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European Journal of Physical and Rehabilitation Medicine 2021 Jul 12

DOI: 10.23736/S1973-9087.21.06916-1

Copyright © 2021 EDIZIONI MINERVA MEDICA

language: English

A systematic review of Clinical Practice Guidelines for the management of fractures in the pediatric population: identification of best evidence for rehabilitation to develop the WHO’s Package of Interventions for Rehabilitation

Francesca GIMIGLIANO 1, Sara LIGUORI 2 , Antimo MORETTI 2, Giuseppe TORO 2, Alexandra RAUCH 3, Stefano NEGRINI 4, 5, Giovanni IOLASCON 2, Technical Working Group 

1 Department of Mental and Physical Health and Preventive Medicine, University of Campania Luigi Vanvitelli, Naples, Italy; 2 Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Naples, Italy; 3 Department for Noncommunicable Diseases, Sensory Functions, Disability and Rehabilitation Unit, World Health Organization, Geneva, Switzerland; 4 IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; 5 Department of Biomedical, Surgical and Dental Sciences, University La Statale, Milan, Italy


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INTRODUCTION: Fractures have been identified as one of the 20 major health conditions for the World Health Organization’s (WHO) Package of Interventions for Rehabilitation (PIR) - that includes also the needs of children and youth. The identification of existing interventions for rehabilitation and related evidence is a crucial step along the development of the PIR. The methods for the identification have been developed by WHO Rehabilitation Programme and Cochrane Rehabilitation under the guidance of WHO’s Guideline Review Committee Secretariat.
EVIDENCE ACQUISITION: This paper is part of the “Best Evidence for Rehabilitation” (be4rehab) series, developed according to the methodology presented in the PIR introductory paper (Rauch, 2019). It is a systematic review of the existing Clinical Practice Guidelines (CPGs) on fractures in pediatric population published between 2009 to 2019.
EVIDENCE SYNTHESIS: We identified 7 relevant CPGs after title and abstract screening. According to inclusion/exclusion criteria and after checking for quality, publication time, multidisciplinarity and comprehensiveness, we have been able to include 2 CPGs: one addresses the treatment of supracondylar humerus fractures and the other provides recommendations on the treatment of diaphyseal femur fractures.
CONCLUSIONS: The selected CPGs on the management of supracondylar humerus and diaphyseal femur fractures in pediatric population include few recommendations considered as interventions for rehabilitation, of low quality of evidence and weak strength. We found several gaps in specific rehabilitative topics. High quality studies are absolutely needed to upgrade the quality of available evidence to inform future development of guidelines.


KEY WORDS: Fractures; Clinical Practice Guidelines; Rehabilitation; Pediatric population; World Health Organization

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