Overcoming activity and participation limitations in children with unilateral congenital below elbow deficiency : a systematic review

Background: Evidence on effective support strategies for enhancing activity and participation in children with congenital forearm reduction deficiencies is limited. This gap highlights the critical need for evidence-based approaches to optimize the interventions of health professionals. The interventions involve the three courses of action, the use of 1) prostheses, 2) alternative adaptive devices (AAD) or 3) compensatory strategies. Objective: The aim was to develop an evidence-based clinical decision support tool for health professionals to guide the use of these three courses of action, including any combination thereof, for children (up to 21 years old) with unilateral congenital transverse below-elbow deficiency (UCTBD). Methodology: We conducted a systematic review by thoroughly searching four databases. Two reviewers independently screened titles and abstracts, followed by full-text evaluations for inclusion. Conflicts were resolved by discussion between the first and last authors. We critically appraised eight included studies and synthesized the findings into a clinical decision-making support flowchart. Findings: Eight articles fulfilled inclusion criteria. Multiple factors must be taken into account, when providing guidance to children with UCTBD and their caregiver(s). The three courses of action, individually or in any combination, offer distinct yet equally effective options to support specific tasks as well as the psychosocial wellbeing of children with UCTBD. The involvement of caregiver(s) is important due to their significant influence. Conclusion: All three courses of action are equally valid and justified. For effective and comprehensive interventions, professionals must be well-versed in the three courses of action, ensuring tailored support that addresses the unique needs of these children and their caregiver(s).