Quality of life in children and adolescents with cerebral palsy: a systematic review with meta-analysis

Background: Cerebral palsy has been linked to decreased quality of life. However use of self- versus proxy-perspectives and norm-sample comparisons to examine quality of life impact may produce different results. Aims: To compare quality of life ratings in children and adolescents with cerebral palsy relative to typically developing peers in consideration of sample and methodological moderators on estimated effects. Methods: Eleven independent studies, comprising a pooled sample of 1475 families living with cerebral palsy and 42119 peers, were identified. Study reporting quality was evaluated with the QualSyst tool and standardised mean group differences (Hedges' g) with associated confidence intervals and p values calculated. Heterogeneity was examined using a random effects model. Results: All studies provided good to excellent methodological and statistical detail. Physical quality of life was significantly impaired among those with cerebral palsy (g range: -0.42 to -1.58). However, inconsistent findings were noted in relation to the effect of cerebral palsy on psychological (g range: 0.04 to -0.80) and social quality of life (g range: -0.80 to -0.51), depending on the measurement used. There was a trend for parents to evaluate their child's physical quality of life lower than child-reported scores. Conclusions: Physical quality of life is, invariably, more affected in those with cerebral palsy. The connection between cerebral palsy and psychosocial quality of life is less clear. Noted parent-child discrepancies highlight the value of a multi-informant approach to child quality of life assessment.