Musculoskeletal health among adults with cerebral palsy: A systematic review.

AIM: To describe the burden of, and investigate prognostic factors for, osteoarthritis, osteopenia and/or osteoporosis, spondylosis, and fracture, and to investigate the effectiveness of protocols for monitoring musculoskeletal disorders and interventions for managing osteoarthritis in adults with cerebral palsy (CP).

METHOD: Six databases were searched from 1990 to 30th September 2024. Titles, abstracts, and full texts were screened by two independent reviewers.

RESULTS

Forty-four reports were included. The burden of osteoarthritis, osteoporosis, and fracture was higher in adults with CP than adults without it, although there was only low to moderate certainty in the evidence. The prevalence of osteoarthritis and osteoporosis/osteopenia was higher in female adults than males. Osteoporosis/osteopenia was more prevalent in adults classified in Gross Motor Function Classification System levels IV and V than levels I to III. Monitoring protocols identified progression of scoliosis and hip displacement but no study compared monitoring against no monitoring. There was very low certainty evidence from one study that total hip arthroplasty improves pain and function in adults with CP and osteoarthritis.

INTERPRETATION: Adults with CP are at increased risk of developing musculoskeletal disorders. The limited evidence about prognostic factors, effectiveness of protocols for monitoring progression of disorders, and interventions for managing osteoarthritis in adults with CP hinders efforts to minimize the impact of musculoskeletal disorders on people with CP.