Evidence
How we made the decision
How we made the decision
We check our guidelines regularly to ensure they remain up to date. We based the decision on surveillance 4 years after the publication of spasticity in under 19s (2012) NICE guideline CG145.
For details of the process and update decisions that are available, see ensuring that published guidelines are current and accurate in 'Developing NICE guidelines: the manual'.
Previous surveillance update decisions for the guideline are on our website.
New evidence
We found 38 new studies in a search for systematic reviews and randomised controlled trials published between 1 July 2014 and 16 May 2016. We also considered 7 additional studies identified by members of the guideline committee who originally worked on this guideline.
Evidence identified in previous surveillance 2 years after publication of the guideline was also considered. This included 7 studies identified by search.
From all sources, 52 studies were considered to be relevant to the guideline.
We also checked for relevant ongoing research, which will be evaluated again at the next surveillance review of the guideline.
See appendix A: summary of new evidence from surveillance and references for all new evidence considered.
Views of topic experts
We considered the views of topic experts, including those who helped to develop the guideline and other correspondence we have received since the publication of the guideline.
Views of stakeholders
Stakeholders commented on the decision not to update the guideline. Overall, 5 stakeholders commented. See appendix B for stakeholders' comments and our responses.
Five stakeholders commented on the proposal to not update the guideline: 2 agreed with the decision and 3 disagreed with the decision.
One stakeholder suggested updating several review questions, including those relating to motor interventions, anti-spasticity treatments, hip screening, therapy approaches, and impact of treatments for motor disorders on functional outcomes. However, surveillance includes all new evidence relevant to the scope and no evidence to suggest these questions should be updated was identified.
Extensions to the scope were suggested by 2 stakeholders; however, no evidence to suggest the scope should be extended was identified. The proposed areas to be added to the scope were:
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Scoliosis:
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Surveillance found limited evidence in this area, and scoliosis can be caused by conditions other than spasticity. NICE's guideline on spasticity in under 19s may not therefore be the most appropriate place for guidance on scoliosis.
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Pure dystonia:
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Surveillance found no evidence in this area, and dystonias are not limited to people with spasticity. NICE's guideline on spasticity in under 19s may not therefore be the most appropriate place for guidance on pure dystonia.
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19–25 year olds:
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Surveillance found no evidence to support extending the scope in this area, and increasing the age limit of the guideline introduces some questions about managing long-term aspects of spasticity. Currently it is not clear how much evidence is available on this to inform recommendations. Managing spasticity in people aged 19 and over with cerebral palsy will be considered for inclusion in the forthcoming NICE guideline on cerebral palsy in adults.
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No new ongoing or published studies were identified by the stakeholders to support views that the guideline should be updated or that the scope should be extended.
See ensuring that published guidelines are current and accurate in 'Developing NICE guidelines: the manual' for more details on our consultation processes.
NICE Surveillance programme project team
Sarah Willett
Associate Director
Philip Alderson
Consultant Clinical Adviser
Emma McFarlane
Technical Adviser
Patrick Langford
Technical Analyst
The NICE project team would like to thank the topic experts who participated in the surveillance process.
ISBN: 978-1-4731-2176-8
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