title: Interventions to improve gross motor performance in children with neurodevelopmental disorders: a meta-analysis.
abstract: Gross motor skills are fundamental to childhood development. The effectiveness of current physical therapy options for children with mild to moderate gross motor disorders is unknown. The aim of this study was to systematically review the literature to investigate the effectiveness of conservative interventions to improve gross motor performance in children with a range of neurodevelopmental disorders.
  
  
  
  A systematic review with meta-analysis was conducted. MEDLINE, EMBASE, AMED, CINAHL, PsycINFO, PEDro, Cochrane Collaboration, Google Scholar databases and clinical trial registries were searched. Published randomised controlled trials including children 3 to ≤18 years with (i) Developmental Coordination Disorder (DCD) or Cerebral Palsy (CP) (Gross Motor Function Classification System Level 1) or Developmental Delay or Minimal Acquired Brain Injury or Prematurity (<30 weeks gestational age) or Fetal Alcohol Spectrum Disorders; and (ii) receiving non-pharmacological or non-surgical interventions from a health professional and (iii) gross motor outcomes obtained using a standardised assessment tool. Meta-analysis was performed to determine the pooled effect of intervention on gross motor function. Methodological quality and strength of meta-analysis recommendations were evaluated using PEDro and the GRADE approach respectively.
  
  
  
  Of 2513 papers, 9 met inclusion criteria including children with CP (n = 2) or DCD (n = 7) receiving 11 different interventions. Only two of 9 trials showed an effect for treatment. Using the least conservative trial outcomes a large beneficial effect of intervention was shown (SMD:-0.8; 95% CI:-1.1 to -0.5) with "very low quality" GRADE ratings. Using the most conservative trial outcomes there is no treatment effect (SMD:-0.1; 95% CI:-0.3 to 0.2) with "low quality" GRADE ratings. Study limitations included the small number and poor quality of the available trials.
  
  
  
  Although we found that some interventions with a task-orientated framework can improve gross motor outcomes in children with DCD or CP, these findings are limited by the very low quality of the available evidence. High quality intervention trials are urgently needed.
authors.affiliation: Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia. blucas@georgeinstitute.org.au.|The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia. blucas@georgeinstitute.org.au.|Poche Centre for Indigenous Health, Sydney School of Public Health, The University of Sydney, Sydney, NSW, 2006, Australia. blucas@georgeinstitute.org.au.|Physiotherapy Department, Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia. blucas@georgeinstitute.org.au.
authors.forename: Barbara R
authors.initials: BR
authors.lastname: Lucas
authors.affiliation: Discipline of Paediatrics and Child Health, The University of Sydney, The Children's Hospital at Westmead, Clinical School, Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.|The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia.|The Sydney Children's Hospital Networks (Westmead), Locked Bag 4001, Westmead, Sydney, NSW, 2145, Australia.
authors.forename: Elizabeth J
authors.initials: EJ
authors.lastname: Elliott
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia.|School of Public Health, Curtin University, GPO Box U1987, Perth, WA, 6845, Australia.
authors.forename: Sarah
authors.initials: S
authors.lastname: Coggan
authors.affiliation: Pain Management Research Institute, University of Sydney at Royal North Shore Hospital, St Leonards, Sydney, NSW, 2065, Australia.|Departamento de Fisioterapia, Faculdade de Ciências e Tecnologia, UNESP-Univ Estadual Paulista, Presidente Prudente, SP, 19060-900, Brazil.
authors.forename: Rafael Z
authors.initials: RZ
authors.lastname: Pinto
authors.affiliation: Division of Occupational Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195, USA.
authors.forename: Tracy
authors.initials: T
authors.lastname: Jirikowic
authors.affiliation: Division of Physical Therapy, Department of Rehabilitation Medicine, University of Washington, Seattle, WA, 98195, USA.
authors.forename: Sarah Westcott
authors.initials: SW
authors.lastname: McCoy
authors.affiliation: The George Institute for Global Health, Sydney Medical School, University of Sydney, PO Box M201, , Missenden Rd, Sydney, NSW, 2050, Australia.
authors.forename: Jane
authors.initials: J
authors.lastname: Latimer
mesh_terms: D001930:Brain Injuries / Q000534:rehabilitation; D002547:Cerebral Palsy / Q000534:rehabilitation*; D002648:Child; D002658:Developmental Disabilities / Q000534:rehabilitation*; D063647:Fetal Alcohol Spectrum Disorders / Q000534:rehabilitation*; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007235:Infant, Premature, Diseases / Q000534:rehabilitation*; D009048:Motor Skills; D019957:Motor Skills Disorders / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D016896:Treatment Outcome
keywords: Cerebral palsy; Child development; Developmental Coordination Disorder; Motor skills; Motor skills disorders; Neurodevelopmental disorders; Physiotherapy