Contemporary physiotherapy interventions for balance rehabilitation in children with Down syndrome: a systematic review of randomized controlled trials.

Children with Down syndrome commonly present with impaired balance and postural control due to musculoskeletal, sensory, and neuromotor deficits, which may negatively affect functional mobility and participation in daily activities. Over the last decade, a variety of contemporary physiotherapy interventions have been investigated to improve balance in this population. The aim of this systematic review was to synthesize evidence from randomized controlled trials evaluating physiotherapy interventions targeting balance rehabilitation in children with Down syndrome. A systematic search was conducted in PubMed and Scopus for studies published between 2015 and 2025. Randomized controlled trials investigating physiotherapy-related interventions targeting balance in children and adolescents with Down syndrome were included. Two independent reviewers performed study selection and data extraction. Methodological quality was assessed using the Physiotherapy Evidence Database (PEDro) scale. A total of 14 randomized controlled trials involving 462 participants were included. The included interventions comprised isokinetic training, trampoline-based plyometric exercise, Pilates, dual-task exercise, hippotherapy, whole-body vibration, foot muscle strengthening, swimming programs, kinesiotaping, and vestibular stimulation. Improvements in balance-related outcomes were observed across a broad range of physiotherapy interventions, particularly when approaches were combined with conventional physiotherapy programs. Conclusion: Contemporary physiotherapy interventions appear to be associated with improvements in balance-related outcomes in children with Down syndrome. The findings of this review support the integration of technology-assisted and task-oriented rehabilitation approaches into pediatric physiotherapy practice. However, the overall methodological quality of the included studies ranged from fair to high, and further large-scale, high-quality RCTs with long-term follow-up are required to strengthen the current evidence base.