Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review

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.

A red stoplight response to Novak and Honan (2019)

“…A red stoplight response to Novak and Honan (2019) As a paediatric occupational therapist certified in the neurodevelopmental treatment (NDT) approach, it is my responsibility to ensure that I make sound, ethical decisions in providing interventions to promote participation in meaningful occupations. Focusing on client-centred and occupation-based goals is critical, with NDT as one strategy to foster effective movement-to promote functional goal attainment.…”

Walking in the Hibbot, an innovative walking aid improves gait characteristics in children with cerebral palsy: a cross-sectional study

“…walking) should start at a young age to enhance experience-dependent neuroplasticity, should be task specific, highly intensive and should be integrated into functional daily activities to enhance motor learning. (12)(13)(14)(15)(16)(17)(18) Evidence for neuroplastic changes induced by early intervention on upper limb motor activity has been found in recent studies. (19)(20)(21) However, research on neuroplastic changes as a result of intervention on lower limb activity is lacking.…”

Reply to: Letter to the Editor RE: Novak and Honan (2019)

“…In Table 1 (aot12573-sup-0001-tables1), each intervention outcome, for each disability, was assigned a separate outcome indicator number (Novak & Honan, 2019). Outcome indicator 114, summarised the evidence from five systematic reviews, for SI influencing the goal achievement of children with ASD (Novak & Honan, 2019). Like you, we concluded there is weak positive evidence to suggest Ayres SI may improve goal achievement and participation of children with ASD.…”

“…We did not conflate the research evidence for any intervention approach between different disabilities. In Table 1 (aot12573-sup-0001-tables1), each intervention outcome, for each disability, was assigned a separate outcome indicator number (Novak & Honan, 2019). Outcome indicator 114, summarised the evidence from five systematic reviews, for SI influencing the goal achievement of children with ASD (Novak & Honan, 2019).…”