Summary of findings 4. Constraint induced movement therapy (CIMT) compared to different forms CIMT for children with unilateral cerebral palsy.

Constraint induced movement therapy compared to different forms CIMT for children with unilateral cerebral palsy
Patient or population: children with unilateral cerebral palsy Setting: mixed (home, clinic) Intervention: Constraint induced movement therapy Comparison: different forms CIMT
Outcomes	Anticipated absolute effects* (95% CI)		Relative effect (95% CI)	№ of participants (studies)	Certainty of the evidence (GRADE)	Comments
	Risk with different forms constraint induced movement therapy	Risk with constraint induced movement therapy
Bimanual performance Assessed with: Assisting Hand Assessment ‐ Kids Scale from: −10.26 to 8.72 Follow‐up: immediately postintervention	The mean bimanual performance in the control group was 0.84 AHA logits	The mean bimanual performance in the intervention group was 2.19 AHA logits higher (1.15 lower to 5.53 higher)	‐	60 (2 RCTs)	⊕⊝⊝⊝ Very lowa,c	Different scale units (logit scale and AHA unit scale) and different reporting (time point and change from baseline) precluded meta‐analysis. Higher score indicates improved bimanual performance
Bimanual performance assessed with: Assisting Hand Assessment ‐ Kids Scale from: 0 to 100 Follow‐up: immediately postintervention	The mean bimanual performance in the control group was 5.3 AHA units	The mean bimanual performance in the intervention group was3.70 AHA units higher (1.27 lower to 8.67 higher)	‐
Unimanual capacity ‐ not measured	‐	‐	‐	‐	‐	No studies measured unimanual capacity using the Melbourne Assessment 2
Unimanual capacity Assessed with: Quality of Upper Extremity Skills Test ‐ Grasp Scale from: 0 to 100 Follow‐up: immediately postintervention	The mean unimanual capacity in the control group was −0.5 points	The mean unimanual capacity in the intervention group was 3.70 points higher (1.91 lower to 8.71 higher)		60 (1 RCT)	⊕⊝⊝⊝ Very lowa,b,c	Higher score indicates improved bimanual performance
Manual Ability ‐ not measured	‐	‐	‐	‐	‐	No studies measured manual ability using the ABILHAND‐Kids
Self‐care ‐ not measured	‐	‐	‐	‐	‐	No studies measured self‐care using the Pediatric Evaluation of Disability Inventory
Individualised measures of performance ‐ not measured	‐	‐	‐	‐	‐	No studies measured individual performance using the Canadian Occupational Performance Measure
Adverse events	2 studies reported no adverse events		‐	94 (3 RCTs)	‐
	1 study did not report the presence or absence of adverse events
*The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; MD: Mean difference; RCT: randomised controlled trial.
GRADE Working Group grades of evidence High certainty: We are very confident that the true effect lies close to that of the estimate of the effect Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

^aDowngraded one level due to risk of bias (all trials are at high risk of bias because it is not possible to blind personnel or participants to group allocation).
 ^bDowngraded one level because results are from a single study.
 ^cDowngraded one level due to small sample size (number of participants < 400).