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Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials.
Eur J Pediatr. 2016 Oct; 175(10):1353-60.EJ

Abstract

Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I(2) statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was -0.83 [-1.16, -0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] -0.46 [-0.7, -0.21]} in the state anxiety was observed amongst parents.

CONCLUSION

We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents.

WHAT IS KNOWN

• Trials with clown doctors in pediatric population have shown conflicting results in allaying anxiety amongst children undergoing either hospitalization or invasive procedures What is new: • This is the first systematic review and meta-analysis on hospital clowns • We found out that hospital clowns reduce anxiety amongst children before undergoing either hospitalization or invasive procedures.

Authors+Show Affiliations

Department of Health Sciences, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji. skannandr@gmail.com.Department of Oral Health, College of Medicine, Nursing and Health Sciences, Fiji National University, Suva, Fiji.

Pub Type(s)

Journal Article
Meta-Analysis
Review
Systematic Review

Language

eng

PubMed ID

27605131

Citation

Sridharan, Kannan, and Gowri Sivaramakrishnan. "Therapeutic Clowns in Pediatrics: a Systematic Review and Meta-analysis of Randomized Controlled Trials." European Journal of Pediatrics, vol. 175, no. 10, 2016, pp. 1353-60.
Sridharan K, Sivaramakrishnan G. Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. Eur J Pediatr. 2016;175(10):1353-60.
Sridharan, K., & Sivaramakrishnan, G. (2016). Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. European Journal of Pediatrics, 175(10), 1353-60. https://doi.org/10.1007/s00431-016-2764-0
Sridharan K, Sivaramakrishnan G. Therapeutic Clowns in Pediatrics: a Systematic Review and Meta-analysis of Randomized Controlled Trials. Eur J Pediatr. 2016;175(10):1353-60. PubMed PMID: 27605131.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Therapeutic clowns in pediatrics: a systematic review and meta-analysis of randomized controlled trials. AU - Sridharan,Kannan, AU - Sivaramakrishnan,Gowri, Y1 - 2016/09/08/ PY - 2016/06/29/received PY - 2016/08/19/accepted PY - 2016/08/01/revised PY - 2016/9/9/entrez PY - 2016/9/9/pubmed PY - 2017/6/24/medline KW - Children KW - Hospital clowns KW - Medical clowns SP - 1353 EP - 60 JF - European journal of pediatrics JO - Eur J Pediatr VL - 175 IS - 10 N2 - UNLABELLED: Children and/or their parents are in fear and anxiety when admitted to hospitals or undergo invasive surgeries or investigations. Clown therapy has been shown as an effective measure in reducing this hospital fear and anxiety. Hence, we carried out a systematic compilation of the existing evidence on the clinical utility of hospital clowns in pediatric population. Electronic databases were searched with an appropriate search strategy, and only randomized controlled trials comparing the effect of clown therapy with standard care in children were included. The key outcome measures were as follows: extent of anxiety and pain felt by children and extent of state and trait parental anxiety. Random effect model was applied when moderate to severe heterogeneity was observed. Forest plot, I(2) statistics and risk of bias were evaluated using RevMan 5.3 software. A total of 19 studies were found eligible to be included in the systematic review and 16 for meta-analysis. The pooled SMD [95 % CI] for child anxiety score was -0.83 [-1.16, -0.51] favoring clown therapy. Similarly, a statistically significant reduction {SMD [95 % CI] -0.46 [-0.7, -0.21]} in the state anxiety was observed amongst parents. CONCLUSION: We found that hospital clowns play a significant role in reducing stress and anxiety levels in children admitted to hospitals as well as their parents. WHAT IS KNOWN: • Trials with clown doctors in pediatric population have shown conflicting results in allaying anxiety amongst children undergoing either hospitalization or invasive procedures What is new: • This is the first systematic review and meta-analysis on hospital clowns • We found out that hospital clowns reduce anxiety amongst children before undergoing either hospitalization or invasive procedures. SN - 1432-1076 UR - https://www.unboundmedicine.com/medline/citation/27605131/Therapeutic_clowns_in_pediatrics:_a_systematic_review_and_meta_analysis_of_randomized_controlled_trials_ DB - PRIME DP - Unbound Medicine ER -