Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
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European journal of pediatrics
Contemporary physiotherapy interventions for balance rehabilitation in children with Down syndrome: a systematic review of randomized controlled trials
Children with Down syndrome commonly present with impaired balance and postural control due to musculoskeletal, sensory, and neuromotor deficits, which may negatively affect functional mobility and participation in daily activities. Over the last decade, a variety of contemporary physiotherapy interventions have been investigated to improve balance in this population. The aim of this systematic review was to synthesize evidence from randomized controlled trials evaluating physiotherapy interventions targeting balance rehabilitation in children with Down syndrome. A systematic search was conducted in PubMed and Scopus for studies published between 2015 and 2025. Randomized controlled trials investigating physiotherapy-related interventions targeting balance in children and adolescents with Down syndrome were included. Two independent reviewers performed study selection and data extraction. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 14 randomized controlled trials involving 462 participants were included. The included interventions comprised isokinetic training, trampoline-based plyometric exercise, Pilates, dual-task exercise, hippotherapy, whole-body vibration, foot muscle strengthening, swimming programs, kinesiotaping, and vestibular stimulation. Improvements in balance-related outcomes were observed across a broad range of physiotherapy interventions, particularly when approaches were combined with conventional physiotherapy programs. Conclusion: Contemporary physiotherapy interventions appear to be associated with improvements in balance-related outcomes in children with Down syndrome. The findings of this review support the integration of technology-assisted and task-oriented rehabilitation approaches into pediatric physiotherapy practice. However, the overall methodological quality of the included studies ranged from fair to high, and further large-scale, high-quality RCTs with long-term follow-up are required to strengthen the current evidence base.
28 July 2026
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Subtypes in developmental coordination disorder: what do we know so far? A systematic review.
UNLABELLED: Developmental coordination disorder (DCD) is a highly heterogeneous disorder. This systematic review examined whether statistically derived clusters can effectively distinguish subgroups of children with DCD. Web of Science, Scopus, PubMed, Embase, and PsycInfo were systematically searched (CRD420251237685) using controlled terminology and free-text terms. Studies were eligible if they included children (aged 0-18 years) with DCD with(out) comorbidities and employed statistical clustering to identify subtypes. Methodological quality was assessed using an adapted version of the Critical Appraisal Skills Programme and certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation. Ten of the 1719 search results were included, three of which included both children with DCD and typical development. Two studies explored clusters unidimensionally (motor-only and mental health-only). Eight studies included multiple domains of functioning: motor (n = 8), sensory functions (n = 5), fitness (n = 3), cognitive functions (n = 3), executive functions (n = 2), mental health (n = 1), and participation (n = 1). Studies identified between four (n = 4) and six (n = 1) subtypes, which primarily reflected gradients of severity rather than distinct domain-specific profiles. The overall certainty of evidence for distinct subtypes in DCD was rated low to very low. CONCLUSION: Evidence suggests that DCD is better conceptualized as a spectrum of pervasiveness rather than discrete subtypes. Existing findings lack consistency across studies due to methodological shortcomings and variable measurement domains. Although evidence-based clinical subtypes cannot yet be recommended, future research should prioritize subtyping studies focused on primary symptoms to better identify potential phenotypes within the DCD population. WHAT IS KNOWN: • DCD is a heterogeneous condition, and identifying discrete subtypes is a long-standing research goal to improve clinical support. • Researchers have proposed various motor and non-motor profiles, but no consensus exists on a definitive subtyping model. WHAT IS NEW: • This review found no consistent discrete subtypes, suggesting DCD is better viewed as a spectrum of pervasiveness rather than categories. • Future research should focus on subtyping primary motor symptoms to determine whether distinct, stable subgroups exist within the broader DCD population.
22 June 2026
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