El‐Etribi 2004.

Methods	Method of randomisation: not described Blinding: not described. Participants and personnel were likely not blinded due to the nature of the interventions. Intention‐to‐treat analysis: no Loss of follow‐up: no Unit of analysis: not described clearly, but likely lower limb for local measures and child for global measures
Participants	Place: 1 centre in Egypt Period of study: March 2001 to March 2003 Number assigned: 40 Number assessed: 40 20 BoNT‐A group 20 control group Inclusion criteria: Children aged 2 to 6 years at study entry Mobile equinus of the ankle Exclusion criteria: Severe or profound mental retardation Fixed contractures Atrophy of leg muscles Previous alcohol or phenol injection into the muscles Age: BoNT‐A group (mean/SD): 3.43/1.5 years Control group (mean/SD): 3.68/1.15 years Gender: Not described Motor distribution: All spastic diplegia GMFCS: Not described
Interventions	BoNT‐A group: Single BoNT‐A injection (onabotulinumtoxinA) into the gastrocnemius, hip adductors, and/or hamstrings (dose 3 to 6 U/kg), not exceeding 200 U for any single injection Physiotherapy 3x/week for 3 months Control group: Physiotherapy 3x/week for 3 months
Outcomes	Length of follow‐up: Follow‐up of 12 weeks Assessments at baseline, 4, 8, and 12 weeks Primary outcomes: Modified Ashworth Scale Modification of the Physician Rating Scale Range of motion of the ankle Electromyogram (H/M rating)
Notes	Comments: Data for 4 and 8 weeks were only available in the form of graphs. Numeric data were available only for baseline and 12 weeks. Source of funding: not reported Conflicts of interest: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: not described
Allocation concealment (selection bias)	Unclear risk	Comment: not described
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: participants and personnel likely not blinded due to the nature of the interventions
Blinding of outcome assessment (detection bias) All outcomes	High risk	Comment: not described, but likely not given the nature of the interventions and assessments
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: no incomplete outcome data
Selective reporting (reporting bias)	Unclear risk	Comment: study protocol not available. It appears that the relevant outcomes were addressed.
Other bias	Low risk	Comment: no other sources of bias identified