Abstract: Background：Previous Studies have focused on the associations between individual factors within the cerebral palsy (CP) population. However, there is limited research that systematically describes or constructs comprehensive networks for interaction analysis. Objective：To develop an innovative methodological framework with novel indicators, cut-off values, and decision pathways and to provide support for exploring the interactions between health-related factors in CP. Design：Mixed-Methods： study. Methods：A systematic literature search was conducted to identify relevant studies on associations or interactions between muscle tone and health-related factors in CP (Step 1). Characteristic data reflecting the effects or interactions of muscle tone were extracted from the selected studies (Step 2). Statistical analysis Methods： used to evaluate the relationships were identified and summarized (Step 3). A definition of muscle tone was established, and other health-related information associated with muscle tone was categorized according to various guideline dimensions (Step 4). Based on this information and multidisciplinary perspectives, indicators for evaluating relationships and their threshold values were proposed (Step 5). A logical framework for summarizing and identifying relationships was developed (Step 6), followed by internal data testing, adjustments, and refinements (Step 7). Main outcome measures：Methodology for identifying relationships between muscle tone and health-related factors in children and adolescents with CP. Results：The study extracted 2 327 rows of data from 106 articles. Of these, a total of 78 articles using correlations analysis included 1 668 data points, 44 using regression analysis included 450 data points, and 13 using other statistical Methods： included 209 data points. Following the established indicators and framework, we first selected data points within the same guideline dimensions. For each dimension, we classified each article into one of three outcomes (related, uncertain, or unrelated), and subsequently derived final judgments by summarizing the outcomes of each article. After summarizing, if the proportion of uncertain articles in a dimension is ≥1/3, the relationship between muscle tone and that guideline dimension is considered uncertain. Otherwise, we classified related and unrelated articles into four distributions (n∶n, 1∶n or n∶1 or 1∶1, 0∶n or n∶0, and 0∶1 or 1∶0) and derived judgments based on two additional indicators. The appropriate sample size is calculated if need. In practice, we applied the framework to the internal data and proposed that the muscle tone may interact with four dimensions (gross motor skills, muscle strength and endurance, secondary musculoskeletal disorder, and quality of life), but not with physical activity. The relationship between muscle tone and the dimensions of gait, participation, activities of daily living, and upper limb function remains unclear. Conclusion：This study introduced an original methodological approach for determining the relationships between muscle tone and other health-related factors in children with CP. A set of judgment indicators and threshold values were proposed, and a logical framework for identifying the relationships was developed.

Key words: Cerebral palsy, Muscle tone, Health-related function, Interaction effect, Methodology development