Abstract
Gait disturbances are common in children and adolescents with cerebral palsy (CP). Robotic-assisted gait training (RAGT) is becoming increasingly widespread, and hence it is important to examine its effectiveness. A network meta-analysis (NMA) of clinical trials comparing treatments with RAGT vs. other physical therapy treatments was carried out. This study was conducted according to the NMA version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines and following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The outcome variables used were the D and E dimensions of the Gross Motor Function Measure (GMFM), gait speed, resistance, and stride length. Among 120 records, 8 trials were included. This NMA did not find statistically significant results for any of the comparisons examined in any of the outcomes studied and the magnitude of the effect size estimates was low or very low. Our NMA results should be interpreted with caution due to the high clinical heterogeneity of the studies included.
Highlights
Cerebral palsy (CP) refers to a group of movement and posture disorders caused by malformations or brain damage during early development, which limit activities of daily life and self-care
To be included in our meta-analysis, studies had to meet the following criteria: (a) randomized controlled trials (RCTs) or controlled clinical trials (CCTs) as study designs; (b) samples of children and adolescents with CP; (c) treated with robotic gait training devices; (d) studies published up to March 2020; (e) written in English, Spanish, or French; (f) studies had to provide the necessary statistical data to calculate effect sizes; and (g) the sample had to include at least 5 subjects in each study group at the end of the intervention period(this threshold is frequently used in systematic reviews and meta-analyses on treatment effectiveness, in order to prevent making very imprecise effect estimates and to reduce the risk of confounding)
Med. 2021, 10, x FOR PEER REVaInEWd screening, 27 full-text articles were evaluated for possible eligi5boifli1t5y, of which 8 articles were included in the network meta-analysis (NMA) [28,29,30,31,32,33,34,35] (Figure 1)
Summary
Cerebral palsy (CP) refers to a group of movement and posture disorders caused by malformations or brain damage during early development, which limit activities of daily life and self-care. The prognosis of gait is mainly determined by the acquisition of certain gross motor patterns and the age at which they are reached, which are essential determinant of the development of independent walking [4]. An early and focused intervention strategy is recommended for CP and should be the standard of care to optimize neuroplasticity, prevent complications, and improve the functional abilities, participation, and quality of life of the child, as well as the well-being of the caregiver [5,6]. Children and adolescents with CP usually present alterations in body movement patterns, with impaired gait, which negatively affect their health and their ability to interact with their peers [7]. Several treatment options are available from physiotherapy, including walking on the ground and on a treadmill with partial weight bearing [8]
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