Sleep positioning systems for children with cerebral palsy

BackgroundSleep positioning systems can be prescribed for children with cerebral palsy to help reduce or prevent hip migration, provide comfortto ease pain and/or improve sleep. As sleep disturbance is common in children with de velopmental disabilities, with impact on theircarers’ sl eep, and as sleep positioning systems can be expensive, guidance is needed to support decisions as to their use.ObjectivesTo dete rmine whether commercially-available sleep positioning systems, compared with usual care, reduce or prevent hip migration inchildren with cerebral palsy. Any negative effect of sleep positioning systems on hip migration will be considered within this objective.Secondary objectives were to determine the effect of sleep positioning systems on: (1) number or frequency of hip problems; (2) sleeppatterns and quality; (3) quality of life of the child and family; (4) pain; and (5) physical functioning. We also sought to identify anyadverse effects from using sle ep positioning systems.Search methodsIn December 2014, we searched CENTRAL, Ovid MEDLINE, E mbase, and 13 other databases. We also searched two trials registers.We applied no restrictions on date of publication, language, publication status or study design. We checked references and contactedmanufacturers and authors for potentially relevant literature, and searched th e internet using Google.Selection criteriaWe included all randomised controlled trials (RCTs) evaluating whole body sleep positioning systems for children and adolescents (upto 18 years of age) with cerebral palsy.Data collection and analysisTwo review authors independently screened reports retrieved from the search against pre-determined inclusion criteria and assessed thequality of eligible studies.Members of th e public (parent carers of children with neurodisability) contributed to this review by suggesting the topic, reﬁning theresearch objectives, interpreting the ﬁndings, and reviewing the plain language summary.Main resultsWe did not identify any randomised controlled trials that evaluated the effectiveness of sleep positioning systems on hip migration.We did ﬁnd two randomised cross-over tr ials that met the inclusion criteria in respect of secondary objectives relating to sleep qualityand pain. Neither study reported any important difference between slee ping in slee p positioning systems and not for sleep patterns orsleep quality (two studies, 21 children, very low quality evidence) and pain (one study, 11 ch ildren, very low quality evidence). Thesewere small studies with established users of sleep positioning systems and were judged to have high risk of bias.We found no el igible trials that explored the other secondar y objectives (number or frequency of hip problems, quality of life of thechild and family, physical functioning, and adverse effects).Authors’ conclusionsWe found no randomised trials that evaluated the effectiveness of sleep positioning systems to reduce or prevent hip migration inchildren with cerebral palsy. Nor did we ﬁnd any randomised trials that evaluated the eff ect of sleep positioning systems on the numberor frequency of hip problems, quality of life of the child and family or on physical functioning.Limited data from two randomised tr ials, which evaluated the effectiveness of sleep positioning systems on sleep quality and pain forchildren with ce rebral palsy, showed no signiﬁcant differences in these aspects of health when children were using and not using a sleeppositioning system.In order to inform clinical decision-making and the prescription of sl eep positioning systems, more rigorous research is needed todetermine effectiveness, cost-effectiveness, and the likelihood of adverse effects.This review beneﬁted from support from National Institute for Health Research (NIHR) Coll aboration for Leadership in AppliedHealth Research and Care of the South West Peninsula (PenCLAHRC) and the charity Cerebra