identify all relevant high-quality evidence.

We focused on randomised controlled trials, which are

least likely to provide biased estimates of eff ect, and used comprehensive searching to identify
relevant systematic reviews and trials. Where possible, we used an explicit and unbiased approach
to data analysis, and any conclusions were considered with reference to the key design features of
the available evidence. Finally, bearing in mind that a meta-analysis can sometimes produce
misleading results, we tried to put this evidence in context by including a semi-quantitative
assessment (considered judgment) with further cross-referencing to the most recent clinical practice
guidelines.11 We are not aware of any previous review of the topic that has taken such a robust and
comprehensive approach.

The main weaknesses relate to the heterogeneity of the available data, such that our Review could
not provide clear guidance on which intervention should be given to a particular patient in a
particular situation. First, there is substantial heterogeneity among the identifi ed trials in terms of
the participants, settings, the amount and duration of the intervention and control comparators,
method of intervention delivery, and the timing of outcome measures. The methodological rigour of
the studies also varied and many studies had several methodological limitations. Second, the
standardised eff ect measures we used expressed the eff ect of the intervention on some form of
motor function (or, failing that, motor impairment) outcome score. Because a range of diff erent
outcomes have been included, direct comparisons between interventions might be diffi cult.