Graduate Program in Rehabilitation Sciences, Universidade Federal de Minas Gerais (UFMG), Belo Horizonte, MG, Brazil.
Hospital Foundation of Minas Gerais State (FHEMIG), Hippotherapy Center of the Alferes Tiradentes Cavalry Regiment (CERCAT), Belo Horizonte, MG, Brazil.
Braz J Phys Ther. 2020 Jul-Aug;24(4):295-305. doi: 10.1016/j.bjpt.2019.04.005. Epub 2019 May 3.
Improvement of postural control in children and adolescents with cerebral palsy is a primary goal in child rehabilitation.
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.
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.
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.
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.
改善脑瘫儿童和青少年的姿势控制是儿童康复的主要目标。
系统评价研究了平衡训练干预与其他主动干预相结合是否能增强主动干预对脑瘫儿童和青少年姿势控制的单独效果。
在 MEDLINE、PEDro、CINAHL、Cochrane 和 EMBASE 数据库中进行了无日期和语言限制的检索。纳入了研究平衡训练干预与其他主动干预相结合对脑瘫儿童和青少年姿势控制影响的随机对照试验。两名独立的审查员筛选研究、提取数据，并评估纳入研究的方法学质量。对符合条件的研究进行了荟萃分析，并按照 GRADE 方法评估证据质量。使用标准化均数差和 95%置信区间呈现汇总数据。
本综述纳入了 7 项涉及 194 名参与者的研究。在短期（标准化均数差为 1.3；95%置信区间为 0.5，2.0，p=0.001），平衡训练干预与神经发育治疗相结合对姿势控制有较大的额外效果。由于发表偏倚、不精确性和不一致性，证据质量非常低。
平衡训练干预与其他主动干预相结合可能在短期内增强对该人群姿势控制的效果。由于估计的效果仅具有非常低质量的证据支持，因此需要进行风险低偏倚的更大规模研究。
