CONTEXT: Spastic cerebral palsy (SCP) presents daily challenges because of spasms, impacting motor function. Although multiple nonsurgical therapies exist, their comparative efficacy remains uncertain. OBJECTIVE: To compare the effectiveness of various nonsurgical therapies for SCP. DATA SOURCES: A systematic search of PubMed, Embase, Web of Science, CINAHL, and Cochrane Library up to February 10, 2025. STUDY SELECTION: Randomized controlled trials (RCTs) measuring the effectiveness of nonsurgical therapies in improving spasticity, gross motor function, walking, and living ability among patients with SCP. DATA EXTRACTION: Effect sizes for outcomes were extracted and calculated through a random effects model. RESULTS: Of 5765 studies retrieved, 81 were included. Biofeedback, transcranial direct current stimulation, extracorporeal shockwave therapy, botulinum toxin A with cast, transcutaneous electrical nerve stimulation, cast, whole-body vibration, acupuncture, and 1 pharmacotherapy (botulinum toxin A) significantly reduced spasticity (standardized mean difference (SMD) -3.29 to -0.73). Hippotherapy, gaming, acupuncture, and whole-body vibration improved gross motor function (SMD 0.91 to 6.75). Acupuncture significantly enhanced daily living and walking (SMDs of 0.72 and 2.04, respectively). LIMITATIONS: The limited number of RCTs supporting the top-ranked therapies, combined with small sample sizes that may overestimate treatment effects, methodological biases, and heterogeneity in key analyses, necessitates cautious interpretation of the findings in the real world. CONCLUSIONS: Biofeedback, hippotherapy, and acupuncture were effective for spasticity, gross motor function, daily living, and walking abilities. Extracorporeal shockwave therapy worked across various spasticity levels. Acupuncture demonstrated consistent and significant efficacy across all outcome measures, highlighting its substantial therapeutic potential. This study provides comprehensive recommendations for optimizing treatment strategies for SCP.
Reproduced with permission from Pediatrics. Copyright by the American Academy of Pediatrics.

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