Effects of trampoline training on lower-limb strength and balance in children and adolescents with special needs: a multilevel systematic review and meta-analysis

Objective To conduct a thorough assessment of how trampoline training affects lower limb strength and balance in children and adolescents with special needs, while also exploring the relationships between intervention dosage, effect sizes, and potential moderating factors. Methods This research adhered to PRISMA standards. A systematic search for randomized controlled trials (RCTs) published through December 10, 2025, was conducted across PubMed, Web of Science, PsycINFO, and the Cochrane Library. Using the PICOS framework, the target population included children and adolescents with special needs; the intervention involved trampoline training; comparisons were made with non-trampoline comparator conditions, including usual care, standard care, physiotherapy, regular physical education, or no intervention; the outcomes measured included lower-limb strength and balance (assessed through standardized scales or objective tests), and the study design involved RCTs. Continuous outcomes were pooled using standardized mean differences (SMDs). A three-level random-effects model was used to account for the dependence of multiple effect sizes within studies. Heterogeneity was assessed using the Q test and I 2 statistic. Sensitivity analyses and publication bias assessments, including Egger’s regression and trim-and-fill methods, were carried out. Additionally, subgroup analyses were performed to identify possible moderators. Results Fifteen RCTs were analyzed. The combined results indicated that trampoline training significantly enhanced static balance (SMD = 1.47, 95% CI [0.66, 2.28], p < 0.001; GRADE: Moderate) and dynamic balance (SMD = 0.72, 95% CI [0.06, 1.37], p = 0.032; GRADE: Low). However, the increase in lower-limb strength was not statistically significant (SMD = 0.43, 95% CI [−0.12, 0.97], p = 0.125; GRADE: Very Low). All three measures exhibited substantial heterogeneity ( I 2 > 75%), and Egger’s tests indicated a potential publication bias. Current evidence most consistently supports trampoline-based training for improving static balance. Evidence for dynamic balance was less stable after bias adjustment, and evidence for lower-limb strength remains insufficient. Subgroup analyses revealed that studies involving longer intervention durations, moderate training frequencies, and primarily children with neurodevelopmental disorders showed greater improvements in balance. Conclusion Trampoline training appears to provide the most consistent benefit for static balance in children and adolescents with special needs, whereas evidence for dynamic balance and lower-limb strength remains uncertain. Given the wide variety of populations included, intervention effects may vary across participant types. Further high-quality studies are needed to clarify these effects. Systematic review registration https://www.crd.york.ac.uk/PROSPERO/view/CRD420251265788 . Unique Identifier: CRD420251265788.