Çağlar 2019.

Methods	Method of randomisation: block randomisation, no further details given Blinding: all participants and personnel blinded to the intervention Intention‐to‐treat analysis: not described Loss of follow‐up: 0 Unit of analysis: not described clearly, but likely each child was the unit of analysis
Participants	Place: 1 centre in Turkey Period of study: not described Number assigned: 30 Number assessed: 30 15 BoNT‐A group 15 control group Inclusion criteria: Spastic CP Aged 2 to 15 years Lower extremity spasticity with MAS > 2 No previous spasticity treatment within the last 6 months Exclusion criteria: Fixed contractures, advanced atrophy, subluxation of the affected extremity Previous BoNT‐A and phenol injections, intrathecal baclofen pump therapy, or surgical treatment of spasticity History of allergy and hypersensitivity against drugs to be used Haematoma, infection, or skin lesion in the injection site Use of aminoglycoside antibiotics Having mental retardation Age: BoNT‐A group (mean (SD)): 9.01 (2.47) Control group (mean (SD)): 9.46 (2.89) Gender: BoNT‐A group: 37.5% males; 56.3% females Placebo group: 46.7% males; 53.3% females Motor distribution: Not described GMFCS: Not described
Interventions	BoNT‐A group: Single BoNT‐A (onabotulinumtoxinA) injection administered at 3 IU/kg per muscle, with total dose not exceeding 300 IU. The lower extremity muscles (gastrocnemius, soleus, tibialis anterior and posterior, quadriceps, hip adductors, and hamstrings muscles) with a Modified Ashworth Scale score > 2 underwent treatment. Children used a resting splint and underwent a rehabilitation protocol with 5 sessions of physical therapy per week (20 sessions), followed by the exercises being maintained at home Control group: The same rehabilitation protocol as above
Outcomes	Length of follow‐up: Follow‐up of 12 weeks Assessments at baseline, 4 and 12 weeks Primary outcomes: Modified Ashworth Scale Secondary outcomes: Goal Attainment Scale Selective motor control test GMFCS
Notes	Comments: The GMFCS level was used as an outcome measure, rather than being used to describe the children's baseline characteristics. Source of funding: the study authors report that this study received no outside funding Conflict of interest: the study authors report no conflict of interest
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Low risk	Comment: the children were divided into the BoNT‐A and control groups by block randomisation (sequences of AB and BA)
Allocation concealment (selection bias)	High risk	Comment: no allocation concealment
Blinding of participants and personnel (performance bias) All outcomes	High risk	Comment: participants were not blinded due to the nature of the interventions. All rehabilitation protocols were performed by blinded physiotherapists.
Blinding of outcome assessment (detection bias) All outcomes	Unclear risk	Comment: blinding of outcome assessment was not clearly described
Incomplete outcome data (attrition bias) All outcomes	High risk	Comment: data were not presented for all muscle groups. It is unclear to which muscles the provided MAS and Tardieu Scale data refer.
Selective reporting (reporting bias)	Unclear risk	Comment: study protocol not available. Most of the relevant outcomes were reported.
Other bias	Low risk	Comment: no other sources of bias identified

AFO: ankle foot orthosis; BoNT‐A: botulinum toxin type A; CP: cerebral palsy; DQ/IQ: Development Quotient/Intelligence Quotient; GMFCS: Gross Motor Function Classification System; GMFM: Gross Motor Function Measure; IU: international units; MAS: Modified Ashworth Scale; MP: Migration percentage; PEDI: Pediatric Evaluation of Disability Inventory; PT: physical therapy; SD: standard deviation;SE: standard error; SWASH: standing, walking and sitting hip orthosis; U: units.