Effectiveness of Rehabilitation Interventions on Participation in Children and Adolescents With Unilateral Cerebral Palsy: A Systematic Review and Meta-Analysis

Abstract

Objective

To determine the effectiveness of rehabilitation interventions on participation outcomes in daily living, leisure, social, and educational contexts for children and adolescents with unilateral cerebral palsy (UCP), and to identify whether specific intervention categories yield superior participation improvements.

Data Sources

MEDLINE via PubMed, Physiotherapy Evidence Database, Cochrane Library, CINAHL, and Scopus were searched from inception to July 31, 2025, for randomized controlled trials (RCTs), non-RCTs, and single-arm pre–post studies involving participants aged 18 months to 18 years with UCP, rehabilitation interventions, and standardized participation measures.

Study Selection

After screening 417 records, 23 studies (19 RCTs and 4 pre–post designs; total N=840) met inclusion criteria.

Data Extraction

Two independent reviewers extracted study characteristics and participation outcomes. Risk of bias was assessed via Risk of Bias 2.0 and Risk Of Bias In Nonrandomized Studies of Interventions-I; certainty of evidence was judged using Grading of Recommendations Assessment, Development and Evaluation.

Data Synthesis

Pooled pre–post analyses using a random-effects model (Restricted Maximum Likelihood) showed a standardized mean difference of 1.44 (95% CI: 0.95-1.92), indicating strong within-group participation improvements; however, certainty of evidence was low because of methodological limitations and high heterogeneity (I²=95%). Secondary analyses showed no significant superiority for constraint-induced movement therapy (standardized mean difference=−0.09; I²=0%), technology-assisted interventions (standardized mean difference=0.15; I²=56%), or bimanual therapy (standardized mean difference=0.69; I²=88%).

Conclusions

Rehabilitation interventions yield substantial pre–post participation gains in children and adolescents with UCP; no specific modality showed clear superiority. Intervention characteristics may be key drivers. Future RCTs with active comparators and standardized, participation-focused protocols are needed.