Effects of ball skills interventions in children and adolescents with (probable) developmental coordination disorder: A systematic review and network meta-analysis.

OBJECTIVE

Developmental coordination disorder (DCD) affects motor performance as well as activity and participation. This systematic review and network meta-analysis evaluated the effects of ball skills interventions for children and adolescents with DCD or (probable) DCD. We also summarized their relevance to International Classification of Functioning, Disability and Health, Children and Youth Version (ICF-CY) domains.

METHODS

Web of Science, PubMed, Scopus, Embase, and the Cochrane Library were searched from inception to December 31, 2025. All eligible studies were included in the narrative synthesis. A random-effects network meta-analysis using standardized mean differences (Hedges' g) was conducted for comparable core motor outcomes, with treatment ranking based on P-scores.

RESULTS

Nineteen studies (n = 626) were included in the narrative synthesis, and nine studies (n = 350) contributed to the network meta-analysis. Compared with control or usual-care comparators, ball skills integrated motor training (BSIMT) showed the most favorable estimate for motor performance (SMD = 1.82, 95% CI 0.98-2.65). However, this finding should be interpreted cautiously given the limited evidence base. Ball sport specific training and virtual reality ball-game simulation training showed positive but uncertain effects. Narrative synthesis suggested possible benefits for cognition, enjoyment and perceived competence.

CONCLUSIONS

While ball skills interventions were associated with improvements in activity-level outcomes in children and adolescents with (probable) DCD, evidence regarding cognitive, psychosocial, and participation-level outcomes remains limited and warrants further investigation. Among the evaluated interventions, BSIMT demonstrated most favorable treatment effect estimates for core motor outcomes.