Abstract：
BACKGROUND: Tailored implementation interventions are required to overcome the diagnostic research-practice gap for cerebral palsy (CP). Evaluating the impact of interventions on patient outcomes is a priority. This review aimed to summarize the established evidence for the effectiveness of guideline implementations in lowering the age of CP diagnosis.
METHODS: A systematic review was conducted according to PRISMA. CINAHL, Embase, PubMed and MEDLINE were searched (2017-October 2022). Inclusion criteria were studies that evaluated effect of CP guideline interventions on health professional behaviour or patient outcomes. GRADE was used to determine quality. Studies were coded for use of theory (Theory Coding Scheme). Meta-analysis was performed and a standardized metric used to summarize statistics of intervention effect estimates.
RESULTS: Of (N.=249) records screened, (N.=7) studies met inclusion, comprising interventions following infants less than 2 years of age with CP risk factors (N.=6280). Guideline feasibility in clinical practice was established through health professional adherence and patient satisfaction. Efficacy of patient outcome of CP diagnosis by 12 months of age was established in all studies. Weighted averages were: (1) high-risk of CP (N.=2) 4.2 months and (2) CP diagnosis (N.=5) at 11.6 months. Meta-analysis of (N.=2) studies found a large, pooled effect size Z = 3.00 (P=0.003) favoring implementation interventions lowering age of diagnosis by 7.50 months, however study heterogeneity was high. A paucity of theoretical frameworks were identified in this review.
CONCLUSIONS: Multifaceted interventions to implement the early diagnosis of CP guideline are effective in improving patient outcomes by lowering the age of CP diagnosis in high-risk infant follow-up clinics. Further targeted health professional interventions including low-risk infant populations are warranted.
METHODS: A systematic review was conducted according to PRISMA. CINAHL, Embase, PubMed and MEDLINE were searched (2017-October 2022). Inclusion criteria were studies that evaluated effect of CP guideline interventions on health professional behaviour or patient outcomes. GRADE was used to determine quality. Studies were coded for use of theory (Theory Coding Scheme). Meta-analysis was performed and a standardized metric used to summarize statistics of intervention effect estimates.
RESULTS: Of (N.=249) records screened, (N.=7) studies met inclusion, comprising interventions following infants less than 2 years of age with CP risk factors (N.=6280). Guideline feasibility in clinical practice was established through health professional adherence and patient satisfaction. Efficacy of patient outcome of CP diagnosis by 12 months of age was established in all studies. Weighted averages were: (1) high-risk of CP (N.=2) 4.2 months and (2) CP diagnosis (N.=5) at 11.6 months. Meta-analysis of (N.=2) studies found a large, pooled effect size Z = 3.00 (P=0.003) favoring implementation interventions lowering age of diagnosis by 7.50 months, however study heterogeneity was high. A paucity of theoretical frameworks were identified in this review.
CONCLUSIONS: Multifaceted interventions to implement the early diagnosis of CP guideline are effective in improving patient outcomes by lowering the age of CP diagnosis in high-risk infant follow-up clinics. Further targeted health professional interventions including low-risk infant populations are warranted.
摘要：
背景：需要量身定制的实施干预措施来克服脑瘫（CP）的诊断研究与实践差距。评估干预措施对患者预后的影响是当务之急。这篇综述旨在总结指南实施在降低CP诊断年龄方面的有效性的既定证据。
方法：根据PRISMA进行系统评价。CINAHL,Embase,检索了PubMed和MEDLINE（2017年-2022年10月）。纳入标准是评估CP指南干预措施对健康专业行为或患者预后的影响的研究。使用等级来确定质量。研究被编码为使用理论(理论编码方案)。进行荟萃分析，并使用标准化指标来总结干预效果估计的统计数据。
结果：的(N.=249）筛选的记录，(N.=7)研究符合纳入，包括2岁以下有CP危险因素的婴儿的干预措施(N.=6280）。临床实践中的指南可行性是通过健康专业人员的依从性和患者满意度来确定的。在所有研究中都建立了12个月大的CP诊断的患者结果的功效。加权平均值为：（1）CP的高风险（N。=2)4.2个月和(2)CP诊断(N.=5）在11.6个月。(N.的Meta分析=2)研究发现，合并效应大小Z=3.00（P=0.003），有利于实施将诊断年龄降低7.50个月的干预措施，然而，研究异质性很高。在这篇综述中发现了缺乏理论框架的问题。
结论：实施CP早期诊断指南的多方面干预措施通过降低高风险婴儿随访诊所的CP诊断年龄，可有效改善患者预后。需要进一步有针对性的健康专业干预措施，包括低风险婴儿人群。
方法：根据PRISMA进行系统评价。CINAHL,Embase,检索了PubMed和MEDLINE（2017年-2022年10月）。纳入标准是评估CP指南干预措施对健康专业行为或患者预后的影响的研究。使用等级来确定质量。研究被编码为使用理论(理论编码方案)。进行荟萃分析，并使用标准化指标来总结干预效果估计的统计数据。
结果：的(N.=249）筛选的记录，(N.=7)研究符合纳入，包括2岁以下有CP危险因素的婴儿的干预措施(N.=6280）。临床实践中的指南可行性是通过健康专业人员的依从性和患者满意度来确定的。在所有研究中都建立了12个月大的CP诊断的患者结果的功效。加权平均值为：（1）CP的高风险（N。=2)4.2个月和(2)CP诊断(N.=5）在11.6个月。(N.的Meta分析=2)研究发现，合并效应大小Z=3.00（P=0.003），有利于实施将诊断年龄降低7.50个月的干预措施，然而，研究异质性很高。在这篇综述中发现了缺乏理论框架的问题。
结论：实施CP早期诊断指南的多方面干预措施通过降低高风险婴儿随访诊所的CP诊断年龄，可有效改善患者预后。需要进一步有针对性的健康专业干预措施，包括低风险婴儿人群。
