A Network Meta-Analysis of the Effects of the Exercise Interventions on Balance in Children with Cerebral Palsy

Purpose: This study aimed to demonstrate the effectiveness of different types of exercise interventions on the balance ability of children with cerebral palsy through network meta-analysis. Methods:The study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) network meta-analysis guidelines for the review of comprehensive research.The study used the PICOS framework (P -Participants; I -Intervention; C -Comparison, O -Outcome; S-Study design) for subject selection wherein P referred to children with cerebral palsy, I referred to exercise programs, C referred to general physical therapy, O referred to balance ability measured by the BBS (Berg Balance Scale), PBS (Pediatric Balance Scale), and S referred to a randomized controlled trial with experimental and control groups.In this study, the network meta-analysis used the "netmeta" package in R to estimate the comparative advantage of exercise programs for cerebral palsy.The effects of the exercise programs were compared and analyzed using the mean and standard deviation of balance ability.Results: Among the exercise programs for children with cerebral palsy analyzed in this study, the Pilates program improved BBS scores (P-score: 64.90%) and was ranked as the most effective.In terms of PBS improvement, the exercise program that was ranked as the most effective in improving the PBS was Pilates combined with conventional physical therapy (Pilates+CPT) (P-score: 67.98%), followed by game-based dual task (P-score: 59.53%), dual task training (P-score: 56.45%), and gaming balance board training (P-score: 56.02%).The Pilates+CPT program showed a larger effect size than other intervention methods, and this difference was statistically significant. Conclusion: These findings support the preferential application of Pilates-based interventions for balance rehabilitation in