Combining balance-training interventions with other active interventions may enhance effects on postural control in children and adolescents with cerebral palsy: a systematic review and meta-analysis

Abstract

Background: Improvement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation.

Objective: A systematic review investigated whether combining balance-training interventions with other active interventions enhances the effects of the active intervention alone on postural control of children and adolescents with cerebral palsy.

Methods: Searches were performed in MEDLINE, PEDro, CINAHL, Cochrane and EMBASE databases without date or language restrictions. Randomized controlled trials investigating the combination of balance-training interventions with other active interventions on the postural control of children and adolescents with cerebral palsy were included. Two independent reviewers screened studies, extracted data, and assessed methodological quality of included studies. Meta-analysis was conducted, and quality of the evidence followed the GRADE methodology. Pooled data were presented using standardized mean difference and 95% confidence interval.

Results: Seven studies involving 194 participants were included in this review. A large additional effect on postural control was found when balance-training interventions were combined with Neurodevelopmental Treatment at short-term (standardized mean difference of 1.3; 95% confidence interval 0.5, 2.0, p=0.001). The quality of the evidence was very low due to publication bias, imprecision and inconsistency.

Conclusion: Combining balance-training interventions with other active interventions may enhance effects on postural control of this population at short-term. As the estimated effect had only very low quality of evidence to support it, larger studies with low risk of bias are needed.

Keywords: Balance-training interventions; Cerebral palsy; Meta-analysis; Postural control; Rehabilitation; Systematic review.

Copyright © 2019 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. Publicado por Elsevier Editora Ltda. All rights reserved.

Figures

Figure 1

Flow of studies in the review.

Figure 2

Pooling data showing a short-term additional effect of balance-training interventions (BTI) to other active intervention (i.e. NDT) (n = 194 participants).

Figure 3

Sensitivity analysis (removing poor-quality studies, PEDro n = 134 participants).