BACKGROUND: In pediatric health care, non-pharmacological interventions such as music therapy have promising potential to complement traditional medical treatment options in order to facilitate recovery and well-being. Music therapy and other music-based interventions are increasingly applied in the clinical treatment of children and adolescents in many countries world-wide. The purpose of this overview is to examine the evidence regarding the effectiveness of music therapy and other music-based interventions as applied in pediatric health care. METHODS: Surveying recent literature and summarizing findings from systematic reviews, this overview covers selected fields of application in pediatric health care (autism spectrum disorder; disability; epilepsy; mental health; neonatal care; neurorehabilitation; pain, anxiety and stress in medical procedures; pediatric oncology and palliative care) and discusses the effectiveness of music interventions in these areas. RESULTS: Findings show that there is a growing body of evidence regarding the beneficial effects of music therapy, music medicine, and other music-based interventions for children and adolescents, although more rigorous research is still needed. The highest quality of evidence for the positive effects of music therapy is available in the fields of autism spectrum disorder and neonatal care. CONCLUSIONS: Music therapy can be considered a safe and generally well-accepted intervention in pediatric health care to alleviate symptoms and improve quality of life. As an individualized intervention that is typically provided in a person-centered way, music therapy is usually easy to implement into clinical practices. However, it is important to note that to exploit the potential of music therapy in an optimal way, specialized academic and clinical training and careful selection of intervention techniques to fit the needs of the client are essential.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
BACKGROUND: Stroke is a leading cause of disabilities worldwide. One of the key disciplines in stroke rehabilitation is physical therapy which is primarily aimed at restoring and maintaining activities of daily living (ADL). Several meta-analyses have found different interventions improving functional capacity and reducing disability.
OBJECTIVES: To systematically evaluate existing evidence, from published systematic reviews of meta-analyses, of subacute physical rehabilitation interventions in (ADLs) for stroke patients.
METHODS: Umbrella review on meta-analyses of RCTs ADLs in MEDLINE, Web of Science, Scopus, Cochrane, and Google Scholar up to April 2018. Two reviewers independently applied inclusion criteria to select potential systematic reviews of meta-analyses of randomized controlled trials (RCTs) of physical rehabilitation interventions (during subacute phase) reporting results in ADLs. Two reviewers independently extracted name of the 1st author, year of publication, physical intervention, outcome(s), total number of participants, and number of studies from each eligible meta-analysis. The number of subjects (intervention and control), ADL outcome, and effect sizes were extracted from each study.
RESULTS: Fifty-five meta-analyses on 21 subacute rehabilitation interventions presented in 30 different publications involving a total of 314 RCTs for 13,787 subjects were identified. Standardized mean differences (SMDs), 95% confidence intervals (fixed and random effects models), 95% prediction intervals, and statistical heterogeneity (I and Q test) were calculated. Virtual reality, constraint-induced movement, augmented exercises therapy, and transcranial direct current stimulation interventions resulted statistically significant (P < .05) with moderate improvements (0.5 ≤ SMD ≤ 0.8) and no heterogeneity (I = 0%). Moxibustion, Tai Chi, and acupuncture presented best improvements (SMD > 0.8) but with considerable heterogeneity (I2 > 75%). Only acupuncture reached "suggestive" level of evidence.
CONCLUSION: Despite the range of interventions available for stroke rehabilitation in subacute phase, there is lack of high-quality evidence in meta-analyses, highlighting the need of further research reporting ADL outcomes.
Síntesis amplia/ Revisión panorámica de revisiones sistemáticas
OBJETIVO: Una "revisión de los exámenes" se realizó para evaluar las cuestiones metodológicas en los estudios de evaluación de las intervenciones no farmacológicas de rehabilitación en pacientes con accidente cerebrovascular.
ESTUDIO DE DISEÑO Y AJUSTE: MEDLINE, CINAHL, PsycINFO, y la Base de Datos Cochrane de Revisiones Sistemáticas se realizaron búsquedas de enero 2000 a enero 2008 en el ajuste de rehabilitación del accidente cerebrovascular. Las búsquedas electrónicas se complementan con las revisiones de las listas de referencias y citas identificadas por los expertos. Los estudios elegibles eran revisiones sistemáticas; citas excluidos eran revisiones narrativas o revisiones de exámenes. Revisión de las características y criterios para evaluar la calidad metodológica de los estudios primarios en su interior se extrajeron.
RESULTADOS: La búsqueda arrojó 949 Inglés-idioma citas. Se incluyeron un conjunto final de 38 revisiones sistemáticas. Las revisiones Cochrane, que tienen una metodología estandarizada, fueron en general de mayor calidad metodológica que los no-Cochrane. La mayoría de las revisiones sistemáticas utiliza criterios estandarizados de evaluación de la calidad de los estudios primarios, pero no todos eran completas. Opiniones de los estudios primarios mostraron que tenía problemas con la asignación al azar, ocultamiento de la asignación y el cegamiento. Comparabilidad inicial, los eventos adversos, y cointervención o la contaminación no se evaluaron de forma coherente. El cegamiento de los pacientes y los proveedores a menudo no era factible y no se evaluó como una fuente de sesgo.
CONCLUSIONES: Las revisiones sistemáticas elegibles identificó importantes deficiencias metodológicas en los estudios evaluados de primaria, lo que sugiere la necesidad de mejora de los métodos de investigación y presentación de informes.
In pediatric health care, non-pharmacological interventions such as music therapy have promising potential to complement traditional medical treatment options in order to facilitate recovery and well-being. Music therapy and other music-based interventions are increasingly applied in the clinical treatment of children and adolescents in many countries world-wide. The purpose of this overview is to examine the evidence regarding the effectiveness of music therapy and other music-based interventions as applied in pediatric health care.
METHODS:
Surveying recent literature and summarizing findings from systematic reviews, this overview covers selected fields of application in pediatric health care (autism spectrum disorder; disability; epilepsy; mental health; neonatal care; neurorehabilitation; pain, anxiety and stress in medical procedures; pediatric oncology and palliative care) and discusses the effectiveness of music interventions in these areas.
RESULTS:
Findings show that there is a growing body of evidence regarding the beneficial effects of music therapy, music medicine, and other music-based interventions for children and adolescents, although more rigorous research is still needed. The highest quality of evidence for the positive effects of music therapy is available in the fields of autism spectrum disorder and neonatal care.
CONCLUSIONS:
Music therapy can be considered a safe and generally well-accepted intervention in pediatric health care to alleviate symptoms and improve quality of life. As an individualized intervention that is typically provided in a person-centered way, music therapy is usually easy to implement into clinical practices. However, it is important to note that to exploit the potential of music therapy in an optimal way, specialized academic and clinical training and careful selection of intervention techniques to fit the needs of the client are essential.
