Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials

Abstract

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<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05). 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.

A musicoterapia em oncologia: percepções de crianças e adolescentes em cuidados paliativos

“…Em estudo, a presença de palhaços hospitalares durante a realização de procedimentos em crianças e adolescentes mostrou-se benéfica e auxiliou a melhora do estado psicológico desses, quando comparados com os que receberam apenas cuidados padrões. No estudo, recomendou-se a avaliação do impacto dos palhaços hospitalares e sua correlação com dados clínicos e biomarcadores 28 .…”

Liga acadêmica de humanização e a formação profissional em saúde: percepções de ligantes egressos

“…O clown, ou o palhaço de hospital, se apresenta como um importante complemento assistencial, com utilização de diferentes recursos, na sua atuação/prática, como a música, o malabarismo, a improvisação, a magia, a narração de histórias e uso de fantoches, entre outras atividades, podendo ser aplicado para todos os públicos. O palhaço de hospital baseia-se nos pressupostos de que "rir é o melhor remédio" e do "poder curativo do amor", permitindo aos pacientes, principalmente, hospitalizados, a expressão e fortalecimento emocional (Lopes-Júnior et al, 2020).…”

School reopening and risks accelerating the COVID-19 pandemic: A systematic review and meta-analysis protocol

“…No restriction to language or date will be employed in the search strategy. Furthermore, we will also scrutinize the reference lists of articles searched to seek additional studies [ 39 ]. The PECOS (Population, Exposure/Comparison/Outcomes/Study Design) acronym [ 40 ] was used to elaborate our research question: “ Which evidence is available from observational studies on school reopening , and does this have an impact on the transmission rate of Coronavirus Disease 2019 pandemic among children , adolescents , young adults , and adults ?…”

“…In addition, primary studies that did not meet the inclusion criteria will be excluded according to the reasons for exclusion. The two review authors (LCLJ and PCS) will perform data extraction for each included study based on forms published previously [ 39 , 41 – 44 ]. The expected completion date for this systematic review is September 30, 2021, due to the urgency to bring this evidence to light, in the current scenario in which the delta variant is spreading rapidly in several countries.…”