Active upper-limb therapies for hand function, individual goal achievement, and self-care in children with cerebral palsy: A network meta-analysis

Abstract

AIM: To compare active upper-limb therapies for children with cerebral palsy using a network meta-analysis. METHOD: For this systematic review, five electronic databases were searched up to 2nd September 2024. Outcomes pertaining to improved hand use (Assisting Hand Assessment, AHA), goal attainment (Canadian Occupational Performance Measure, COPM), and self-care were analysed with therapies classified into 15 discrete categories. RESULTS: Quantitative analysis of 48 randomized controlled trials (n = 1629) was performed. Compared with control, treatment effect on hand function (AHA mean difference, standard error) was greater for bimanual therapy (BiM: 4.6, 1.0), modified constraint-induced movement therapy (mCIMT; 4.0, 1.0), goal-directed therapy (GDT; 3.8, 1.6), action observation (4.9, 1.1), and mCIMT + intensive (7.4, 2.5). For COPM performance, treatment effect was greater for cognitive orientation to occupational performance (CO-OP; 5.9, 1.4), BiM (3.3, 0.4), mCIMT (2.5, 0.5), GDT (2.3, 0.7), mirror therapy (2.6, 1.2), and mCIMT + GDT (4.2, 1.1). For self-care, treatment effect (standardized mean difference, standard error) was greater for BiM (0.39, 0.10), mCIMT (0.37, 0.08), and mCIMT + GDT (0.43, 0.32). INTERPRETATION: BiM and mCIMT were confirmed as effective interventions for hand function, self-care, and individual goal achievement. Mirror therapy, CO-OP, and four different combination approaches feature single studies, small sample sizes, and high risk of bias, requiring further clinical trials to confirm efficacy.