The U.S. government’s Agency for Healthcare Research and Quality (AHRQ) serves as a focal point in the U.S. government for assessing the status and quality of health care practices. Through its Evidence-Based Practice Centers, it sponsors the development of evidence reports and technology assessments to assist public-private sector organizations in their efforts to improve the quality of health care in the United States. The reports prepared by its designated centers undergo peer review by experts in the area prior to their release.

Report #85 addressing the evidence on the efficacy of “Hyperbaric Oxygen Therapy for Brain Injury, Cerebral Palsy, and Stroke” was prepared by a team at the Oregon Health & Science University Evidence-based Practice Center; Portland, Oregon. The evaluation team reviewed the world literature on the subject and interviewed family members of persons with cerebral palsy. Its deliberations were enriched by a technical expert advisory group composed of 8 clinicians and scientists. The draft of its Report was then reviewed by 21 national leaders in the field prior to its submission to AHRQ. A copy of Report #85 is available on the AHRQ Web site or by writing to:

Center for Practice and Technology Assessment
Agency for Healthcare Research and Quality
540 Gaither Road
Rockville, MD 20850

The following is the published summary of the Report’s findings on hyperbaric oxygen therapy (HBOT) and cerebral palsy as presented on pages 5-6 of the Report:

• “There is insufficient evidence to determine whether the use of HBOT improves functional outcomes in children with cerebral palsy. (emphasis added) The results of the only truly randomized trial were difficult to interpret because of the use of pressurized room air in the control group. As both groups improved, the benefit of pressurized air and HBOT at 1.3-1.5 atm should both be examined in future studies.
• The only other controlled study compared HBOT treatments with 1.5 atm to delaying treatment for 6 months. As in the placebo controlled study, significant improvements were seen, but there was not a significant difference between groups.
• Two fair-quality uncontrolled studies (one time-series, one before-after) found improvements in functional status comparable to the degree of improvement seen in both groups in the controlled trial.
• Although none of the studies adequately measured caregiver burden, study participants often noted meaningful reductions in caregiver burden as an outcome of treatment.”

The Report also discusses the information available about the adverse effects of HBOT and methods for evaluating the effects of HBOT; in addition, it suggests studies that are needed to better understand the role of HBOT in the treatment of these neurological disorders including cerebral palsy.

Comment:

This Report of the AHQR reinforces the Foundation’s previous conclusion that information about the efficacy of HBOT for cerebral palsy does not at this time meet the criteria established for evidence-based clinical practice. Both basic science and well designed clinical studies are needed before a meaningful conclusion can be made about the possible role of HBOT in cerebral palsy. The Foundation is stimulating the conduct of such studies.