Aim To update a systematic review of evidence published up to December 2015 for pharmacological/neurosurgical interventions among individuals with cerebral palsy (CP) and dystonia. Method Searches were updated (January 2016 to May 2020) for oral baclofen, trihexyphenidyl, benzodiazepines, clonidine, gabapentin, levodopa, botulinum neurotoxin (BoNT), intrathecal baclofen (ITB), and deep brain stimulation (DBS), and from database inception for medical cannabis. Eligible studies included at least five individuals with CP and dystonia and reported on dystonia, goal achievement, motor function, pain/comfort, ease of caregiving, quality of life (QoL), or adverse events. Evidence certainty was evaluated using GRADE. Results Nineteen new studies met inclusion criteria (two trihexyphenidyl, one clonidine, two BoNT, nine ITB, six DBS), giving a total of 46 studies (four randomized, 42 non‐randomized) comprising 915 participants when combined with those from the original systematic review. Very low certainty evidence supported improved dystonia (clonidine, ITB, DBS) and goal achievement (clonidine, BoNT, ITB, DBS). Low to very low certainty evidence supported improved motor function (DBS), pain/comfort (clonidine, BoNT, ITB, DBS), ease of caregiving (clonidine, BoNT, ITB), and QoL (ITB, DBS). Trihexyphenidyl, clonidine, BoNT, ITB, and DBS may increase adverse events. No studies were identified for benzodiazepines, gabapentin, oral baclofen, and medical cannabis. Interpretation Evidence evaluating the use of pharmacological and neurosurgical management options for individuals with CP and dystonia is limited to between low and very low certainty. Meta‐analysis suggests that intrathecal baclofen (ITB) and deep brain stimulation (DBS) may improve dystonia and pain. Meta‐analysis suggests that DBS may improve motor function. Clonidine, botulinum neurotoxin, ITB, and DBS may improve achievement of individualized goals. ITB and DBS may improve quality of life. No direct evidence is available for oral baclofen, benzodiazepines, gabapentin, or medical cannabis.

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Background Hospitalized children face pain and anxiety associated with the environment and procedures. Objective This review aimed to assess the impact of music, play, pet and art therapies on pain and anxiety in hospitalized paediatric patients. RCTs assessing the impact of music, play, pet, and/or art therapies on pain and/or anxiety in hospitalized paediatric patients were eligible. Methods Database searching and citation screening was completed to identify studies. A narrative synthesis was used to summarize study findings and certainty of evidence was assessed using GRADE. Of the 761 documents identified, 29 were included spanning music (n = 15), play (n = 12), and pet (n = 3) therapies. Results A high certainty of evidence supported play in reducing pain and moderate certainty for music and pet. A moderate certainty of evidence supported music and play in reducing anxiety. Conclusion Complementary therapies utilized alongside conventional medical treatment may mitigate pain and anxiety in hospitalized paediatric patients.

Background The hospital can provoke significant feelings of pain, fear, and anxiety in children. Being in a new setting, often separated from loved ones and undergoing multiple medical procedures may elicit negative emotions. Complementary treatments may minimize these feelings and facilitate a more positive experience for children in hospital. Objectives This systematic review aims to explore the impact of music, play, pet, and art therapy on pain and anxiety in paediatric patients in hospital. Design/Methods Databases MEDLINE, CINAHL, Cochrane Library, and EMBASE were searched from database inception to November 2020 and reference lists were screened. Randomized control trials (RCTs) of paediatric patients evaluating the impact of music, pet, play, and/or art therapy on pain and/or anxiety were eligible for inclusion. Study setting was limited to the hospital (inpatient/outpatient) and/or emergency department. No restrictions were placed on the comparator. Duplicate studies were removed, and abstract and full-text screening was completed independently and in duplicate by reviewers. Reviewers extracted data from eligible studies into predeveloped REDCap forms independently and in duplicate. A narrative synthesis was used to summarize study findings using the synthesis without meta-analysis (SWiM) guidelines. Quality of evidence was then assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) across studies for each intervention and outcome. Results 761 documents were identified and 30 RCTs were included, covering music (n=15), play (n=13), and pet (n=3) therapy. One study examined music and play therapy. No art therapy studies were identified. Studies took place in the inpatient setting (n=18), outpatient setting (n=5), a combination of both inpatient and outpatient (n=3), and the emergency department (n=4). Most studies (n=25, 83%) evaluated patients’ pain and/or anxiety before, during, and/or after undergoing procedures in hospital such as surgery, venipuncture, and imaging. There was high certainty of evidence for play therapy in reducing pain and moderate certainty for music and pet therapy. Moderate certainty of evidence supported music and play therapy in reducing anxiety; however, pet therapy was found to have little to no significant difference. None of the interventions were found to increase pain or anxiety. Conclusion Complementary therapies such as music, play, and pet therapy should be utilized in parallel to medical treatments in paediatric patients receiving care in hospital to mitigate pain and anxiety in addition to promoting a positive hospital experience.