically significant difference | Very Low |
Physical function (change from baseline in Nine-Hole Peg Test) | No statistically significant difference | Very Low |
Independence (change from baseline in Barthel Index) | See note ᵃ | Very Low |
Task-orientated upper limb training, before versus after outcomes | ||
Participation - Motor Activity Log (amount of use) | No statistically significant difference | Very Low |
Physical Function (Nine-Hole Peg Test) | No statistically significant difference | Very Low |
Recommendations as stated in the source guideline The National Institute of Health and Care Excellence (NICE) 2019 guideline on Cerebral palsy in adults makes the following recommendations: Discuss with adults with cerebral palsy (and their families or carers, if agreed) the importance of physical activity in maintaining general fitness and physical and mental health. Provide information on accessible local services that support people with cerebral palsy to take part in physical activity. Consider referring people with cerebral palsy to services with experience and expertise in neurological impairments that can provide support with physical activities (including sport) and tasks of daily living.
Note Based on the strength of the evidence, the guideline committee felt they could only make weak recommendations. The guideline committee noted that low-quality evidence from one randomised controlled trial showed that physical activity interventions can improve physical function and independence in adults with cerebral palsy. The committee also discussed that for strengthening training to maintain physical function, there were no clear differences between groups for frequency of falls, fatigue, and soreness, suggesting this is a safe intervention for adults with cerebral palsy. ᵃ Both the mean and standard deviation of change from baseline in the standard care group were zero, therefore NICE were unable to calculate the difference in effectiveness between groups.
This evidence table is related to the following section/s:
Cochrane Clinical Answers
Cochrane Clinical Answers (CCAs) provide a readable, digestible, clinically focused entry point to rigorous research from Cochrane systematic reviews. They are designed to be actionable and to inform decision making at the point of care and have been added to relevant sections of the main Best Practice text.
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