Active mobility, active participation: a systematic review of modified ride-on car use by children with disabilities.

Seventeen of the included studies were at the lowest evidence level (IV or V), and the three Level III studies were rated as weak. No study reported effect sizes, and most did not use the same outcome measures, so results cannot be compared across studies. Sample sizes were small (1 to 29 children per study, with one exception of 74), and parents who self-select to participate in MROC studies are likely very proactive with therapy, making it impossible to conclude that observed changes were due to the MROC alone. Eight of the 23 included articles came from just four underlying studies (each published as two papers), which slightly overestimates the number of unique studies. The authors acknowledge they are themselves contributors to MROC research, which may introduce bias in interpretation. Only English-language studies were included, and the authors note that publication bias may mean only studies with meaningful results were published.

Authors report no financial or other conflict of interest. They acknowledge that they are contributors to MROC research and that this may introduce bias in interpreting the included studies.

Do not read the positive outcomes (mobility gains, social interaction, parent satisfaction) as proof that MROCs cause these changes. The evidence is almost entirely case series and case reports with small samples, no effect sizes, and no randomization. The authors themselves state that the low quality of evidence makes it difficult to draw confident conclusions about the true effect of MROC interventions.