Physical therapy interventions to improve sitting ability in children with or at-risk for cerebral palsy: a systematic review and meta-analysis.

Inamdar, Ketaki; Molinini, Rebecca M; Panibatla, Siva Tejaa; Chow, Jason C; Dusing, Stacey C

AIM To conduct a systematic review and meta-analysis on the effectiveness of physical therapy interventions to improve sitting ability in young children with or at risk for cerebral palsy (CP). METHOD A systematic literature search was performed using five databases. Study selection criteria were randomized controlled trials published in English on physical therapy interventions targeting sitting, reporting developmental or functional sitting outcomes, and focused on young children with or at risk for CP (mean age ≤5y). Risk of bias (ROB) was assessed using the Cochrane ROB 2.0 tool. RESULTS Twelve unique studies met the inclusion criteria and were categorized into one of two categories: (1) comparison of two physical therapy interventions or (2) physical therapy plus adjunct versus physical therapy alone. The combined pooled effect size (g) for the 10 studies included in meta-analysis was large (g=0.78) but non-significant. Pooled effect for category 1 was small (g=-0.06) and non-significant. Interventions in category 2 showed a large and significant effect (g=1.90, p=0.022). INTERPRETATION There is a lack of strong evidence for physical therapy interventions targeting sitting in young children with or at-risk for CP due to limitations in methodological rigor and sample sizes. Components of impairment remediation combined with functional balance training should be explored to improve sitting in children diagnosed with CP. Given the benefits of early achievement of sitting, strong evidence-based research is needed.