Action Observation for Children and Adolescents with Cerebral Palsy: Hope or Hype? A Systematic Review with Meta-Analysis

Cerebral palsy generates an elevated burden on both patients and health-care systems. Cost-effective therapies such as action observation therapy (AOT), have been proposed to enhance motor performance in these patients. Objective: This systematic review with meta-analysis aimed to evaluate the effectiveness of AOT in children and adolescents with CP and describe its prescription parameters. Results: Fourteen studies involving a total of 393 patients with CP were included. Most studies presented some concerns on risk of bias. Meta-analyses compared AOT to placebo (no motor content) observation and found inconclusive results for the following: unilateral upper limb function (g = 0.565; 95% CI -0.174, 1.305), assisting hand function during bimanual activities (g = 0.200; 95% CI -0.742, 1.143), manual function daily activities (g = -0.022; 95% CI -3.134, 3.090), and hand grip strength (MD (kg) = 1.175; 95% CI -0.280, 2.630). Meta-analysis comparing AOT and physical therapy also yielded inconclusive findings for standing (g = 0.363; 95% CI -5.172, 5.898), as well as the combined dimension of walking, standing, and jumping (g = 0.798; 95% CI -8.821, 10.417) within gross motor function. Conclusions: Current evidence is imprecise and does not support definitive conclusions regarding the effectiveness of AOT over placebo observation, or over physical therapy, on functional outcomes including upper limb, hand, and lower limb functioning parameters. Current findings prevent recommending AOT for its employment in clinical practice. Further evidence is required to draw precise conclusions.