The epidemiology of cerebral palsy in adulthood: A systematic review and meta-analysis of the most frequently studied outcomes's Story

OBJECTIVE:
To describe the epidemiology of health status, impairments, activities and participation in adults with cerebral palsy (CP).

DATA SOURCES:
Embase, Medline, Web-of-Science, PsycINFO, CINAHL, Cochrane and Google Scholar were searched for three themes (‘cerebral palsy’, ‘adult’, and ‘outcome assessment’) in literature published between January 2000 and December 2018.

STUDY SELECTION:
Full paper, peer-reviewed, English journal articles on descriptive, observational or experimental studies describing the most studied outcomes in adults with CP (n ≥ 25, age ≥ 18 years) were included. Studies were included in the analyses if frequently studied outcomes were described in at least 3 studies using similar methods of assessment.

DATA EXTRACTION:
Data were extracted independently by two authors from 65 articles (total n=28429) using a standardized score sheet.

DATA SYNTHESIS:
Meta analyses revealed that overall, on average 65.1% (95% CI: 55.1;74.5) of adults with CP experienced pain, 57.9% (51.1;64.6) were ambulant, 65.5% (61.2;69.7) had little or no limitation in manual ability, 18.2% (10.6;27.2) had tertiary education, 39.2% (31.5;47.1) were employed and 29.3% (9.0;55.3) lived independently. Considering adults without intellectual disability, proportions of individuals who were ambulant (72.6% [58.8;84.5]) and lived independently (90.0% [83.8;94.9]) were higher (respectively p=0.014 and p<0.01). The Fatigue Severity Scale score was 4.1 (3.8;4.4). Epilepsy (28.8% [20.1;38.4]) and asthma (28.3% [18.7;38.9]) were especially prevalent comorbidities.

CONCLUSIONS:
The present systematic review and meta-analysis on the epidemiology of adults with CP provided state-of-the-art knowledge on the most frequently studied outcomes. On the average adults with CP are fatigued, a majority experiences pain, is ambulant and has little or no difficulty with manual ability. On average, 40% is employed and 30% lives independently. More uniformity in assessment and reports is advised to improve knowledge on epidemiology and gain insight in more outcomes.

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