Title Page
Contents
ABSTRACT 13
I. INTRODUCTION 15
A. Background 15
B. Purpose of Study 20
C. Hypotheses 21
D. Definition of Terms 22
II. LITERATURE REVIEWS 24
A. Cerebral palsy gait training 24
B. Cerebral palsy gross motor function, gait parameter, endurance 37
III. METHODS 48
A. Experimental Design 48
B. Selection of studies 49
C. Methodological evaluation 51
D. Data extraction and analysis 52
IV. RESULTS 54
A. Study selection and characteristics 54
B. Risk of bias assessment 56
C. General characteristics of subject research 59
D. Meta- analysis 64
1. Total size of effect 72
2. Effect size according to rehabilitation intervention type 93
V. DISCUSSION 102
A. Discussion of overall effect size 104
B. Discussion of effect size for rehabilitation intervention program 109
C. Assessment of the quality of selected literature 113
D. Research limitations 115
VI. CONCLUSION 116
REFERENCES 117
APPENDICES 129
APPENDIX 1. SEARCH STRATEGY 129
APPENDIX 2. FINAL SELECTION PAPERS 135
APPENDIX 3. RISK OF BIAS ASSESSMENT (FINAL STUDIES) 139
Table 1. Classification of gait parameters 24
Table 2. Studies on cerebral palsy gait training 27
Table 3. Studies of cerebral palsy gross motor function, gait parameter, endurance 39
Table 4. Selection of studies 49
Table 5. Descriptive Summary of Included Studies 61
Table 6. Included Studies of Meta- analysis 65
Table 7. Gait parameter, Gross motor function, Gait endurance Effect size 92
Table 8. Rehabilitation intervention Characteristics 93
Figure 1. PRISMA flow diagram 55
Figure 2. Risk of bias summary 57
Figure 3. Risk of bias graph 58
Figure 4. Forest plots of the effects on GMFM 72
Figure 5. Funnel plots of the effects on GMFM 72
Figure 6. Forest plots of the effects on GMFM D 73
Figure 7. Funnel plots of the effects on GMFM D 73
Figure 8. Forest plots of the effects on GMFM E 74
Figure 9. Funnel plots of the effects on GMFM E 74
Figure 10. Forest plots of the effects on gait speed 75
Figure 11. Funnel plots of the effects on gait speed 76
Figure 12. Forest plots of the effects on stride length 77
Figure 13. Funnel plots of the effects on stride length 77
Figure 14. Forest plots of the effects on cadence 78
Figure 15. Funnel plots of the effects on cadence 78
Figure 16. Forest plots of the effects on cycle time 79
Figure 17. Funnel plots of the effects on cycle time 79
Figure 18. Forest plots of the effects on step length 80
Figure 19. Funnel plots of the effects on step length 80
Figure 20. Forest plots of the effects on 6MWT 81
Figure 21. Funnel plots of the effects on 6MWT 81
Figure 22. Funnel plots of the effects on gait speed (Before trim-and-fill) 83
Figure 23. Funnel plots of the effects on gait speed (After trim-and-fill) 83
Figure 24. Funnel plots of the effects on stride length (Before trim-and-fill) 84
Figure 25. Funnel plots of the effects on stride length (After trim-and-fill) 84
Figure 26. Funnel plots of the effects on cycle time (Before trim-and-fill) 85
Figure 27. Funnel plots of the effects on cycle time (After trim-and-fill) 85
Figure 28. Gradepro evidence assessment (gross motor function) 87
Figure 29. Gradepro evidence assessment (gait parameters) 89
Figure 30. Gradepro evidence assessment (gait endurance) 90
Figure 31. Forest plots of the effects on gait speed (gait training) 94
Figure 32. Funnel plots of the effects on gait speed (gait training) 95
Figure 33. Forest plots of the effects on stride length (gait training) 95
Figure 34. Funnel plots of the effects on stride length (gait training) 96
Figure 35. Forest plots of the effects on gait speed (Resistance training) 97
Figure 36. Funnel plots of the effects on gait speed (Resistance training) 97
Figure 37. Forest plots of the effects on balance training 98
Figure 38. Funnel plots of the effects on balance training 98
Figure 39. Funnel plots of the effects on gait training- gait speed (Before trim-and-fill) 100
Figure 40. Funnel plots of the effects on gait training- gait speed (After trim-and-fill) 100
Figure 41. Funnel plots of the effects on gait training- stride length (Before trim-and-fill) 101
Figure 42. Funnel plots of the effects on gait training- stride length (After trim-and-fill) 101