Individualized orthotic alignment and footwear for balance and mobility in children with bilateral spastic cerebral palsy: A randomized trial.

Only 19 children finished the study, and 15 of them were boys, a bigger skew than the roughly 60% of males in the cerebral palsy population. No one measured how long the braces and shoes were actually worn, so the difference between groups could come from different wear time rather than the devices themselves. The braces and shoes the children used before the study were not controlled, which could bias how either intervention performed. Seven of the 19 children took part during COVID-19 restrictions, and the authors say this limited daily mobility and may have affected parental perceptions and wear time. The physiotherapist who scored balance knew which brace each child had, so bias in that measure is possible. The study could not say whether the brace was optimal for any individual child. Only the first three months are reported, before the waitlist group crossed over, so nothing is said about longer-term use or about the second phase.

The text supplied contains no funding or conflict-of-interest statement. All orthoses were fabricated by Cascade Orthotics (Bellingham, WA, USA) and the study supplied standardized DC high-top skate shoes; how the design, conduct and reporting of the trial were funded is not stated in the material available.

Do not read this as proof that custom-aligned braces and modified shoes work better in general. The two groups differed in two things at once, the alignment of the brace and the modification of the shoes, so nothing here says which of them produced the balance difference. With only 19 children, no measure of how long the devices were actually worn, and a balance tester who knew which brace each child had, the size of the effect is not settled.