Anterior or posterior walkers for children with cerebral palsy? A systematic review.

OBJECTIVE: To review the literature comparing use of anterior and posterior walkers (PW's) by children with cerebral palsy (CP) to determine which walker type is preferable. METHODS: Electronic databases were searched using pre-defined terms by two independent reviewers. Reference lists of included studies were hand searched. Studies published between 1985 and 2016 comparing use of anterior and PW's by children with CP were included. All study designs and outcomes were accepted. Risk of bias was assessed using the "Quality assessment standard for a cross-over study". Quality of evidence was evaluated using GRADE. RESULTS: Six studies were analysed. All studies had small sample sizes. A total of 4/6 studies were randomized. A total of 4/6 had high risk of bias. Outcomes included velocity, pelvic tilt, hip flexion, knee flexion, step length, stride length, cadence, double stance time, oxygen cost and participant/parental preference. Velocity, trunk flexion/pelvic tilt, and stability may be improved by using a PW, however, GRADE quality was very low for all outcomes and there was heterogeneity between studies. The majority of participants and parents preferred the PW. CONCLUSIONS: Heterogeneity and low quality of existing evidence prevented recommendation of one walker type. Well-designed studies with adequate power are needed to inform clinical recommendations. Implications for rehabilitation Clinical recommendations cannot be made for whether anterior or posterior walkers are preferable for children with cerebral palsy based on the existing evidence. Velocity, trunk flexion/pelvic tilt, and stability may be improved by using a posterior walker. The majority of walking aid users and their parents preferred posterior walkers. Adequately powered studies designed to minimize bias are needed.

Compliance with the quality standards of National Diabetic Retinopathy Screening Committee.

AIMS: The National Diabetic Retinopathy Screening Committee has recommended 19 standards for quality assurance of screening programmes in the United Kingdom. Five of the standards apply to the care provided by ophthalmology departments. This study assesses the quality assurance of the eye care provided by the Wakefield and North Kirklees Screening programme. METHODS: A retrospective audit of case notes of patients for 12 consecutive months in 2007. The outcomes were compared with the five quality standards. RESULTS: Out of a total number of 15,080 patients screened for diabetic retinopathy (DR), 479 (3.17%) required referral to ophthalmology department (screen-positive). Of these, 352 (2.33% of total screened) were referred for diabetic retinopathy. Forty-three patients (13%) were referred for proliferative retinopathy (R3), 279 (79%) for maculopathy (M1), 24 (7%) for non-proliferative retinopathy (R2), and 4 (1%) for a history of previous photo-coagulation (P1). Fifty-eight patients (16%) failed to attend. A timely consultation was achieved in 33% of R3 and 77% of M1 patients. Only 31% of R3 and 8% of M1 at screening were listed at their first visit to ophthalmology clinic and received laser treatment in stipulated time. CONCLUSION: Significant progress is required for timely consultation and management of screen-positive patients. In order to achieve these targets efficiently, it may be appropriate to re-define M1 so that a significant proportion of patients with M1 may be referred to and better managed by primary care physicians or diabetologists.