Učinkovitost bolničkih klovnova za upravljanje simptomima u pedijatriji: sistematski pregled randomiziranih i nerandomiziranih kontroliranih studija.
BMJ (Clinical research ed.)
Sažetak istraživanja
Cilj Procijeniti dokaze iz randomiziranih kontroliranih studija i nerandomiziranih kontroliranih studija o djelotvornosti bolničkih klovnova za niz klastera simptoma kod djece i adolescenata primljenih u bolnicu s akutnim i hroničnim stanjima.
Dizajn Sistematski pregled randomiziranih i nerandomiziranih kontroliranih studija. Izvori podataka Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, Američko psihološko udruženje PsycINFO, Kumulativni indeks medicinske sestrinske i srodne zdravstvene literature i latinoamerička i karipska zdravstvena literatura. Odabir studije Randomizirane i nerandomizirane kontrolirane studije recenzirane su uz korištenje sljedećih kriterija podobnosti: djeca i adolescenti koji su primljeni u bolnicu zbog akutnih stanja ili kroničnih poremećaja, studije koje upoređuju korištenje bolničkih klovnova sa standardnom njegom i studije koje procjenjuju učinak bolničkih klovnova na liječenje simptoma stacionarne djece i adolescenata. Ekstrakcija i sinteza podataka Dva istraživača su nezavisno pregledala studije, izvukli podatke i procenili rizik od pristranosti. Metodološku procjenu procijenila su dva istraživača nezavisno koristeći Jadad skalu, revidirani Cochrane alat za rizik od pristrasnosti za randomizirana kontrolirana ispitivanja (RoB 2) i alat za rizik od pristranosti u nerandomiziranim studijama (ROBINS-I) za nerandomizirana kontrolirana ispitivanja.
Rezultati 24 studije (n=1612) ispunile su kriterijume za uključivanje i analizu podataka. Većina studija bila su randomizirana kontrolirana ispitivanja (n=13). Anksioznost je bila najčešće analizirani simptom (n=13), praćen bolom (n=9), psihološkim i emocionalnim reakcijama i percipiranim blagostanjem (n=4), stresom (n=4), umorom od raka (n=3) i plačem (n=2). Pet studija koristilo je biomarkere, uglavnom kortizol, za procjenu stresa ili umora nakon bolničkih klovnova. Većina randomiziranih kontroliranih studija (n=11; 85%) ocijenjena je kao da su pokazala zabrinutost, a dva ispitivanja su ocijenjena s visokim rizikom od pristrasnosti. Većina nerandomiziranih kontroliranih studija (n=6; 55%) ocijenjena je sa umjerenim rizikom od pristranosti prema ROBINS-I alatu. Istraživanja su pokazala da su djeca i adolescenti koji su bili u prisustvu bolničkih klovnova, sa ili bez prisutnog roditelja, prijavili značajno manju anksioznost tokom niza medicinskih procedura, kao i poboljšanu psihičku prilagodbu (P
Zaključci Ovi nalazi sugeriraju da bi prisustvo bolničkih klovnova tokom medicinskih procedura, uvođenje anestezije u preoperativnu sobu moglo biti dio strategije liječenja hroničnih stanja). Nadalje, bolnički klaunovi mogu pomoći u poboljšanju psihičkog stanja primljene djece i adolescenata s akutnim i kroničnim poremećajima, u poređenju sa onima koji su primili samo standardnu njegu PROSPERO CRD42018107099.
Prikaži originalni naslov i sažetak na engleskom
Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials.
Objective To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions.
Design Systematic review of randomised and non-randomised controlled trials. Data sources Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature. Study selection Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome. Data extraction and synthesis Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials.
Results 24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P
Conclusions These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care. Systematic review registration PROSPERO CRD42018107099.
Izvorni podaci
- DOI
- 10.1136/bmj.m4290
- PMID
- 33328164
- PMCID
- PMC7737653
- Provjereno
- 2026-07-26
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