Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy

2.50
Hdl Handle:
http://hdl.handle.net/10755/163843
Category:
Abstract
Type:
Article
Level of Evidence:
Systematic Review
Research Approach:
Translational Research/Evidence-based Practice
Title:
Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy
Author(s):
Bialocerkowski, Andrea; Kurlowicz, Kirsty; Vladusic, Sharon; Grimmer, Karen
Author Details:
Andrea Bialocerkowski, PhD, MAppSc(Phty), GradDipPublicHealth,School of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia, email: aebial@unimelb.edu.au; Kirsty Kurlowicz, BApppSc(Phty); Sharon Vladusic, Bphty, PostGradCertPhty(Paediatrics); Karen Grimmer, PhD, MMedSc, Bphty, LMusA, CertHealthEc
Abstract:
Background: Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1 - 3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives: The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy: A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria: Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis: Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results: Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. Conclusions: There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies.
Keywords:
brachial plexus palsy; infants
Repository Posting Date:
27-Oct-2011
Date of Publication:
2005
Citation:
Bialocerkowski, A., Kurlowicz, K., Vladusic, S., & Grimmer, K. (2005). Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.�International Journal Of Evidence-Based Healthcare,�3(2), 27-44.
Publisher:
Wiley-Blackwell
Conference Date:
2006
Conference Name:
Joanna Briggs Institute 2006 International Convention
Conference Host:
Joanna Briggs Institute
Conference Location:
Hilton Adelaide, South Australia
Note:
This is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.

Full metadata record

DC FieldValue Language
dc.type.categoryAbstracten_US
dc.typeArticleen_GB
dc.evidence.levelSystematic Reviewen_US
dc.research.approachTranslational Research/Evidence-based Practiceen_US
dc.titleEffectiveness of primary conservative management for infants with obstetric brachial plexus palsyen_GB
dc.contributor.authorBialocerkowski, Andreaen_US
dc.contributor.authorKurlowicz, Kirstyen_US
dc.contributor.authorVladusic, Sharonen_US
dc.contributor.authorGrimmer, Karenen_US
dc.author.detailsAndrea Bialocerkowski, PhD, MAppSc(Phty), GradDipPublicHealth,School of Physiotherapy, The University of Melbourne, Melbourne, VIC, Australia, email: aebial@unimelb.edu.au; Kirsty Kurlowicz, BApppSc(Phty); Sharon Vladusic, Bphty, PostGradCertPhty(Paediatrics); Karen Grimmer, PhD, MMedSc, Bphty, LMusA, CertHealthEcen_US
dc.identifier.urihttp://hdl.handle.net/10755/163843-
dc.description.abstractBackground: Obstetric brachial plexus palsy, a complication of childbirth, occurs in 1 - 3 per 1000 live births internationally. Traction and/or compression of the brachial plexus is thought to be the primary mechanism of injury and this may occur in utero, during the descent through the birth canal or during delivery. This results in a spectrum of injuries that vary in severity, extent of damage and functional use of the affected upper limb. Most infants receive treatment, such as conservative management (physiotherapy, occupational therapy) or surgery; however, there is controversy regarding the most appropriate form of management. To date, no synthesised evidence is available regarding the effectiveness of primary conservative management for obstetric brachial plexus palsy. Objectives: The objective of this review was to systematically assess the literature and present the best available evidence that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy. Search strategy: A systematic literature search was performed using 14 databases: TRIP, MEDLINE, CINAHL, AMED, Web of Science, Proquest 5000, Evidence Based Medicine Reviews, Expanded Academic ASAP, Meditext, Science Direct, Physiotherapy Evidence Database, Proquest Digital Dissertations, Open Archives Initiative Search Engine, Australian Digital Thesis Program. Those studies that were reported in English and published over the last decade (July 1992 to June 2003) were included in this review. Selection criteria: Quantitative studies that investigated the effectiveness of primary conservative management for infants with obstetric brachial plexus palsy were eligible for inclusion in this review. This excluded studies that solely investigated the effect of primary surgery for these infants, management of secondary deformities and the investigation of the effects of pharmacological agents, such as botulinum toxin. Data collection and analysis: Two independent reviewers assessed the eligibility of each study for inclusion into the review, the study design used and its methodological quality. Where any disagreement occurred, consensus was reached by discussion. Studies were assessed for clinical homogeneity by considering populations, interventions and outcomes. Where heterogeneity was present, synthesis was undertaken in a narrative format. Results: Eight studies were included in the review. Most were ranked low on the Hierarchy of Evidence (no randomised controlled trials were found), and had only fair methodological quality. Conservative management was variable and could consist of active or passive exercise, splints or traction. All studies lacked a clear description of what constituted conservative management, which would not allow the treatment to be replicated in the clinical setting. A variety of outcome instruments were used, none of which had evidence of validity, reliability or sensitivity to detect change. Furthermore, less severely affected infants were selected to receive conservative management. Therefore, it is difficult to draw conclusions regarding the effectiveness of conservative management for infants with obstetric brachial plexus palsy. Conclusions: There is scant, inconclusive evidence regarding the effectiveness of primary conservative intervention for infants with obstetric brachial plexus palsy. Further research should be directed to develop outcome instruments with sound psychometric properties for infants with obstetric brachial plexus palsy and their families. These outcome instruments should then be used in well-designed comparative studies.en_GB
dc.subjectbrachial plexus palsyen_US
dc.subjectinfantsen_US
dc.date.available2011-10-27T11:30:33Z-
dc.date.issued2005en_GB
dc.date.accessioned2011-10-27T11:30:33Z-
dc.identifier.citationBialocerkowski, A., Kurlowicz, K., Vladusic, S., & Grimmer, K. (2005). Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.�International Journal Of Evidence-Based Healthcare,�3(2), 27-44.en_US
dc.publisherWiley-Blackwellen_US
dc.identifier.issn1744-1595-
dc.conference.date2006-
dc.conference.nameJoanna Briggs Institute 2006 International Convention-
dc.conference.hostJoanna Briggs Institute-
dc.conference.locationHilton Adelaide, South Australia-
dc.identifier.citationBialocerkowski, A., Kurlowicz, K., Vladusic, S., & Grimmer, K. (2005). Effectiveness of primary conservative management for infants with obstetric brachial plexus palsy.�International Journal Of Evidence-Based Healthcare,�3(2), 27-44.en_US
dc.description.noteThis is an abstract-only submission. If the author has submitted a full-text item based on this abstract, you may find it by browsing the Virginia Henderson Global Nursing e-Repository by author. If author contact information is available in this abstract, please feel free to contact him or her with your queries regarding this submission. Alternatively, please contact the conference host, journal, or publisher (according to the circumstance) for further details regarding this item.-
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