Situational Ethics of Study Designs for Orthopaedic Surgery Interventions in Children With Cerebral Palsy

Tamer A. El-Sobky, MD; Mohamed El-Sayed, MD


Curr Orthop Pract. 2019;30(2):178-180. 

In This Article

Abstract and Introduction


Cerebral palsy (CP) is one of the world's leading causes of childhood disability. The health burden of CP on the low-resource countries is specifically heavy. Motor underdevelopment is an essential feature of children with CP. In CP the neurologic insult is primary and permanent while the orthopaedic lesions are secondary and progressive. Most clinical research efforts in CP are thus directed at optimizing the physical rehabilitation protocols and orthopaedic care.[1,2] In human experimentation and from a purely technical standpoint, ethical considerations seem to be at odds with the credibility of evidence extracted. Contrastingly, in animal experimentation ethical considerations do not present appreciable obstacles to obtaining well-grounded and generalizable evidence. Nevertheless, animal experimentation is assumed only to give clues to human disease mechanisms and their possible cure pathways. Randomized controlled trials (RCTs) rank the best of all primary study designs regarding the validity of extracted evidence. When RCTs are put into practice, they are fraught with considerable limitations and can be unworkable nonetheless.[3] Such unworkability may result from socioeconomic, cultural, ethical or logistic challenges especially in children with CP. Consequently, this may negatively affect the level of extracted evidence. The aim of this mini-review was to look at the ethical limitations of various study designs used in CP research. The mini-review will focus on interventions related to the musculoskeletal system. Additionally, the study intends to explore the common grounds between ethics and evidence and suggests a practical management strategy.