Twenty-one studies were included in the review (n 168, range one to 41): five RCTs (n=114); two pretest post-test design with control group (n=16); three one-group pretest post-test designs (n=27); three single-subject studies (n=11); and eight case report designs (n=11).
The RCTs and pretest post-test study designs had validity scores between 7 and 11 out of 16. The two one group designs that were assessed had scores of 5 and 7 out of 11. Study duration ranged from one week to 18 months.
Four studies allowed computation of effect size and one additional study provided effect size (eta values) within the paper. One of these studies reported five outcome measures at the body functions and structure level of which one (Modified Ashworth Scale – shoulder) was statistically significant (p<0.05). These five studies reported a total of 14 different activity level outcomes of which five were statistically significant (p<0.05): Caregiver Functional Use Survey – How frequently (one study); Assisting Hand Assessment (one study); Emerging Behaviour Scale (one study); Pediatric Motor Activity Log – Amount of use (one study); and WeeFIM Self-Care (one study). All significant effect size values were medium to large (d=0.6 to 1.16).
The other 16 studies reported positive outcomes in fine motor and functional activities post treatment and up to 12 months follow-up.