title: Single-event multilevel surgery for children with cerebral palsy: a systematic review.
abstract: OBJECTIVE
  To conduct a systematic review of single-event multilevel surgery (SEMLS) for children with cerebral palsy, with the aim of evaluating the quality of the evidence and developing recommendations for future research.
  
  
  METHODS
  The systematic review was conducted using standard search and extraction methods in Medline, EMBASE, CINAHL, and Cochrane electronic databases. For the purposes of this review, SEMLS was defined as two or more soft-tissue or bony surgical procedures at two or more anatomical levels during one operative procedure, requiring only one hospital admission and one period of rehabilitation. Studies were included if: (1) the primary focus was to examine the effect of SEMLS in children with cerebral palsy; (2) the results focused on multiple anatomic levels and reported findings of one or more World Health Organization International Classification of Functioning, Disability and Health (ICF) domains. Studies that focused on a single intervention or level, or on the utility of a specific outcome measure were excluded. Study quality was appraised with the Methodological Index for Non-Randomized Studies (MINORS) and the Oxford Centre for Evidence-Based Medicine scale. The review also examined the reporting of surgery, adverse events, and rehabilitation.
  
  
  RESULTS
  Thirty-one studies fulfilled the criteria for inclusion, over the period 1985 to October 2010. The MINORS score for these studies varied from 4 to 19, with marked variation in the quality of reporting. Study quality has improved over recent years. Valid measures of gait and function have been introduced and several of the most recent studies have addressed multiple dimensions of the ICF. A statistical synthesis of the outcome data was not conducted, although a trend towards favourable outcomes in gait was evident. Caution is advised with interpretation owing to the variable study quality. Uncontrolled studies may have resulted in an overestimation of treatment efficacy.
  
  
  CONCLUSIONS
  The design and reporting of studies of SEMLS are improving with the development of multidisciplinary teamwork and frameworks such as the ICF. However, the evidence base is limited by the lack of randomized clinical trials, especially when compared with other surgical interventions such as selective dorsal rhizotomy.
authors: Murdoch Childrens Research Institute, Flemington Road, Parkville, Victoria 3052, Australia.
authors: Jennifer L
authors: JL
authors: McGinley
authors: Fiona
authors: F
authors: Dobson
authors: Rekha
authors: R
authors: Ganeshalingam
authors: Benjamin J
authors: BJ
authors: Shore
authors: Erich
authors: E
authors: Rutz
authors: H Kerr
authors: HK
authors: Graham
mesh_terms: D000293:Adolescent; D002547:Cerebral Palsy / Q000175:diagnosis / Q000601:surgery*; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual / Q000706:statistics & numerical data; D019317:Evidence-Based Medicine; D006801:Humans; D017063:Outcome Assessment, Health Care; D010372:Pediatrics; D016896:Treatment Outcome