Effectiveness of Interventions for Children With Developmental Coordination Disorder in Physical Therapy Contexts: A Systematic Literature Review and Meta-Analysis

Abstract

Purpose: The purpose of this systematic literature review and meta-analysis is to identify the types of interventions in physical therapy contexts that have been explored in children with developmental coordination disorder, the most common variables being addressed, and whether these interventions are effective. Method: This systematic search of MEDLINE, PEDro, CINAHL, SPORTDiscus, PsycINFO, and Cochrane Library identified interventions in physical therapy contexts for children and adolescents with DCD, and studies were screened using these criteria and assessed using the PEDro and NIH quality assessment scales. AMSTAR was used to evaluate systematic reviews and a meta-analysis was conducted. Results: From the articles reviewed, 29 articles of moderate to good quality were included in the qualitative analysis. Task-oriented approaches as well as motor skill training-based interventions have shown beneficial effects in improving motor function in children with DCD. Data from 14 articles was extracted for inclusion in the meta-analysis, providing support for the effectiveness of physical therapy interventions against inaction. Conclusion: Researchers recommend the use of task-oriented and traditional physical therapy interventions for children with DCD. In addition, interventions in physical therapy contexts need clear goals and outcome measures for individual children.Keywords: developmental coordination disorder, child, adolescent, physical therapy, interventions, systematic reviews, meta-analysis, motor skill disorders Developmental coordination disorder (DCD) is a condition in which difficulties in motor skills exist but are not due to the overall intellect, primary sensor, or motor neurology of the individual. A primary characteristic of DCD is the difficulty in learning and performing everyday tasks in all aspects of life (home, school, play, etc.). The estimated prevalence of DCD ranges between 2% and 7% of all school-aged children (American Psychiatric Association [APA], 2013) with some reports suggesting that boys have a higher incidence than girls (Hillier, 2007). Children with DCD generally perform more poorly than other children on a variety of measures reflective of motor control and motor learning as well as sensory and perceptual processing. DCD can occur with other conditions such as specific language impairment (SLI) or attention-deficit hyperactivity disorder (ADHD) (Cermark, Gubbay, & Larkin, 2009).According to the Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5; APA, 2013), the criteria for a DCD diagnosis involve the following characteristics:(a) Acquisition and execution of coordinated motor skills are below what would be expected at a given chronologic age and opportunity for skill learning and use; difficulties are manifested as clumsiness (e.g. dropping or bumping into objects) and as slowness and inaccuracy of performance of motor skills (e.g. catching an object, using scissors, handwriting, riding a bike, or participating in sports), (b) The motor skills deficit si...

Intervention for children with developmental coordination disorder: How robust is our recent evidence?

“…Figure 2 shows the 45 primary studies whose data were included in the meta‐analyses performed. As before, we can see that Offor et al (2016) and Smits‐Engelsman et al (2018) are more distant from the others, indicating that they share fewer primary studies as sources of data. Putting the lack of overlap another way, 26 of the 45 primary studies (62%) were used for meta‐analysis only once; eleven twice, four three times and only one four times.…”

“…By observing the relationships between the eight reviews and their respective sources of evidence, it is also possible to determine how similar they are in terms of the primary studies sourced. Figure 1 shows that Miyahara, Hillier, et al (2017), Yu et al (2018), Preston et al (2017), Lucas et al (2016) and de Oliveira et al (2017) are relatively close to each other, whereas Saha et al (2016), Smits‐Engelsman et al (2018) and Offor et al (2016) are more distant, indicating that these three reviews relied on more distinct sources. Despite the similarities in their inclusion criteria, it is interesting to note that from the 17 RCTs covered by Miyahara, Hillier, et al (2017) and the 10 covered by de Oliveira et al (2017), only four were common to both.…”

“…Our search of the databases yielded 82 bibliometric references. After the initial title and abstract screening, six studies (Lucas et al, 2016; Miyahara, Hillier, Pridham, & Nakagawa, 2017; Offor, Williamson, & Caçola, 2016; Preston et al, 2017; Smits‐Engelsman et al, 2018; Yu, Burnett, & Sit, 2018) were identified as possible candidates for inclusion. From a Google search, we then found two more possible reviews (de Oliveira, Oliveira, Guendler, Rocha, & Sarinho, 2017; Saha, Sultana, Ahmed, & Saha, 2016).…”

“…As Table 1 shows, Saha et al (2016) was the only review to focus exclusively on randomized controlled trials (RCTs), whereas most others included a combination of RCTs and quasi‐RCTs or RCTs and non‐RCTs. Although Offor et al (2016) made no mention of research design in their method section, they actually included studies of all designs. With regard to the time periods covered in the search for primary studies, all were specified, but there was considerable variation.…”

“…Turning to those reviews that included meta analyses, the addition of numerical effect estimates does not seem to provide sounder evidence on which to base the conclusions drawn. To illustrate this fact, we have elected to consider the reviews by Offor et al (2016) and Smits‐Engelsman et al (2018). According to our raters, both sets of reviewers failed to (a) use an appropriate method for statistical combination of NRSIs (Item 11b); (b) assess the potential impact of RoB on the results of the meta‐analysis (Item 12); and (c) assess the potential impact of RoB when interpreting the results (Item 13).…”