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Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis
Barbara R Lucas1,2,3,4, Elizabeth J Elliott5,6,7, Sarah Coggan6,8
1Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. blucas@georgeinstitute.org.au.
Insights
Conservative interventions show potential for improving gross motor skills in children with developmental coordination disorder or cerebral palsy, but evidence quality is very low. More high-quality trials are needed to confirm effectiveness.
Area of Science:
- Pediatrics
- Developmental Neuroscience
- Rehabilitation Medicine
Background:
- Gross motor skills are crucial for child development.
- Effectiveness of physical therapy for mild-to-moderate gross motor disorders is unclear.
- Systematic review to assess conservative interventions for neurodevelopmental disorders.
Purpose of the Study:
- To systematically review literature on conservative interventions for gross motor disorders in children.
- To evaluate the effectiveness of non-pharmacological, non-surgical treatments.
- To synthesize evidence for children with conditions like DCD and CP.
Main Methods:
- Systematic review and meta-analysis of randomized controlled trials.
- Searched multiple databases (MEDLINE, EMBASE, Cochrane, etc.) and registries.
- Included children aged 3-18 with DCD, CP (GMFCS Level 1), or other neurodevelopmental conditions.
Main Results:
- Nine trials involving children with CP or DCD met inclusion criteria.
- Only two trials showed a treatment effect.
- Pooled analysis showed a large effect (SMD: -0.8) with very low quality evidence, or no effect (SMD: -0.1) with low quality evidence.
Conclusions:
- Task-oriented interventions may improve gross motor outcomes in children with DCD or CP.
- Findings are limited by the very low quality of available evidence.
- High-quality intervention trials are urgently needed to confirm effectiveness.
Background:
Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders.
Methods:
A systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively.
Results:
Of 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to -0.5) with "very low quality" GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with "low quality" GRADE ratings. Study limitations included the small number and poor quality of the available trials.
Conclusion:
Although we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.
