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Physiotherapy Approaches for Motor Proficiency in Children with Down Syndrome: A Systematic Review of Systematic Reviews and A Meta-Analysis

Shimaa Mohamed Reffat, Faten Hassan Abdelaziem

Objective: Children with Down Syndrome (DS) experiences global neuromotor retardation and developmental delay. Various treatment methods had been used in rehabilitation procedures in regardless its effectiveness in facing specific problem. Thus, this systematic review of systematic reviews and meta-analysis done on almost several modalities of physiotherapy used to improve motor proficiency; provide evidence regarding the effectiveness of physiotherapy approaches for specific outcomes related to motor skills and capability for children with DS.

Design: A systematic review of systematic reviews and a meta-analysis.

Participants: Children with DS.

Interventions: Physiotherapy interventions included in the systematic reviews such as treadmill training, progressive resistive exercises, virtual reality, neuromuscular and whole-body vibration training.

Outcome measures: Outcome measures that involved in the systematic reviews include the following: Muscular fitness (strength and endurance), balance, cardiovascular fitness, body composition and locomotor skills.

Methods: Database searching for systematic reviews of physiotherapy approaches for DS were individually done by two independent reviewers through Google Scholar, Scopus Medline, Pub-Med and PEDro from inception till May 2022 for collecting the most relevant systematic reviews without language restrictions. A meta-analysis was conducted using RevMan software (V5.4).

Setting: 12 systematic reviews with total 117 RCT included.

Results: Overall twelve of systematic reviews, evaluated for eligibility and involved in the review after considering the guidelines of extension statement for reporting systematic reviews. The finding of each systematic review was scheduled according to the evidence level and the results classified with the international classification of function, disabilities and health. Methodological quality assessment was done by modified Revised Measurement Tool to Assess Systematic Reviews (R-AMSTAR) scoring system.

Conclusions: A conclusive interpretation was reached on the most effective physical intervention that relates to a specific outcome that could be beneficial in making decision process in the management of children with Down syndrome and was supported with an evidence-based approach.