Novita Research Report January 1999 - Novita Children's Services

Evidence based practice review of occupational therapy interventions
to assist pre-school children with physical disabilities to become spontaneous
and independent players, and guidelines for clinical practice
Sonya Murchland
Senior Research
Occupational Therapist
Occupational
Therapy Staff
Objective
The emergence of occupational science over the past ten years within occupational therapy, has seen an
emphasis being placed on play as an occupational behaviour and role of children, rather than a means to achieve
other therapy goals. This review reflected this change in emphasis, and aimed to determine the interventions that
occupational therapists use to promote the ability of children to be spontaneous and independent players.
Method
A systematic review was undertaken using Medline and CINAHL, with additional hand searching of the reference
lists. Staff also forwarded any existing articles that they had located. Staff were then allocated two articles to
appraise, following training in a consistent method of appraisal. A modified version of Crombie’s Appraisal Tool
(adapted by the Clinical Research Department, Novita Children’s Services), was used with the initial appraisals,
and then the McMaster Clinical Appraisal Forms were used later. All studies and papers were included. The review
period was limited to an 18 month period.
Results
Of the 60 articles distributed, only 39 were returned (65%). 26 were review articles. Of the remaining 13 studies, four
were cross-sectional, three were case control studies, and the others were a cohort study, a quasi-experimental,
and a qualitative study. There was a great variability in the quality of the papers, reflecting in appraisal scores that
varied widely. Most of the studies were a low level of scientific exploration, and those of higher level only received
moderate appraisal ratings.
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Implications
This was the first EBP review undertaken by the occupational therapy discipline and as such, was a learning
process for all those involved.
Critical appraisal of the literature found that the evidence for occupational interventions to promote play was
inconclusive. Key themes for promoting play in children with physical disabilities were identified and guidelines
for practice developed.
Project completed in 2003
Novita Children’s Services Incorporated • Research Report January 1999 – June 2004