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Id 85
Author Sridharan, K.; Sivaramakrishnan, G.
Title Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials.

Sridharan, K., & Sivaramakrishnan, G. (2016). Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. European journal of pediatrics, 175(10), 1353-1360.

Keywords therapeutic clowns; children; hospital; anxiety
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Abstract Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I2 statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was −0.83 [−1.16, −0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] −0.46 [−0.7, −0.21]} in the state anxiety was observed amongst parents.

Metodology A thorough literature search was conducted and was completed on 14 June 2016. The primary data base used was Medline (via PubMed), Cochrane central register of clinical trials, Database of Abstracts of Reviews of Effects and Google Scholar. The key words used were clown [tiab]. This search was further supplemented by hand searching of relevant references from review articles and other eligible studies. No limits were applied in the present review. The primary outcome measures were the number of children with anxiety, the extent of anxiety measured by any scale and the extent of pain felt as measured by any scale. The secondary outcome measures were the number of children who cooperated, extent of cooperation measured by any scale, number of caregivers with anxiety, extent of anxiety felt by the caregivers, time taken for inducing anesthesia, number of children shifted from the planned inhalational to intravenous anesthesia, number of children requiring an increased requirement of anesthesia, number of children satisfied with the care provided, number of parents satisfied with the care provided, number of times anxiolytic drugs were used and number of attending interruptions by the hospital staff.

Findings A total of 91 studies were obtained from the electronic databases of which finally 19 were found eligible to be included in the present review. We found that clown therapy significantly reduces the anxiety experienced by children and state anxiety in parents. The size of the reduction in anxiety was found to be large with children and medium with parents in the present study. We found that medical clowns are therapeutically useful to alleviate fear and anxious symptoms in admitted children. Good communication between healthcare staff and children, as well as their parents is an essential support to be offered, to ease stress in parents whose child is admitted in pediatric wards. Hospital clowning is an interdisciplinary art with a wide variety of multiple skills such as humor, drama, music, and dance due to which a beneficial, therapeutic impact have been noted in patients. To conclude, we found that hospital clowns play a significant role in reducing stress and anxiety levels of children admitted to hospitals as well as their parents.
Open Access NO
DOI 10.1007/s00431-016-2764-0
Search Database Researcher knowledge
Technique Systematic literature review; Standardized Mean Differences (SMD); Risk Ratio (RR); Meta-analysis; Randomized controlled trial
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