Three RCTs (n=64) and 9 uncontrolled studies (n=107) were included in the review. The sample size ranged from 1 to 32.
The RCTs were of high quality and the uncontrolled studies were of sufficient quality.
Effects on spasticity and tone.
One RCT reported improved outcomes in the wrist and elbow at 2 weeks and 3 months in the intervention group. Four uncontrolled studies also reported improved outcomes in the wrist and elbow compared with the baseline measurement. The other 2 RCTs and 3 uncontrolled trials assessing this outcome reported no significant differences. Two RCTs and 5 uncontrolled studies measured long-term spasticity or tone; only one uncontrolled study reported a significant difference in comparison with the baseline measurement.
Effects on range of motion.
One RCT reported a significant increase in active range of motion in elbow extension and thumb extension at 2 weeks in the intervention group. One RCT reported a significant change in supination of the wrist after 2 weeks and 9 months in favour of the control group. None of the 5 uncontrolled studies reported any significant changes in short-term active range of motion or long-term active range of motion. One uncontrolled study found a significant increase in flexion of the wrist and the first carpo-metacarpal joint after 1 month.
One RCT and 5 uncontrolled studies found no significant short-term changes in passive range of motion. One RCT and 6 uncontrolled studies found no significant long-term changes in passive range of motion. One uncontrolled study reported a significant increase in wrist extension after 4 months.
Two uncontrolled studies measured range of motion with the web-space method. One reported a significant increase in the space between the thumb and index finger, but the length of follow-up was not reported. The other study reported no significant changes.
Effects on level of activity.
One RCT reported that the grasp and release score improved significantly in the intervention group compared with the control group after 3 months. One RCT reported a significant change in the Quality of Upper Extremity Skills Test score in the intervention group compared with the control group after 1 month; however no significant differences were found after 3 months. The same RCT also reported a significant improvement in the raw scores of the self-care domain of the Pediatric Evaluation of Disability Inventory (PEDI). Significant improvements in scores of the self-care domain of the PEDI were also reported in one uncontrolled study. However, one other RCT and two other uncontrolled studies that used the self-care domain of the PEDI found no significant differences.
One RCT and one uncontrolled study that used the Melbourne Assessment of unilateral upper limb function found no significant differences.
Five of the 9 uncontrolled studies that assessed the effects of botulinum toxin type A injections reported significant improvements in comparison with baseline measurements, whilst the other four found no significant improvements; a variety of outcome measures were used.
Two RCTs reported long-term measurements but found no significant differences between the intervention and control groups. Seven uncontrolled studies reported long-term measurements; two reported significant long-term improvements.