Table CStrength of the evidence for behavioral interventions assessed in Snider review16

InterventionOutcome(s)Level of Evidence (Sackett)EPC Equivalent
Strength of Evidence (Direction of Effect)
Oral sensorimotor interventionsIncreased feeding safety and efficiency4 (conflicting)Insufficient
Inconsistent evidence and a paucity of comparative studies. Poor quality studies had positive results; whereas those with more rigor showed no effect, but may have been underpowered.
PositioningIncreased feeding safety and efficiency2b (limited)Low
No RCTs, but positive results consistently observed in other study designs. Studies were small, and therefore imprecise.
Altering food consistencyIncreased feeding safety and efficiency2b (limited)Low
One experimental study that was of adequate size showed some positive effects on increasing feeding safety and efficiency.
Oral appliancesEnhanced oral sensorimotor skills1b (moderate)Moderate
One good RCT, one fair RCT, and additional supporting studies of varying designs. Better quality studies showed positive effects, but effects were not entirely consistent; small sample sizes suggest imprecision and rigorous studies should be replicated.
Oral appliancesIncreased feeding safety and efficiency, generalized postural control5 (no good evidence)Insufficient
Only studies of poor quality were available to assess feeding efficiency and generalized postural control.
Feeding devicesIncreased feeding efficiency2b (limited)Low
Consistently positive results in two non-RCTs of small sample sizes.
Feeding devicesEnhanced oral-motor behaviors2b (limited)Low
Consistently positive results in two non-RCTs of small sample sizes.
Feeding devicesIncreased independence2b (limited)Low
Consistently positive results in two non-RCTs of small sample sizes.

EPC = Evidence-based Practice Center; RCT = randomized controlled trial

From: Executive Summary

Cover of Interventions for Feeding and Nutrition in Cerebral Palsy
Interventions for Feeding and Nutrition in Cerebral Palsy [Internet].
Comparative Effectiveness Reviews, No. 94.
Ferluga ED, Archer KR, Sathe NA, et al.

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