Abstract
IntroductionPaediatric occupational therapy seeks to improve children's engagement and participation in life roles. A wide variety of intervention approaches exist. Our aim was to summarise the best‐available intervention evidence for children with disabilities, to assist families and therapists choose effective care.MethodsWe conducted a systematic review (SR) using the Cochrane methodology, and reported findings according to PRISMA. CINAHL, Cochrane Library, MEDLINE, OTSeeker, PEDro, PsycINFO were searched. Two independent reviewers: (i) determined whether studies met inclusion: SR or randomised controlled trial (RCT); an occupational therapy intervention for children with a disability; (ii) categorised interventions based on name, core components and diagnostic population; (iii) rated quality of evidence and determined the strength of recommendation using GRADE criteria; and (iv) made recommendations using the Evidence Alert Traffic Light System.Results129 articles met inclusion (n = 75 (58%) SRs; n = 54 (42%)) RCTs, measuring the effectiveness of 52 interventions, across 22 diagnoses, enabling analysis of 135 intervention indications. Thirty percent of the indications assessed (n = 40/135) were graded ‘do it’ (Green Go); 56% (75/135) ‘probably do it’ (Yellow Measure); 10% (n = 14/135) ‘probably don't do it’ (Yellow Measure); and 4% (n = 6/135) ‘don't do it’ (Red Stop). Green lights were: Behavioural Interventions; Bimanual; Coaching; Cognitive Cog‐Fun & CAPS; CO‐OP; CIMT; CIMT plus Bimanual; Context‐Focused; Ditto; Early Intervention (ABA, Developmental Care); Family Centred Care; Feeding interventions; Goal Directed Training; Handwriting Task‐Specific Practice; Home Programs; Joint Attention; Mental Health Interventions; occupational therapy after toxin; Kinesiotape; Pain Management; Parent Education; PECS; Positioning; Pressure Care; Social Skills Training; Treadmill Training and Weight Loss ‘Mighty Moves’.ConclusionEvidence supports 40 intervention indications, with the greatest number at the activities‐level of the International Classification of Function. Yellow light interventions should be accompanied by a sensitive outcome measure to monitor progress and red light interventions could be discontinued because effective alternatives existed.
Highlights
Paediatric occupational therapy seeks to improve children’s engagement and participation in life roles
More than 54 randomised controlled trial (RCT) exist in the paediatric occupational therapy evidence base, but we treated any RCT that was cited within an included systematic review (SR) as a duplicate
Included studies were across the following childhood disability diagnoses: arthrogyposis; attention deficit hyperactivity disorder (ADHD); autism spectrum disorder (ASD); behaviour disorders; brachial plexus injury; brain injury (BI); burns; cerebral palsy (CP); cancer; chronic pain; developmental coordination disorder (DCD); developmental disability (DD); Down syndrome; foetal alcohol spectrum disorder; learning disability (LD); mental health; intellectual disability (ID); obesity; preterm infants; physical disability; rheumatoid arthritis; and spina bifida
Summary
Paediatric occupational therapy seeks to improve children’s engagement and participation in life roles. Occupational therapy intervention for children promotes engagement and participation in children’s daily life roles (Mandich & Rodger, 2006). Occupational therapists select interventions for children based upon an analysis of the child’s performance of daily life roles, how their performance is affected by their disability, and how their environment supports or constrains their performance (Mandich & Rodger, 2006). International Classification of Functioning, Disability and Health (ICF; World Health Organisation, 2001) These frameworks have led many occupational therapists to move away from impairment-based interventions at the body structures and functions level aimed at remediating the child’s deficits (known as ‘bottomup’ interventions), and instead to focus on improving functional activity performance and participation (‘topdown’ interventions) (Weinstock-Zlotnick & Hinojosa, 2004), as well as partnering with parents to deliver therapy embedded within daily life
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