Physiotherapy interventions to improve gross motor skills in people with an intellectual disability aged six years and older: a systematic review

Abstract

Intellectual disability is a life-long condition occurring during the early developmental years, resulting in impaired learning ability, reduced adaptive behaviour skills, and decreased functional independence. It affects approximately one percent of the world’s population, and affected individuals have poorer health outcomes. People with an intellectual disability may benefit from specific teaching and learning approaches in therapy interventions which accommodate their cognitive and behavioural needs. Gross motor skills (GMSs) are larger movements of the body, such as standing and walking, which are typically attained before the age of six. Deficits in GMSs may occur due to congenital conditions, such as cerebral palsy or Down syndrome, in which there occurs altered neuromuscular coordination and tone. GMS deficits can negatively affect a person’s functional independence. People with an intellectual disability who also suffer from GMS deficits can benefit from physiotherapy interventions to help improve their GMSs. Previous research has reported improvements in walking and balance for this population. Much research has supported early intervention programmes for children aged under six years. There is a comparative lack of research for people with an intellectual disability aged older than this, and no prior systematic review. A systematic review would inform clinicians and consumers regarding identifying effective interventions. The object of this thesis was to conduct a systematic review which investigated the effectiveness of physiotherapy interventions to improve GMSs in people with an intellectual disability aged six years and older. The data sources for identifying quantitative research were: PubMed, CINAHL, Embase and ProQuest. Reference lists of relevant identified papers were hand-searched. Papers published in English from 1-1-2008 to 22-10-14 were considered for inclusion. Types of eligible study designs were randomized controlled trial (RCT), pseudo-RCT, repeated measures, and case report. Overall, 866 potential articles were identified, of which 42 were retrieved for full-text review, and seven were finally included. Critical appraisal was conducted by two reviewers independently using the Joanna Briggs Institute (JBI) appraisal checklists; no papers were excluded following critical appraisal. Data extraction was performed using JBI Meta Analysis of Statistics Assessment and Review Instrument (MAStARI) data extraction instruments. High heterogeneity between the studies precluded meta-analysis of the results, and a narrative synthesis was completed instead. Two RCTs, two pseudo-RCTs, two repeated measures studies and one case report were included. Studies varied in regard to participants’ intellectual disabilities, and also regarding the interventions used. All interventions were well tolerated with negligible adverse effects. Significant improvements were reported for: cadence and non-dimensionalized gait velocity following body-weight supported gait training; cadence following lower limb strengthening exercises; and for the Gross Motor Function Measure-88 measure following adapted Judo training. These results suggest that task-specific training may be useful. However, based on the critical appraisal the overall quality of evidence was low. The systematic review found limited evidence supporting physiotherapy for improving GMSs in people with an intellectual disability. Further research is needed to validate the early significant findings identified in this review and to define effective physiotherapy approaches which meet the learning needs of people with an intellectual disability.