Effect of therapist-delivered task-oriented training on functional mobility and balance in children with cerebral palsy: a systematic review and meta-analysis

Abstract

AIM: This study is a systematic literature review and meta-analysis that aimed to explore and assess the effectiveness of physiotherapist-delivered task-oriented training on functional mobility and balance in children with cerebral palsy (CP).

METHOD: This is a systematic literature review in which the following electronic databases were searched in order to find and include relevant trials for the meta-analysis: CINAHL, Cochrane Library, EMBASE, MEDLINE, PEDro, PubMed and PsycINFO. Nine randomized clinical trials (RCT) were included in the study. Eight of the studies were included in a quantitative meta-analysis that was conducted on each measurement instrument using the RevMan 5.3 software. The included measurement instruments were Pediatric Balance Scale (PBS), Timed Up & Go (TUG), and Gross Motor Function Measure (GMFM) domains D & E. The standardised mean difference (SMD) and 95% confidence intervals (95%CI) were calculated and examined from pre- and post-test scores. The PRISMA (Preferred Reporting Items for Systematic reviews and Meta-Analyses statement) and the Cochrane Handbook for Systematic Reviews of Interventions were followed in order to ensure the best possible quality for this review.

RESULTS: A total of 253 children of 2 to 15 years old participated in eight RCTs that were included in the final meta-analysis. The experimental groups in each study received taskoriented training focusing on functional goal-directed tasks, while the control groups received physical therapy with a focus on facilitation and normalization of movement patterns, or passive stretching and range of motion exercises. The duration of the intervention varied from 4 weeks to 41 months, while the intensity range across the trials was between 6 times a week to approximately 3 times a month, single sessions varying from 45min to 1 hour. A significant effect of task-oriented training was observed from the scores in Pediatric Balance Scale (P=0.0003, Mean D 3.80) and Timed Up & Go -test (P=0.02, Mean D 1.98), while no statistical or clinical significance was observed in the scores of Gross Motor Function Measure D & E.

CONCLUSION: The results from the meta-analysis implicate a significant effect of task-oriented training in children with cerebral palsy when assessed in Pediatric Balance Scale and Timed Up & Go -test, when compared to other treatment methods used in the included trials. Improvements in functional mobility and balance in experimental and comparison groups were observed in all of the studies.