title: Prognostic predictors for ambulation in children with cerebral palsy: a systematic review and meta-analysis of observational studies.
abstract: OBJECTIVE
  The purpose of this study is to investigate the prognostic predictors for ambulation in children with cerebral palsy using meta-analysis of observational studies.
  
  
  METHODS
  Electronic searches were conducted in PubMed, SCOPUS, CINAHL, ProQuest, Ovid, Wiley InterScience, and ScienceDirect databases from their start dates to December 2015.
  
  
  RESULTS
  Of the 1123 identified articles, 12 met the inclusion criteria for qualitative synthesis, eight of which were deemed appropriate for meta-analysis. Qualitative synthesis found that the type of cerebral palsy, early motor milestones, primitive reflexes and postural reactions, absence of visual impairment, absence of intellectual disability, absence of epilepsy or seizure, and ability to feed self were indicated as potential predictors for ambulation. Meta-analysis detected four significant prognostic predictors for ambulation: sitting independently at 2 years, absence of visual impairment, absence of intellectual disability, and absence of epilepsy or seizure.
  
  
  CONCLUSIONS
  These prognostic predictors should be taken into consideration in therapeutic plans and rehabilitation goals, especially sitting independently before the age of 2 years. Implications for rehabilitation The meta-analysis supports strong evidence that sitting independently at 2 years of age, absence of visual impairment, absence of intellectual disability, and absence of epilepsy or seizure are positive predictors for ambulation in children with cerebral palsy. The therapeutic plans and rehabilitation goals should be considered cautiously for these predictors, especially sitting independently before the age of two years.
authors.affiliation: a Clinical Epidemiology Program, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.|b Faculty of Public Health , Naresuan University , Phitsanulok , Thailand.
authors.forename: Orawan
authors.initials: O
authors.lastname: Keeratisiroj
authors.affiliation: c Department of Physical Therapy, Faculty of Associated Medical Sciences , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Nuanlaor
authors.initials: N
authors.lastname: Thawinchai
authors.affiliation: d Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH) , Khon Kaen University , Khon Kaen , Thailand.
authors.forename: Wantana
authors.initials: W
authors.lastname: Siritaratiwat
authors.affiliation: e Department of Rehabilitation Medicine, Faculty of Medicine , Chiang Mai University , Chiang Mai , Thailand.
authors.forename: Montana
authors.initials: M
authors.lastname: Buntragulpoontawee
authors.affiliation: b Faculty of Public Health , Naresuan University , Phitsanulok , Thailand.
authors.forename: Chayanin
authors.initials: C
authors.lastname: Pratoomsoot
mesh_terms: D002547:Cerebral Palsy / Q000503:physiopathology / Q000534:rehabilitation; D002648:Child; D006801:Humans; D008607:Intellectual Disability / Q000175:diagnosis; D009048:Motor Skills; D010347:Patient Care Planning; D011379:Prognosis; D014786:Vision Disorders / Q000175:diagnosis*; D016138:Walking
keywords: Cerebral palsy; meta-analysis; prognosis; systematic review; walking