Effectiveness of Rehabilitation Interventions on Participation in Children and Adolescents With Unilateral Cerebral Palsy: A Systematic Review and Meta-Analysis.

The studies did not report functional severity consistently, so the authors could not examine whether results differ according to how severely affected a child is. All 19 randomised trials compared two active rehabilitation approaches and no study used a no-treatment control group, so the improvement seen before and after therapy could reflect natural development, other therapy or simply the passage of time. Participation was nearly always measured by asking the child or family, and neither participants nor therapists could be blinded, so expectations could have pushed scores up. Heterogeneity was considerable in the main analysis and in the bimanual analysis, meaning the studies were not all measuring the same thing. Egger's test suggested publication bias; small studies with positive results are more likely to be published. Follow-up was inconsistent or absent, so nothing is known about whether any gains last. The four single-arm studies were rated at serious risk of bias because they had no comparison group, and the authors rated certainty of the evidence low or very low throughout.

The investigators declared no financial or nonfinancial disclosures in relation to this project. The paper reports no external funder and no sponsor role in the design, analysis or writing.

Do not read the improvement after rehabilitation as proof that any particular therapy works. Every randomised trial compared two active treatments, no study had a no-treatment group, and the authors rated the certainty of the evidence low or very low.