605 - Knowledge and use of cerebral palsy early diagnostic tools among rehabilitation professionals: a systematic review and meta-analysis of survey data

Publication Number: 3586.605

Alessandra Lemos de. Carvalho, Boston Children's Hospital, Brookline, MA, United States; Fernanda Jordao Pinto Marques, University of Iowa Stead Family Children's Hospital, Coralville, IA, United States; Fabiana Utsch, SARAH, Belo Horizonte, Minas Gerais, Brazil; Rosiane F A. Souza, SARAH Network of Rehabilitation Hospitals, Salvador, Bahia, Brazil; Rafaela Christine. Dutra, Unifap, Belo Horizonte, Minas Gerais, Brazil

Background: Early identification of cerebral palsy (CP) enables timely intervention and improves neurodevelopmental outcomes. Standardized tools such as the Hammersmith Infant Neurological Examination (HINE) and General Movements Assessment (GMA) allow diagnosis within the first year of life. Their dissemination and adoption among rehabilitation professionals, however, remain unclear worldwide. No prior review has pooled global data on the knowledge and use of these early diagnostic tools.

Objective: To synthesize quantitative evidence on the knowledge and use of early CP diagnostic tools among rehabilitation professionals.

Design/Methods: We conducted a systematic review and meta-analysis following PRISMA guidelines. Database searches (PubMed, Embase, Web of Science, PsycINFO, Cochrane, SciELO, LILACS) identified survey studies reporting quantitative data on knowledge, awareness, or use of standardized tools for early CP diagnosis among rehabilitation professionals. Extracted data included sample size and number of respondents reporting knowledge or use. A single-arm meta-analysis of proportions was performed in R (meta package) using logit transformation and the inverse-variance method under a random-effects model (REML) with Knapp-Hartung adjustment. Heterogeneity was assessed using I² and τ² statistics, and risk of bias was evaluated with the Appraisal Tool for Cross-Sectional Studies (AXIS).

Results: Six studies encompassing 890 participants met inclusion criteria. The pooled proportion of professionals aware that CP can be diagnosed early was 86.0% (95% CI 24-99%; I² = 95.3%). Awareness was higher for the HINE (62%; 95% CI 19-92%; I² = 94.9) than for the GMA (58%; 95% CI 23-87%; I² = 92.5%). Actual tool use was lower: GMA 22% (95% CI 7-51%; I² = 94.2%) and HINE 38% (95% CI 31-45%; I² = 13.2%).

Conclusion(s): Although most rehabilitation professionals recognize that CP can be diagnosed early, the use of standardized tools such as the HINE and GMA remains limited. Targeted educational strategies and dissemination initiatives are needed to bridge this gap between awareness and practice and to promote early, evidence-based early CP diagnosis worldwide.

Figure 1: Flowchart of Study Identification and Selection (PRISMA 2020)
PRISMA 2020 flow diagram illustrating the process of study identification, screening, eligibility assessment, and inclusion.

Figure 2. Forest Plot Showing the Use of the General Movements Assessment (GMA) for Early Diagnosis of Cerebral Palsy
Forest plot displaying the pooled proportion (with 95% confidence intervals) of rehabilitation professionals who reported using the General Movements Assessment (GMA) for early diagnosis of cerebral palsy

Figure 3. Forest Plot Showing the Use of the Hammersmith Infant Neurological Examination (HINE) for Early Diagnosis of Cerebral Palsy
Forest plot displaying the pooled proportion (with 95% confidence intervals) of rehabilitation professionals who reported using the Hammersmith Infant Neurological Examination (HINE) for early diagnosis of cerebral palsy