Effectiveness of therapeutic exercise programs on balance and gait in children and adolescents with unilateral cerebral palsy: A systematic review and meta-analysis of randomized controlled trials.
María Martínez-Olagüe Jácome, Patricia Domínguez-López, Raquel Rodrigo-Masanet et al.
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In 30 seconds
This systematic review and meta-analysis of randomized controlled trials assessed therapeutic exercise programs for balance and gait in children and adolescents aged 2–18 years with unilateral cerebral palsy. Thirteen trials were included. Exercise had a significant moderate pooled effect on balance (SMD = 0.61; 95% CI: 0.38 to 0.83; I² = 0.003%). The pooled effect on gait was moderate but not statistically significant (SMD = 0.51; 95% CI: -0.22 to 1.23), with high heterogeneity (I² = 91.1%). Analyses also suggested a dose-response relationship for balance.
Key findings
- Exercise programs improved balance with a moderate pooled effect (SMD = 0.61; 95% CI: 0.38 to 0.83; I² = 0.003%).
- The pooled gait effect was moderate but not significant (SMD = 0.51; 95% CI: -0.22 to 1.23), with high heterogeneity (I² = 91.1%).
- Meta-regression indicated a positive dose-response relationship for balance.
- Subgroup analyses suggested larger balance effects with non-plyometric training and larger gait effects with plyometric training.
Why it matters
Balance is a relevant rehabilitation outcome for young people with unilateral cerebral palsy, and this synthesis finds evidence of benefit from therapeutic exercise. The uncertain gait result cautions against assuming that balance gains translate into improved gait. Variation in gait findings also highlights the importance of considering intervention type and outcome when interpreting the evidence.
What to keep in mind
Gait results were highly heterogeneous and not statistically significant, limiting confidence in the pooled estimate. The abstract does not report the certainty ratings assigned by GRADE.