Effectiveness of Rehabilitation Interventions to Improve Gait Speed in Children With Cerebral Palsy: Systematic Review and Meta-analysis

Abstract

Background: Children with cerebral palsy (CP) have decreased gait speeds, which can negatively affect their community participation and quality of life. However, evidence for effective rehabilitation interventions to improve gait speed remains unclear.

Purpose: The purpose of this study was to determine the effectiveness of interventions for improving gait speed in ambulatory children with CP.

Data sources: MEDLINE/PubMed, CINAHL, ERIC, and PEDro were searched from inception through April 2014.

Study selection: The selected studies were randomized controlled trials or had experimental designs with a comparison group, included a physical therapy or rehabilitation intervention for children with CP, and reported gait speed as an outcome measure.

Data extraction: Methodological quality was assessed by PEDro scores. Means, standard deviations, and change scores for gait speed were extracted. General study information and dosing parameters (frequency, duration, intensity, and volume) of the intervention were recorded.

Data synthesis: Twenty-four studies were included. Three categories of interventions were identified: gait training (n=8), resistance training (n=9), and miscellaneous (n=7). Meta-analysis showed that gait training was effective in increasing gait speed, with a standardized effect size of 0.92 (95% confidence interval=0.19, 1.66; P=.01), whereas resistance training was shown to have a negligible effect (effect size=0.06; 95% confidence interval=-0.12, 0.25; P=.51). Effect sizes from negative to large were reported for studies in the miscellaneous category.

Limitations: Gait speed was the only outcome measure analyzed.

Conclusions: Gait training was the most effective intervention in improving gait speed for ambulatory children with CP. Strength training, even if properly dosed, was not shown to be effective in improving gait speed. Velocity training, electromyographic biofeedback training, and whole-body vibration were effective in improving gait speed in individual studies and warrant further investigation.

Figure 1.

Flowchart of study selection.

Figure 2.

Forest plot of standardized effect sizes (Hedges' g) and 95% confidence intervals (represented by error bars) for effects of gait training on gait speed. Overall effect size (g)=0.92; 95% confidence interval=0.19, 1.66; Z=2.45; P=.014. * Partial body-weight–supported treadmill training (experimental) vs overground walking (control). ^† Gait training with pedometer (experimental) vs gait training without pedometer (control). The relative weight of each study is illustrated by the size of the square symbol.

Figure 3.

Forest plot of standardized effect sizes (Hedges' g) and 95% confidence intervals (represented by error bars) for effects of resistance training on gait speed. Overall effect size (g)=0.06; 95% confidence interval=–0.12, 0.25; Z=0.66; P=.51. * Combined treatment groups; data pooled. ^† Velocity training (experimental) vs strength training (control). The relative weight of each study is illustrated by the size of the square symbol.