Effectiveness of Ankle-Foot Orthoses Combined with Physiotherapy on Gross Motor Function in Children with Spastic Cerebral Palsy: A Systematic Review and Meta-Analysis
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Background: Ankle-foot orthoses (AFOs) are used alongside physiotherapy in children with spastic cerebral palsy, but their additional contribution to rehabilitation outcomes remains uncertain. Objective: To evaluate evidence addressing combined AFO–physiotherapy treatment through a systematic review and meta-analysis focused on gross motor function and related outcomes. Methods: The manuscript reports searches of PubMed/MEDLINE, Scopus, Web of Science, PEDro, Embase, CINAHL, and the Cochrane Library for English-language controlled studies. Eligibility required spastic cerebral palsy, a relevant physiotherapy component, and extractable gross motor outcomes. Independent screening and extraction, RoB 2 assessment, GRADE evaluation, and quantitative or narrative synthesis were described; supporting search records and appraisal results were not supplied. Results: The reported evidence comprised 32 articles involving 544 children and 56 comparisons, with 884 repeated participant contributions. These totals and pooled estimates corresponded to a previously published review predominantly comparing AFO-on with AFO-off conditions. Reported effects favored AFO use for GMFM standing (SMD 0.30; 95% CI 0.10–0.51; I²=26%) and walking, running, and jumping (SMD 0.24; 95% CI 0.04–0.45; I²=0%). Gait speed increased (SMD 0.28; 95% CI 0.14–0.41; I²=76%), whereas oxygen consumption showed no significant difference (SMD 0.00; 95% CI −0.23–0.23; I²=52%). Formal evidence certainty could not be established. Conclusion: The assembled evidence suggests selected biomechanical and functional benefits during AFO use but does not establish superiority of combined AFO–physiotherapy treatment over physiotherapy alone. Direct comparative evidence and independently documented review procedures are required
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