OBJECTIVE To systematically review the effectiveness of Hand-Arm Bimanual Intensive Training (HABIT) on upper limb function in children with cerebral palsy. METHODS Six databases (MEDLINE, CINAHL, PubMed, Embase, Cochrane Library, and PsycINFO) were searched for HABIT-related studies published in English between 2007 and 2017. The methodological quality of the included studies was classified based on the Levels of Evidence of the American Occupational Therapy Association guidelines. If the included studies were randomized controlled trials (RCTs), the methodological quality was evaluated using the Revised Cochrane risk of bias tool. Cohen's d effect sizes were computed and synthesized to assess the effectiveness. RESULTS Among 646 studies, 15 fulfilled the inclusion criteria. Eleven studies were RCTs, 64% of which were rated as having a high risk of bias; one was a quasi-RCT, one was a retrospective study, and two were longitudinal studies. Nearly half of the included studies used HABIT for 6 h a day for three consecutive weeks (totaling 90 h), and some studies used different doses/schedules or added training components to HABIT. Synthesis of the results demonstrated a significantly small effect size (d = 0.36, P = 0.017) for improving upper limb function immediately after the interventions, and the improvements were maintained at follow-up. Similarly, significantly moderate or large effect sizes were found for self-care function (d = 0.52, P = 0.003) and goal improvements (d = 1.78-2.28, P < 0.001). CONCLUSION This review supports the effectiveness of HABIT as an intervention for improving upper limb function in children with cerebral palsy.

中文翻译：

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手臂双手强化训练对脑瘫患儿上肢功能的有效性：系统评价

目的系统评价手-臂双手强化训练（HABIT）对脑瘫患儿上肢功能的影响。方法 在 6 个数据库（MEDLINE、CINAHL、PubMed、Embase、Cochrane Library 和 PsycINFO）中搜索 2007 年至 2017 年间以英文发表的 HABIT 相关研究。纳入研究的方法学质量根据证据水平进行分类。美国职业治疗协会指南。如果纳入的研究是随机对照试验 (RCT)，则使用修订的 Cochrane 偏倚风险工具评估方法学质量。计算并综合 Cohen 的 d 效应大小以评估有效性。结果 646 项研究中，15 项符合纳入标准。11 项研究是 RCT，其中 64% 被评为具有高偏倚风险；一项是准随机对照试验，一项是回顾性研究，两项是纵向研究。近一半的纳入研究连续三周（共 90 小时）使用 HABIT 每天 6 小时，一些研究使用不同的剂量/时间表或在 HABIT 中添加训练成分。结果的综合表明，干预后立即改善上肢功能的效果显着较小（d = 0.36，P = 0.017），并且在随访中保持改善。类似地，发现自我保健功能（d = 0.52，P = 0.003）和目标改善（d = 1.78-2.28，P < 0.001）具有显着的中等或较大的效应量。