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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.
Reference		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
Link to article		https://doi.org/10.1007/s00431-016-2764-0
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.
Technique		Systematic literature review; Standardized Mean Differences (SMD); Risk Ratio (RR); Meta-analysis; Randomized controlled trial