Table 2 Evaluation of the certainty of the evidence presented for each outcome.
From: Neuromuscular exercise in children with Down Syndrome: a systematic review
Certainty evaluation | No. of patients | Effect | Certainty | Importance | ||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|
No. of studies | Study design | Risk of bias | Inconsistency | Indirect evidence | Imprecision | Other considerations | Neuromuscular Exercise | Control | Relative (95% CI) | Absolute (95% CI) | ||
Chest muscle strength. Intervention: Mechanotherapy. Measuring instrument: Maximum resistance (MR) (Shield 2010 and 2013) (Follow-up: Mean 11 weeks; evaluated using MR (kg)) | ||||||||||||
2 | Randomized trials | Not serious | Not serious | Not serious | Seriousa | None | 45 | 46 | – | MD 8.51 higher. (2.35 to 14.67) | ⨁⨁⨁◯ MODERATE | CRITICAL |
Muscle strength of the lower limbs. Intervention: Mechanotherapy. Measuring instrument: Maximum resistance (MR) (Shield 2010 and 2013) (Follow-up: Mean 10 weeks; evaluated using MR (kg)) | ||||||||||||
2 | Randomized trials | Not serious | Not serious | Not serious | Seriousa | None | 45 | 46 | – | MD 21.54 higher. (1.64 to 41.43) | ⨁⨁⨁◯ MODERATE | CRITICAL |
Muscle strength of the lower limbs. Intervention: Isokinetic training. Instrument: Maximum peak torque (Newtons) (Eid 2017) (Follow-up: 12 weeks; evaluated using Maximum peak torque (Newtons)) | ||||||||||||
1 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 16 | 15 | – | MD 2.68 higher (1.68 to 3.68) | ⨁⨁⨁⨁ HIGH | CRITICAL |
Hip and knee muscle strength. Intervention: Exercise with treadmill and Wii. Instrument: Manual dynamometry (Lbs) (Lin 2012) (Follow-up: 18 weeks) | ||||||||||||
1 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 46 | 46 | – | MD 1.08 higher. (0.8 higher to 1.36 higher) | ⨁⨁⨁⨁ HIGH | CRITICAL |
Knee muscle strength. Intervention: Isometric training. Instrument: Manual dynamometer (kg) (Ulrich 2011) (Follow-up: weekly for 12 months) | ||||||||||||
1 | Randomized trials | Very seriousb | Not serious | Not serious | Not serious | None | 19 | 27 | – | MD 3.18 higher. (1.87 higher to 4.5 higher) | ⨁⨁◯◯ LOW | CRITICAL |
Knee muscle strength. Intervention: Conventional physiotherapy and therapeutic vibration (Eid 2015 and Emara 2016) Instrument: Manual dynamometry (Newtons) (Follow-up: 12 weeks) | ||||||||||||
2 | Randomized trials | Serious | Not serious | Not serious | Seriousc | None | 32 | 30 | – | MD 2.53 higher. (1.89 higher to 3.16 higher) | ⨁⨁◯◯ LOW | CRITICAL |
Balance. Intervention: Conventional physiotherapy plus isokinetic training/core stability exercises (Eid 2017 and Sobhy 2016). Instrument: Stability Index (Biodex System)) (Follow-up: 12 weeks) | ||||||||||||
2 | Randomized trials | Not serious | Not serious | Not serious | Not serious | None | 16 | 15 | – | MD 0.2 lower (0.29 lower to 0.12 lower) | ⨁⨁⨁⨁ HIGH | CRITICAL |
Balance. Intervention: Neuromuscular exercise using unstable surfaces and balloons (Jankowics 2012). Instrument: Path length center of gravity (mm) (Follow-up: 12 weeks) | ||||||||||||
1 | Randomized trials | Very seriousd | Not serious | Not serious | Very seriouse | None | 20 | 20 | – | MD 336.54 lower (948.52 lower to 275.44 higher) | ⨁◯◯◯ VERY LOW | CRITICAL |
Unipedal balance. Intervention: Isometric training and unipedal balance (Ulrich 2011). Instrument: Unipedal balance maintained (seconds) (Follow-up: 12 months) | ||||||||||||
1 | Randomized trials | Very seriousd | Not serious | Not serious | Serious | None | 17 | 27 | – | MD 2.54 higher. (0.62 higher to 4.45 higher) | ⨁◯◯◯ VERY LOW | CRITICAL |
