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Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis

BACKGROUND: A vital objective to treat people with cerebral palsy (CP) is to increase gait velocity and improve gross motor function. This study aimed to evaluate the relative effectiveness of gait training interventions for persons with CP. METHODS: Studies published up to October 26, 2022 were sea...

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Autores principales: Qian, Guoping, Cai, Xiaoye, Xu, Kai, Tian, Hao, Meng, Qiao, Ossowski, Zbigniew, Liang, Jinghong
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871496/
https://www.ncbi.nlm.nih.gov/pubmed/36703638
http://dx.doi.org/10.3389/fneur.2022.1005485
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author Qian, Guoping
Cai, Xiaoye
Xu, Kai
Tian, Hao
Meng, Qiao
Ossowski, Zbigniew
Liang, Jinghong
author_facet Qian, Guoping
Cai, Xiaoye
Xu, Kai
Tian, Hao
Meng, Qiao
Ossowski, Zbigniew
Liang, Jinghong
author_sort Qian, Guoping
collection PubMed
description BACKGROUND: A vital objective to treat people with cerebral palsy (CP) is to increase gait velocity and improve gross motor function. This study aimed to evaluate the relative effectiveness of gait training interventions for persons with CP. METHODS: Studies published up to October 26, 2022 were searched from four electronic databases [including Medline (via PubMed), Web of Science, Embase and Cochrane]. Studies with randomized controlled trials (RCTs), people with CP, comparisons of different gait training interventions and outcomes of gait velocity and gross motor function measures (GMFM) were included in this study. The quality of the literature was evaluated using the risk of bias tool in the Cochrane Handbook, the extracted data were analyzed through network meta-analysis (NMA) using Stata16.0 and RevMan5.4 software. RESULTS: Twenty RCTs with a total of 516 individuals with CP were included in accordance with the criteria of this study. The results of the NMA analysis indicated that both external cues treadmill training (ECTT) [mean difference (MD) = 0.10, 95% confidence interval CI (0.04, 0.17), P < 0.05] and partial body weight supported treadmill training (BWSTT) [MD = 0.12, 95% CI (0.01, 0.23), P < 0.05] had better gait velocity than over ground gait training (OGT), BWSTT [MD = 0.09, 95%CI(0.01,0.18), P < 0.05] had a better gait velocity than robot-assisted gait training (RAGT), BWSTT [MD = 0.09, 95% CI (0.06, 0.13) P < 0.05] had a better gait velocity than treadmill training (TT), and BWSTT [MD = 0.14, 95% CI (0.07, 0.21), P < 0.05] had a better gait velocity than conventional physical therapy (CON). The SUCRA ranking indicated that BWSTT optimally improved the gait velocity, and the other followed an order of BWSTT (91.7%) > ECTT (80.9%) > RAGT (46.2%) > TT (44%) > OGT (21.6%) > CON (11.1%). In terms of GMFM, for dimension D (GMFM-D), there was no statistical difference between each comparison; for dimension E (GMFM-E), RAGT [MD = 10.45, 95% CI (2.51, 18.40), P < 0.05] was significantly more effective than CON. Both SUCRA ranking results showed that RAGT improved GMFM-D/E optimally, with rankings of RAGT (69.7%) > TT (69.3%) > BWSTT (67.7%) > OGT (24%) > CON (20.3%), and RAGT (86.1%) > BWSTT (68.2%) > TT (58%) > CON (20.1%) > OGT (17.6%) respectively. CONCLUSION: This study suggested that BWSTT was optimal in increasing the gait velocity and RAGT was optimal in optimizing GMFM in persons with CP. Impacted by the limitations of the number and quality of studies, randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of gait ability in this population. SYSTEMATIC REVIEW REGISTRATION: https://doi.org/10.37766/inplasy2022.10.0108, identifier: INPLASY2022100108.
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spelling pubmed-98714962023-01-25 Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis Qian, Guoping Cai, Xiaoye Xu, Kai Tian, Hao Meng, Qiao Ossowski, Zbigniew Liang, Jinghong Front Neurol Neurology BACKGROUND: A vital objective to treat people with cerebral palsy (CP) is to increase gait velocity and improve gross motor function. This study aimed to evaluate the relative effectiveness of gait training interventions for persons with CP. METHODS: Studies published up to October 26, 2022 were searched from four electronic databases [including Medline (via PubMed), Web of Science, Embase and Cochrane]. Studies with randomized controlled trials (RCTs), people with CP, comparisons of different gait training interventions and outcomes of gait velocity and gross motor function measures (GMFM) were included in this study. The quality of the literature was evaluated using the risk of bias tool in the Cochrane Handbook, the extracted data were analyzed through network meta-analysis (NMA) using Stata16.0 and RevMan5.4 software. RESULTS: Twenty RCTs with a total of 516 individuals with CP were included in accordance with the criteria of this study. The results of the NMA analysis indicated that both external cues treadmill training (ECTT) [mean difference (MD) = 0.10, 95% confidence interval CI (0.04, 0.17), P < 0.05] and partial body weight supported treadmill training (BWSTT) [MD = 0.12, 95% CI (0.01, 0.23), P < 0.05] had better gait velocity than over ground gait training (OGT), BWSTT [MD = 0.09, 95%CI(0.01,0.18), P < 0.05] had a better gait velocity than robot-assisted gait training (RAGT), BWSTT [MD = 0.09, 95% CI (0.06, 0.13) P < 0.05] had a better gait velocity than treadmill training (TT), and BWSTT [MD = 0.14, 95% CI (0.07, 0.21), P < 0.05] had a better gait velocity than conventional physical therapy (CON). The SUCRA ranking indicated that BWSTT optimally improved the gait velocity, and the other followed an order of BWSTT (91.7%) > ECTT (80.9%) > RAGT (46.2%) > TT (44%) > OGT (21.6%) > CON (11.1%). In terms of GMFM, for dimension D (GMFM-D), there was no statistical difference between each comparison; for dimension E (GMFM-E), RAGT [MD = 10.45, 95% CI (2.51, 18.40), P < 0.05] was significantly more effective than CON. Both SUCRA ranking results showed that RAGT improved GMFM-D/E optimally, with rankings of RAGT (69.7%) > TT (69.3%) > BWSTT (67.7%) > OGT (24%) > CON (20.3%), and RAGT (86.1%) > BWSTT (68.2%) > TT (58%) > CON (20.1%) > OGT (17.6%) respectively. CONCLUSION: This study suggested that BWSTT was optimal in increasing the gait velocity and RAGT was optimal in optimizing GMFM in persons with CP. Impacted by the limitations of the number and quality of studies, randomized controlled trials with larger sample sizes, multiple centers, and high quality should be conducted to validate the above conclusion. Further studies will be required to focus on the total duration of the intervention, duration and frequency of sessions, and intensity that are optimal for the promotion of gait ability in this population. SYSTEMATIC REVIEW REGISTRATION: https://doi.org/10.37766/inplasy2022.10.0108, identifier: INPLASY2022100108. Frontiers Media S.A. 2023-01-10 /pmc/articles/PMC9871496/ /pubmed/36703638 http://dx.doi.org/10.3389/fneur.2022.1005485 Text en Copyright © 2023 Qian, Cai, Xu, Tian, Meng, Ossowski and Liang. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Neurology
Qian, Guoping
Cai, Xiaoye
Xu, Kai
Tian, Hao
Meng, Qiao
Ossowski, Zbigniew
Liang, Jinghong
Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis
title Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis
title_full Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis
title_fullStr Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis
title_full_unstemmed Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis
title_short Which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? A systematic review and network meta-analysis
title_sort which gait training intervention can most effectively improve gait ability in patients with cerebral palsy? a systematic review and network meta-analysis
topic Neurology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9871496/
https://www.ncbi.nlm.nih.gov/pubmed/36703638
http://dx.doi.org/10.3389/fneur.2022.1005485
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