Physical therapy for deficits associated with chemotherapy induced peripheral neuropathy in children with cancer: a systematic review

Background: Chemotherapy-induced peripheral neuropathy (CIPN) is a frequent side effect in children undergoing chemotherapy, causing impairments that often lead to limitations in daily activities and restrictions in participation. Physical therapy (PT) may help maintain and restore the physical function impaired by CIPN, as well as maximize independence in daily life activities. Although, there is a paucity of high-quality studies evaluating PT interventions for CIPN as a clinical entity in the pediatric population, some studies have examined PT interventions for impairments and symptoms resulting from CIPN. This review aims to synthesize the evidence on PT interventions for CIPN symptoms and deficits in children with cancer. Methods: A systematic review was conducted with the following PICOS (population, intervention, comparison intervention, outcomes, study design) approach: children with cancer, PT interventions, control group or standard care, and randomized controlled trials (RCTs) and controlled clinical trials (CCTs) comprising CIPN symptoms and deficits, range of motion, muscle strength, motor function, balance, gait, functional mobility, foot posture, pain, and adverse events outcomes. Searches were conducted in five electronic databases (Medline, Embase, CINAHL, CENTRAL, and Scopus), reference lists, grey literature, and clinical trial websites in February 2024. Two authors reviewed the studies, extracted information, and appraised the quality using the Cochrane risk-of-bias tool for randomized trials (RoB-2). Outcomes were analyzed descriptively. Results: Nine full-text studies met the inclusion criteria, including a total of 439 participants. Six studies were RCTs, one was a pilot RCT with preliminary results only, one was a CCT, and one was a pilot CCT. The quality appraisal revealed that all studies had a high risk of bias. None of the studies included a measure of CIPN symptoms and deficits (primary outcome); however, all studies included at least one outcome that assessed an impairment resulting from CIPN. Although we found benefits for some physical function outcomes, given the heterogeneity of interventions, the evidence is not at a stage to provide recommendations for clinical practice. Conclusions: There is a lack of high-quality research focused on CIPN in children living with, and beyond cancer. Consensus on a core outcome set to measure CIPN in children would allow for comparison of findings across future studies.