Developing Cerebral Palsy Diagnosis Guideline

We conducted a systematic review to develop an international clinical practice guideline in accord with the World Health Organization’s Handbook for Guideline Development¹⁵ and the Institute of Medicine’s standards.¹⁶ We followed the Equator Network reporting recommendations outlined in the Appraisal of Guidelines, Research and Evaluation (AGREE) II instrument^{17 (link)} and the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement.¹⁸ We systematically searched MEDLINE (1956–2016), EMBASE (1980–2016), CINAHL (1983–2016), and the Cochrane Library (1988–2016) and hand searched using the following terms: cerebral palsy, diagnosis, detection, prediction, identification, predictive validity, accuracy, sensitivity, and specificity. We included systematic reviews with or without meta-analyses, criteria of diagnostic accuracy, and evidence-based clinical guidelines. Quality was appraised using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS) methodological rating checklist for systematic reviews of diagnostic accuracy.^{19 (link)}The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) framework was used to assess quality and formulate recommendations along a 4-part continuum, including strong for, conditional for, conditional against, and strong against.^{20 (link)} As per the GRADE method, we weighed (1) the balance between desirable and undesirable consequences of different management strategies or not acting; (2) family preferences, including benefits vs risks and inconvenience; and (3) cost. Recommendations were discussed face-to-face among all authors, and the manuscript was reviewed, edited, and agreed on by all coauthors. Authors were clinicians involved in the diagnosis of cerebral palsy, including neurologists, pediatricians, neonatologists, rehabilitation specialists, general practitioners, neuroradiologists, psychiatrists, physical therapists, psychologists, occupational therapists, speech pathologists, nurses, and early educators. Individuals with cerebral palsy and parents also contributed as equal authors, ensuring that recommendations addressed their views and preferences.