{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T21:18:01Z","timestamp":1788988681009,"version":"build-2803163510"},"reference-count":45,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2021,10,24]],"date-time":"2021-10-24T00:00:00Z","timestamp":1635033600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Agencia Estatal de Investigaci\u00f3n (Government of Spain) and FEDER Funds","award":["PID2019-104033GA-I00\/AEI\/10.13039\/501100011033."],"award-info":[{"award-number":["PID2019-104033GA-I00\/AEI\/10.13039\/501100011033."]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Gait disturbances are common in children and adolescents with cerebral palsy (CP). Robotic-assisted gait training (RAGT) is becoming increasingly widespread, and hence it is important to examine its effectiveness. A network meta-analysis (NMA) of clinical trials comparing treatments with RAGT vs. other physical therapy treatments was carried out. This study was conducted according to the NMA version of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA-NMA) guidelines and following the recommendations of the Cochrane Handbook for Systematic Reviews of Interventions. The outcome variables used were the D and E dimensions of the Gross Motor Function Measure (GMFM), gait speed, resistance, and stride length. Among 120 records, 8 trials were included. This NMA did not find statistically significant results for any of the comparisons examined in any of the outcomes studied and the magnitude of the effect size estimates was low or very low. Our NMA results should be interpreted with caution due to the high clinical heterogeneity of the studies included.<\/jats:p>","DOI":"10.3390\/jcm10214908","type":"journal-article","created":{"date-parts":[[2021,10,24]],"date-time":"2021-10-24T22:06:16Z","timestamp":1635113176000},"page":"4908","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Effects of Robotic-Assisted Gait Training in Children and Adolescents with Cerebral Palsy: A Network Meta-Analysis"],"prefix":"10.3390","volume":"10","author":[{"given":"Raquel","family":"Olmos-G\u00f3mez","sequence":"first","affiliation":[{"name":"International Doctoral School of the University of Murcia (EIDUM), University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonia","family":"G\u00f3mez-Conesa","sequence":"additional","affiliation":[{"name":"Research Group Research Methods and Evaluation in Social Sciences, Mare Nostrum Campus of International Excellence, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6213-4424","authenticated-orcid":false,"given":"Inmaculada","family":"Calvo-Mu\u00f1oz","sequence":"additional","affiliation":[{"name":"Department of Physiotherapy, Faculty of Health Sciences, Catholic University San Antonio of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jos\u00e9 A.","family":"L\u00f3pez-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Basic Psychology and Methodology, Faculty of Psychology, University of Murcia, 30100 Murcia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2021,10,24]]},"reference":[{"key":"ref_1","first-page":"8","article-title":"A Report: The Definition and Classification of Cerebral Palsy April 2006","volume":"109","author":"Rosenbaum","year":"2007","journal-title":"Dev. Med. Child Neurol. Suppl."},{"key":"ref_2","unstructured":"European Commission, and Joint Research Centre (2017). Surveillance of Cerebral Palsy in Europe: Development of the JRC SCPE Central Database and Public Health Indicators, Publications Office of the European Union."},{"key":"ref_3","doi-asserted-by":"crossref","unstructured":"te Velde, A., Morgan, C., Novak, I., Tantsis, E., and Badawi, N. (2019). Early Diagnosis and Classification of Cerebral Palsy: An Historical Perspective and Barriers to an Early Diagnosis. J. Clin. Med., 8.","DOI":"10.3390\/jcm8101599"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"786","DOI":"10.1111\/j.1469-8749.2003.tb00890.x","article-title":"Ambulatory Capacity in Cerebral Palsy: Prognostic Criteria and Consequences for Intervention","volume":"45","author":"Bottos","year":"2003","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"897","DOI":"10.1001\/jamapediatrics.2017.1689","article-title":"Early, Accurate Diagnosis and Early Intervention in Cerebral Palsy: Advances in Diagnosis and Treatment","volume":"171","author":"Novak","year":"2017","journal-title":"JAMA Pediatr."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"970","DOI":"10.1136\/bmj.326.7396.970","article-title":"Cerebral Palsy: What Parents and Doctors Want to Know","volume":"326","author":"Rosenbaum","year":"2003","journal-title":"BMJ"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e89","DOI":"10.1542\/peds.111.1.e89","article-title":"Classification and Definition of Disorders Causing Hypertonia in Childhood","volume":"111","author":"Sanger","year":"2003","journal-title":"Pediatrics"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1097\/NPT.0b013e31819800e2","article-title":"A Systematic Review of the Effectiveness of Treadmill Training and Body Weight Support in Pediatric Rehabilitation","volume":"33","author":"Damiano","year":"2009","journal-title":"J. Neurol. Phys. Ther."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1534","DOI":"10.1093\/ptj\/81.9.1534","article-title":"Effects of a Functional Therapy Program on Motor Abilities of Children with Cerebral Palsy","volume":"81","author":"Ketelaar","year":"2001","journal-title":"Phys. Ther."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"139","DOI":"10.1016\/j.spen.2013.06.006","article-title":"Robot-Assisted and Computer-Enhanced Therapies for Children with Cerebral Palsy: Current State and Clinical Implementation","volume":"20","year":"2013","journal-title":"Semin. Pediatr. Neurol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"2","DOI":"10.1186\/1743-0003-4-2","article-title":"Gait Rehabilitation Machines Based on Programmable Footplates","volume":"4","author":"Schmidt","year":"2007","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_12","first-page":"CD006185","article-title":"Electromechanical-Assisted Training for Walking after Stroke","volume":"10","author":"Mehrholz","year":"2020","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1002\/mds.21802","article-title":"Improved Gait Parameters after Robotic-Assisted Locomotor Treadmill Therapy in a 6-Year-Old Child with Cerebral Palsy","volume":"23","author":"Borggraefe","year":"2008","journal-title":"Mov. Disord. Off. J. Mov. Disord. Soc."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"2332","DOI":"10.1016\/j.apmr.2017.06.018","article-title":"Robotic Gait Training for Individuals With Cerebral Palsy: A Systematic Review and Meta-Analysis","volume":"98","author":"Carvalho","year":"2017","journal-title":"Arch. Phys. Med. Rehabil."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1186\/s12984-016-0214-x","article-title":"The Effectiveness of Robotic-Assisted Gait Training for Paediatric Gait Disorders: Systematic Review","volume":"14","author":"Lefmann","year":"2017","journal-title":"J. Neuroeng. Rehabil."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1007\/s11739-016-1583-7","article-title":"Network Meta-Analysis: An Introduction for Clinicians","volume":"12","author":"Rouse","year":"2017","journal-title":"Intern. Emerg. Med."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"777","DOI":"10.7326\/M14-2385","article-title":"The PRISMA Extension Statement for Reporting of Systematic Reviews Incorporating Network Meta-Analyses of Health Care Interventions: Checklist and Explanations","volume":"162","author":"Hutton","year":"2015","journal-title":"Ann. Intern. Med."},{"key":"ref_18","unstructured":"Higgins, J.P.T., Thomas, J., Chandler, J., Cumpston, M., Li, T., Page, M.J., and Welch, V.A. (2021). Chapter 3: Defining the Criteria for Including Studies and How They Will Be Grouped for the Synthesis. Cochrane Handbook for Systematic Reviews of Interventions version 6.2 (updated February 2021), Available online: https:\/\/training.cochrane.org\/handbook\/current\/chapter-03."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"214","DOI":"10.1111\/j.1469-8749.1997.tb07414.x","article-title":"Development and Reliability of a System to Classify Gross Motor Function in Children with Cerebral Palsy","volume":"39","author":"Palisano","year":"1997","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"744","DOI":"10.1111\/j.1469-8749.2008.03089.x","article-title":"Content Validity of the Expanded and Revised Gross Motor Function Classification System","volume":"50","author":"Palisano","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_21","unstructured":"World Health Organization (2001). International Classification of Functioning, Disability and Health: ICF, World Health Organization."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"d5928","DOI":"10.1136\/bmj.d5928","article-title":"The Cochrane Collaboration\u2019s Tool for Assessing Risk of Bias in Randomised Trials","volume":"343","author":"Higgins","year":"2011","journal-title":"BMJ"},{"key":"ref_23","first-page":"177","article-title":"Evaluating Coding Decisions","volume":"2","author":"Orwin","year":"2009","journal-title":"Handb. Res. Synth. Meta-Anal."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1111\/j.1469-8749.1989.tb04003.x","article-title":"The Gross Motor Function Measure: A means to evaluate the effects of physical therapy","volume":"31","author":"Russell","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"370","DOI":"10.1111\/j.1469-8749.2008.02048.x","article-title":"Test-Retest Reliability of the 10-Metre Fast Walk Test and 6-Minute Walk Test in Ambulatory School-Aged Children with Cerebral Palsy","volume":"50","author":"Thompson","year":"2008","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2057","DOI":"10.3758\/s13428-017-0973-8","article-title":"A Methodological Review of Meta-Analyses of the Effectiveness of Clinical Psychology Treatments","volume":"50","year":"2018","journal-title":"Behav. Res. Methods"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1002\/jrsm.1044","article-title":"Consistency and Inconsistency in Network Meta-analysis: Concepts and Models for Multi-arm Studies","volume":"3","author":"Higgins","year":"2012","journal-title":"Res. Synth. Methods"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/PHM.0b013e318201741e","article-title":"Improved Gait after Repetitive Locomotor Training in Children with Cerebral Palsy","volume":"90","author":"Smania","year":"2011","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_29","first-page":"14","article-title":"Spatial-temporal analysis and clinical findings of gait: Comparison of two modalities of treatment in children with cerebral palsy-spastic hemiplegia. Preliminary report","volume":"81","year":"2013","journal-title":"Cir. Cir."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"358","DOI":"10.2340\/16501977-1114","article-title":"Functional Effects of Robotic-Assisted Locomotor Treadmill Thearapy in Children with Cerebral Palsy","volume":"45","author":"Rusek","year":"2013","journal-title":"J. Rehabil. Med."},{"key":"ref_31","first-page":"671","article-title":"Effects of Dose and Duration of Robot-Assisted Gait Training on Walking Ability of Children Affected by Cerebral Palsy","volume":"25","author":"Peri","year":"2017","journal-title":"Technol. Health Care Off. J. Eur. Soc. Eng. Med."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"765","DOI":"10.1097\/PHM.0000000000000776","article-title":"Effects of the Integration of Dynamic Weight Shifting Training Into Treadmill Training on Walking Function of Children with Cerebral Palsy: A Randomized Controlled Study","volume":"96","author":"Wu","year":"2017","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"55","DOI":"10.1016\/j.gaitpost.2017.11.007","article-title":"Effect of Robotic-Assisted Gait Rehabilitation on Dynamic Equilibrium Control in the Gait of Children with Cerebral Palsy","volume":"60","author":"Wallard","year":"2018","journal-title":"Gait Posture"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"361","DOI":"10.5606\/tftrd.2019.3078","article-title":"Comparison of the Effectiveness of Partial Body Weight-Supported Treadmill Exercises, Robotic-Assisted Treadmill Exercises, and Anti-Gravity Treadmill Exercises in Spastic Cerebral Palsy","volume":"65","author":"Aras","year":"2019","journal-title":"Turk. J. Phys. Med. Rehabil."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"397","DOI":"10.1016\/j.gaitpost.2019.03.017","article-title":"Effects of Robotic Rehabilitation on Walking and Balance in Pediatric Patients with Hemiparetic Cerebral Palsy","volume":"70","author":"Tekin","year":"2019","journal-title":"Gait Posture"},{"key":"ref_36","unstructured":"Cohen, J. (1977). Statistical Power Analysis for the Behavioral Sciences, Academic Press."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"44","DOI":"10.21767\/2172-0479.100044","article-title":"Robotic Therapies for Children with Cerebral Palsy: A Systematic Review","volume":"7","author":"Bayon","year":"2016","journal-title":"Transl. Biomed."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"572038","DOI":"10.3389\/fneur.2020.572038","article-title":"A Systematic Review of Training Methods That May Improve Selective Voluntary Motor Control in Children with Spastic Cerebral Palsy","volume":"11","author":"Fahr","year":"2020","journal-title":"Front. Neurol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"900","DOI":"10.1111\/j.1469-8749.2007.00900.x","article-title":"Feasibility of Robotic-Assisted Locomotor Training in Children with Central Gait Impairment","volume":"49","author":"Borggraefe","year":"2007","journal-title":"Dev. Med. Child Neurol."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"615","DOI":"10.1136\/adc.2008.145458","article-title":"Improvement of Walking Abilities after Robotic-Assisted Locomotion Training in Children with Cerebral Palsy","volume":"94","author":"Schmartz","year":"2009","journal-title":"Arch. Dis. Child."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"S9","DOI":"10.1016\/j.gaitpost.2009.08.017","article-title":"Enhancement and Retention of Locomotor Function in Children with Cerebral Palsy after Robotic Gait Training","volume":"30","author":"Patritti","year":"2009","journal-title":"Gait Posture"},{"key":"ref_42","first-page":"125","article-title":"Sustainability of Motor Performance after Robotic-Assisted Treadmill Therapy in Children: An Open, Non-Randomized Baseline-Treatment Study","volume":"46","author":"Borggraefe","year":"2010","journal-title":"Eur. J. Phys. Rehabil. Med."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"496","DOI":"10.1016\/j.ejpn.2010.01.002","article-title":"Robotic-Assisted Treadmill Therapy Improves Walking and Standing Performance in Children and Adolescents with Cerebral Palsy","volume":"14","author":"Borggraefe","year":"2010","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1016\/j.ejpn.2014.04.012","article-title":"Prospective Controlled Cohort Study to Evaluate Changes of Function, Activity and Participation in Patients with Bilateral Spastic Cerebral Palsy after Robot-Enhanced Repetitive Treadmill Therapy","volume":"18","author":"Schroeder","year":"2014","journal-title":"Eur. J. Paediatr. Neurol."},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Jin, L.H., Yang, S., Choi, J.Y., and Sohn, M.K. (2020). The Effect of Robot-Assisted Gait Training on Locomotor Function and Functional Capability for Daily Activities in Children with Cerebral Palsy: A Single-Blinded, Randomized Cross-Over Trial. Brain Sci., 10.","DOI":"10.3390\/brainsci10110801"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4908\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T07:22:23Z","timestamp":1760167343000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/10\/21\/4908"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,10,24]]},"references-count":45,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2021,11]]}},"alternative-id":["jcm10214908"],"URL":"https:\/\/doi.org\/10.3390\/jcm10214908","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,10,24]]}}}