This update of a review has found limited, moderate-quality evidence that suggests some benefit of a family-centred care intervention for children's clinical care, parental satisfaction, and costs, but this is based on a small dataset and needs confirmation in larger RCTs. There is no evidence of harms. Overall, there continues to be little high-quality quantitative research available about the effects of family-centred care. Further rigorous research on the use of family-centred care as a model for care delivery to children and families in hospitals is needed. This research should implement well-developed family-centred care interventions, ideally in randomised trials. It should investigate diverse participant groups and clinical settings, and should assess a wide range of outcomes for children, parents, staff and health services.
had no easily accessible translation, and if they recruited subjects older than age 21. Study Participants & Setting: The target population included children with CP of all five GMFCS classification levels and any type of spasticity, ages 0-21 years. Materials/Methods: The initial search resulted in 280 potential articles, which were screened for the stated inclusion and exclusion criteria as well as for duplicates. Results: Fourteen articles satisfied the inclusion criteria. There were two case reports, one case series, one pilot study, three cohort studies, five quasi-experimental studies, and two ran-domized controlled trials. A total of 294 children with cere-bral palsy participated in these investigations. Sample size across the research studies varied from 1 to 46 children. The ages of the participants varied from 3 to 21 years old. Conclusions/Significance: The evidence suggests that aquatic therapy interventions and/or aquatic exercises are effective in the short term for improving gross movement and gait parameters as well as social function and self-esteem in children with CP ages 0-21, and that aquatic therapy or exercises are feasible , safe, and fun for this population. However, the overall body of evidence is inconclusive due to a lack of high-quality evidence, small sample sizes, and variability in intervention parameters (frequency, duration, intensity, etc.), severity of disease, and outcome measures. More research must be conducted with larger sample sizes, higher quality study design, and more consistent outcome measures to determine effective exercise parameters and to further support the success of aquatic exercises as a physical therapy intervention for this population.
Based on this review alone, and the acknowledgement that only one quasi-experimental study met the inclusion criteria, no firm conclusion could be drawn about the effectiveness of family-centred care for children in hospital. However, taken with the recent Cochrane review update on the effectiveness of the model of family-centred care, we suggest that it is time to search for a more effective model of care delivery which supports the child and family without putting undue pressure on families to stay with their child if it is difficult to do so.
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