Flett 1999.

Methods	Method of randomisation: sequence generation not clearly described. Allocation carried out by the hospital pharmacy. Blinding: participants and person administering treatment were aware of treatment allocation. Research clinicians were blinded to the intervention arms. Intention‐to‐treat analysis: no Loss of follow‐up: 2 dropouts from the BoNT‐A group ("one for social reasons, and the other at parental request because of the perceived need to treat differently by a combination of botulinum toxin A and fixed plaster treatment") Unit of analysis: lower limb for local measures and likely child for global measures
Participants	Place: 1 centre in Australia Period of study: not described Number assigned: 20 Number assessed: 18 8 BoNT‐A group 10 casts group Inclusion criteria: Ambulatory children with CP and lower limb spasticity, dynamic muscle tightness, equinovarus or equinovalgus of the foot, and unresponsive to other treatment modalities Passive dorsiflexion of the ankle achievable Aged 2 to 8 years Exclusion criteria: Previous surgery and previous phenol injection Fixed contractures or severe athetoid movements Leg‐length discrepancy > 5 cm Significant muscle weakness of atrophy in the calf muscles Children over 8 years of age Age: BoNT‐A group (mean/SD): 3.89/1.44 years Casts group (mean/SD): 3.56/1.32 years Gender: BoNT‐A group: 5 males; 3 females Casts group: 6 males; 4 females Motor distribution: BoNT‐A group: 6 diplegia; 1 quadriplegia; 1 hemiplegia; 0 triplegia Casts group: 4 diplegia; 1 quadriplegia; 4 hemiplegia; 1 triplegia GMFCS: Not described. Likely all GMFCS I, II, and III
Interventions	BoNT‐A group: Single BoNT‐A injection (onabotulinumtoxinA) into the gastrocnemius (dose 4 to 8 U/kg) not exceeding 20 U per site Night plasters for 8 weeks Casts group: Fixed plaster casts for 4 weeks (2 × 2 weeks) Night plasters for 8 weeks
Outcomes	Length of follow‐up: Follow‐up of 6 months Assessments at baseline, 2, 4, and 6 months Primary outcomes: Physician Rating Scale Global Scoring Scale for Gait Modified Ashworth Scale Range of motion of the ankle Gross Motor Function Measure
Notes	Comments: none Source of funding: Crippled Children’s Association Research and Development Fund Conflicts of interest: not reported
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	Comment: not clearly described
Allocation concealment (selection bias)	Low risk	Comment: central allocation
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: no blinding
Blinding of outcome assessment (detection bias) All outcomes	Low risk	Comment: blinding of outcome assessors
Incomplete outcome data (attrition bias) All outcomes	Low risk	Comment: no missing 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