Effects of active rehabilitation on gait, balance and postural stability in children and adolescents with cerebral palsy: a systematic review and three-level meta-analysis

Cerebral palsy is the most common developmental motor disorder in childhood. Gait abnormalities and balance impairments are core issues affecting children’s activity participation. Active motor rehabilitation has been widely applied, yet systematic comparisons of the relative effects among different intervention modalities remain lacking. To systematically evaluate the effects of active motor rehabilitation on gait, balance, and postural stability in children and adolescents with cerebral palsy whose reported mean ages ranged from 6.2 to 15.9 years, and to compare effect patterns across intervention modalities, outcome measures, age groups, and cerebral palsy topographic distributions. PubMed, Embase, Web of Science, and Cochrane Library were searched from inception to June 19, 2026. Randomized controlled trials evaluating active motor rehabilitation in children and adolescents with CP were included; the included studies reported mean ages ranging from 6.2 to 15.9 years. Hedges’ g was synthesized using a three-level random-effects model. Analyses examined outcome category, intervention modality, CP topography, age group, and training dosage; robustness was assessed by leave-one-study-out sensitivity analysis. PROSPERO registration number: CRD420261459915. Twenty-six RCTs contributed 58 effect sizes. The broad cross-domain estimate was significant (g = 0.511, 95% CI: 0.299–0.724, p < 0.001), with I²₂ = 65.9%, I²₃ = 7.9%, and a 95% prediction interval of − 0.774 to 1.796. Outcome-specific analyses showed significant effects for balance function (g = 0.554, p = 0.008) and postural stability (g = 0.889, p = 0.043). In the intervention-modality analysis, balance training showed the highest pooled point estimate (g = 1.038, p = 0.046), while the between-modality test was not significant ( p = 0.214). Between-subgroup tests were also not significant for outcome category, CP topography, or age. Based on current evidence, active motor rehabilitation can serve as an effective component of individualized motor-function management for children and adolescents with cerebral palsy. Although between-subgroup tests were not statistically significant, the effect estimates indicated clearer benefits for balance function and postural stability, and balance training showed the highest pooled point estimate among intervention modalities. Structured balance training may therefore be considered when balance function or postural control is the treatment target.