Impact of International Classification of Functioning, Disability and Health personal factors on outcomes following lower limb orthopaedic surgery in children with cerebral palsy: a systematic review

Purpose: To investigate impact of International Classification of Functioning, Disability and Health (ICF) personal factors on pain, function, or quality of life following lower limb orthopaedic surgery in children with cerebral palsy (CP). Materials and methods: Systematic review of prospective studies of lower limb orthopaedic surgery in children with CP reporting relationships between ICF personal factors, and pain, function, or quality of life. Results: Eight prospective studies reporting various orthopaedic procedures (median follow-up 2.1 years) were eligible, but not sufficiently homogenous for meta-analysis. Functional outcomes most reported (n = 6), then pain (n = 3) and quality of life (n = 1). Personal factors were age (n = 3), sex (n = 4), child education (n = 1), and co-morbidities (n = 1). Older children had lower function (p < 0.01), and children in "special education" greater improvement in function compared to those in "regular" education (p = 0.001) post-single-event multi-level surgery (SEMLS). Age and sex not associated with function, pain, or quality of life post-single-joint procedures (p > 0.05), except females with higher pain intensity (p = 0.019) and lower function (p = 0.018) post-Schanz procedure. No association between sex and function post-SEMLS (p > 0.05). Conclusions: Further prospective cohort studies are needed to understand the influence of personal factors identified in this review and investigate the effect of other personal factors on pain, quality of life, and function.