Intervenciones basadas en tareas para niños con trastorno de desarrollo de la coordinación
Información
- DOI:
- https://doi.org/10.1002/14651858.CD010914.pub2Copiar DOI
- Base de datos:
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- Cochrane Database of Systematic Reviews
- Versión publicada:
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- 31 julio 2017see what's new
- Tipo:
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- Intervention
- Etapa:
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- Review
- Grupo Editorial Cochrane:
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Grupo Cochrane de Problemas de desarrollo, psicosociales y de aprendizaje
- Copyright:
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- Copyright © 2017 The Cochrane Collaboration. Published by John Wiley & Sons, Ltd.
Cifras del artículo
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Autores
Contributions of authors
Motohide Miyahara (MM) drafted the protocol and all authors contributed advice.
Susan L Hillier (SLH) and Liz Pridham (LP) performed second review author roles with MM, from inclusion through to risk of bias and data extraction stages.
Shinichi Nakagawa provided statistical advice.
MM, SLH, and LP wrote the final review text.
Sources of support
Internal sources
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University of Otago, New Zealand.
In the form of a salary for Motohide Miyahara and Shinichi Nakagawa (to March 2015)
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University of South Australia, Australia.
In the form of a salary for Susan Hillier and Liz Pridham
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University of New South Wales, Australia.
In the form of salary for Shinichi Nakagawa (from 1 March 2015)
External sources
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None, Other.
Declarations of interest
Motohide Miyahara (MM): none known.
Susan L Hillier (SLH) is an author of two included studies: Hillier 2010 and ACTRN12614000106639. SLH was not involved in assessing the risk of bias or the quality of the evidence from these studies. These tasks were performed by two independent review authors (MM and LP).
Liz Pridham (LP): none known.
Shinichi Nakagawa: none known.
Acknowledgements
We thank the following for their assistance.
The University of Otago, the University of South Australia, and the University of New South Wales: the development and publication of the protocol (Miyahara 2014), and this review, was made possible thanks to a salary from each author's university.
Cochrane Developmental, Psychosocial and Learning Problems (CDPLP): provided advice and assistance in producing this review.
Richard German (Librarian), Health Sciences Library (Medical and Dental) and Justin Farquhar (Librarian), Science Library, University of Otago, and Anthea Worley (Research Associate), University of South Australia: assisted with searching strategies.
Margaret Anderson, CDPLP: conducted the final search.
Version history
| Published | Title | Stage | Authors | Version |
| 2017 Jul 31 | Task‐oriented interventions for children with developmental co‐ordination disorder | Review | Motohide Miyahara, Susan L Hillier, Liz Pridham, Shinichi Nakagawa | |
| 2014 Jan 09 | Task‐oriented interventions for children with developmental co‐ordination disorder | Protocol | Motohide Miyahara, Susan L Hillier, Liz Pridham, Shinichi Nakagawa | |
Differences between protocol and review
Please see our protocol (Miyahara 2014).
Methods section
Types of outcomes
We moved adverse effects from our list of secondary outcomes to our primary outcomes in keeping with MECIR standards (Chandler 2013).
Search methods for identification of studies
We added WorldCat (worldcat.org) as an international source of theses, and searched for relevant systematic reviews in the Cochrane Database of Systematic Reviews (CDSR) and Database of Abstracts of Reviews of Effects (DARE). We also searched Ovid MEDLINE Epub Ahead of Print and Ovid MEDLINE In‐Process & Other Non‐Indexed Citations to find the most current MEDLINE content. Since the protocol for this review was published (Miyahara 2014), Current Controlled Trials has been replaced by the ISTRCN Registry (isrctn.com), and the metaRegister of Controlled Trials is under review and no longer in service. We did not search SportDiscus because the database was no longer available to the editorial base or review team.
Data collection and analysis
We specified in our protocol (Miyahara 2014), that " Two authors (SH and MM) will independently assess all studies identified by the search strategy for inclusion." However, this task was performed by MM and LP for two studies on which SLH is an author (ACTRN12614000106639; Hillier 2010). See also: Declarations of interest.
Data extraction and management
We specified that MM and SN would independently extract and manage data, but this task was performed by MM and SLH.
Assessment of risk of bias in included studies
We specified that we also assessed the blinding of participants and personnel (even though this was impossible given the nature of the intervention), and other potential sources of bias.
Measures of treatment effect
Continuous outcome data
Because all the studies that were included in meta‐analyses employed the MABC, we used the mean difference (MD) instead of the standardised mean difference (SMD). In future updates of this review, should we encounter studies that use different measures for the same outcome, we will use the standardised mean difference (SMD) (Borenstein 2009).
Multiple outcome data
As there was an insufficient number of included studies with postintervention data at multiple time points, we were unable to conduct a separate meta‐analysis using the SMD from both postintervention and follow‐up phases, as planned. We used immediate postintervention data only for meta‐analyses.
Dichotomous data
We found one trial, Pless 2000b, which reported dichotomous data. Pless 2000b divided participants into definite motor difficulties (MABC scores < 5th percentile) and borderline motor difficulties (MABC scores between 5th and 15th percentile) because no participant improved beyond the 15th percentile after intervention. It should be noted that in future studies, there is a possibility that some participants may improve beyond the 15th percentile, which would create trichotomous data. In this circumstance a future review would need a consensus to be reached as to whether the diagnostic cutoff should be the 5th or 15th percentile; this would enable dichotomous data to be extracted. Should we find such data in future updates of this review, we will calculate the odds ratio and convert them to SMDs (Borenstein 2009).
We used the latest version of Review Manager 5.3 to perform the analyses (Review Manager 2014).
Unit of analysis issues
For cross‐over trials, we decided to extract the outcome data from the first phase of the intervention period only, to avoid carry‐over effects. This is a change from the protocol where we said we would account for the carry‐over effect by obtaining (inter‐individual) correlation coefficients between pre‐ and postintervention periods (Miyahara 2014).
We were unable to include cluster‐randomised trials in the meta‐analyses. In future updates of this review, we will endeavour to obtain the intra‐cluster correlation coefficients from the study authors, as necessary, so we may appropriately integrate the effect from cluster‐randomised trials when calculating the SMDs and corresponding variances.
Dealing with missing data.
As expected, we did not have any missing data that required multiple imputation. Should we encounter such data in future updates of this review, we will conduct a sensitivity analysis using a multiple imputation technique for missing subgroup information, assuming the data are missing at random (Pigott 2012).
Assessment of heterogeneity
As we used the random‐effects model, we also reported Tau2, which is an estimate of between‐study variability.
In future updates of this review, where we encounter moderate to high heterogeneity, we will conduct a random‐effects meta‐analysis and explore the causes of heterogeneity by conducting subgroup analyses and meta‐regression, providing we have sufficient studies.
Assessment of reporting bias
We did not assess small study effects as we only included six studies in meta‐analyses. In future updates of this review, should we include sufficient studies, we will conduct a visual assessment of funnel plot asymmetry to identify possible publication bias and other small study effects (Sterne 2011). If funnel asymmetry is due to a lack of data points in the non‐statistically significant region of a funnel plot, we will interpret the funnel plot asymmetry as an indicator of possible publication bias; that is, multiple or singular publication of research findings, depending on the nature and direction of the results. We will only create a funnel plot for a meta‐analysis that contains at least 10 studies (SMDs).
Data synthesis
We decided to present the results of the random‐effects model only. We conducted a sensitivity analysis using the fixed‐effect model to assess the robustness of the results.
In future updates of this review, we will conduct subsequent meta‐analyses on subgroups according to the criteria described in the 'Subgroup analysis and investigation of heterogeneity' section, should we find sufficient studies. Also, where studies are unsuitable for meta‐analysis, we will provide narrative descriptions of their results.
Summary of findings tables
We included a new section on 'Summary of findings' tables in the Methods, at the request of the editorial base.
Subgroup analysis and investigation of heterogeneity
We could not conduct any subgroup analyses due to the small number of included studies with limited independent variables. In future updates of this review, if we find sufficient studies, we will perform the following subgroup analyses.
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Age (preschool versus junior; primary versus senior; primary versus secondary or high school).
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Sex (male versus female).
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Severity of DCD in terms of cutoffs used for standard performance outcome tests and questionnaires (for example, second percentile; fifth percentile; 15th percentile).
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Intervention intensity calculated as a combination of frequency and duration (for example, < 3 times a week versus ≧ 3 times a week; or < 6 weeks versus ≧ 6 weeks).
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Type of intervention (for example, NTT versus CO‐OP).
Sensitivity analysis
Due to the small number of eligible studies, we were unable to conduct our preplanned sensitivity analyses. In future updates of this review, we will conduct sensitivity analyses to explore the impact of all three aspects of study quality (risk of bias) associated with issues of blinding of outcome assessment, completeness of data, and sequence generation and allocation concealment.
We tested the robustness of the results by conducting the following, post hoc sensitivity analyses.
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Fixed‐effect model, combining MDs (not SMDs) for the reason explained above, versus random‐effects model.
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Meta‐analysis combining two RCTs and three quasi‐RCTs versus meta‐analysis of two RCTs only.
Keywords
MeSH
Medical Subject Headings (MeSH) Keywords
Medical Subject Headings Check Words
Child; Child, Preschool; Female; Humans; Male;
PICO
Study flow diagram.
Risk of bias graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.
Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Forest plot of comparison: 1 Random‐effects model, outcome: 1.1 Movement Assessment Battery for Children (MABC): Total score.
Forest plot of comparison: 3 Fixed model, outcome: 2.1 Movement Assessment Battery for Children Total.
Comparison 1 Random‐effects model, Outcome 1 Movement Assessment Battery for Children (MABC): Total score.
Comparison 2 Fixed‐effect model, Outcome 1 Movement Assessment Battery for Children (MABC): Total score.
| Task‐oriented interventions versus no intervention for children with developmental co‐ordination disorder (DCD) | ||||||
| Participant or population: children with DCD Settings: hospital settings; university‐based clinic, laboratory, or centre; community centres; home; and school Intervention: task‐oriented interventions Comparison: no intervention | ||||||
| Outcomes | Anticipated absolute effects* (95% CI) | Relative effect | No of participants | Quality of the evidence | Comments | |
| Risks with no intervention | Risks with task‐oriented interventions | |||||
| MABC,Total Impairment Score, RCTs and quasi‐RCTs. Follow‐up: range 6 weeks to 6 months. | The mean MABC, Total Impairment Score in the inactive control groups ranged from 5.5 to 27.0 | The mean MABC, Total Impairment Score in the intervention group was 3.63 lower (5.88 lower to 1.39 lower) | ‐ | 169 | ⊕⊝⊝⊝ | Green 2008; Hillier 2010; Pless 2000b; Tsai 2009; Tsai 2012 Analysis conducted on the total impairment scores of the MABC; the higher the score, the more impaired. |
| MABC, Total Impairment Score, RCTs only. Follow‐up: range 6 weeks to 20 weeks. | The mean MABC, Total Impairment Score in the inactive control groups ranged from 17.13 to 20.80 | The mean MABC, Total Impairment Score in the intervention group was 2.34 lower (7.50 lower to 2.83 higher) | ‐ | 51 | ⊕⊕⊝⊝ | Analysis conducted on the total impairment scores of the MABC; the higher the score, the more impaired. |
| Adverse events | 0 events reported in both the intervention and control group. | Not estimable | 340 (11 RCTs) | ‐ | ACTRN12614000106639; Fong 2016; Green 2008; Hillier 2010; Hung 2010; Miller 2001; Pless 2000b; Sugden 2003; Thornton 2016; Tsai 2009; Tsai 2012 | |
| Changes in motor co‐ordination, as measured by standardised rating scales | 1 study used the DCDQ (Green 2008), and 2 studies used the MABC Checklist (Pless 2000b; Sugden 2003). Green 2008 reported no data on the questionnaire to be used for a randomised comparison. Pless 2000b found no significant intervention effect on the MABC Checklist, and Sugden 2003 used the MABC Checklist at pre‐intervention only, not at postintervention. | Not estimable | 111 (3 RCTs) | ⊕⊝⊝⊝ | Important outcome to accumulate data for future evidence synthesis. | |
| Measures of impairment (e.g. sensation, physical fitness) | See comment. | ‐ | ‐ | ‐ | Not reported. Important outcome to accumulate data for future evidence synthesis. | |
| Measures of psychosocial factors | 3 studies used perceived competence scales (ACTRN12614000106639; Hillier 2010; Miller 2001). ACTRN12614000106639 used the PSPCSA and found a significant intervention effect on perceived physical competence, but no differential intervention effect between intervention setting and provider. Hillier 2010 also used the PSPCSA and found no evidence of an effect on perceived physical competence as a result of intervention. Miller 2001 used the Self Perception Profile for Children (Harter 1985) and found no significant intervention effect on the scale. It was impossible to estimate the anticipated absolute effects of the 3 studies for 2 reasons: 1. Hillier 2010 reported median and range, whereas ACTRN12614000106639 and Miller 2001 reported means and SDs; 2. Hillier 2010 and Miller 2001 used inactive controls, whereas ACTRN12614000106639 used active controls. | Not estimable | 126 (3 RCTs) | ⊕⊝⊝⊝ | Important outcome to accumulate data for future evidence synthesis. | |
| Measures of occupational and task performance | 2 studies used the COPM and reported improved performance and satisfaction as a result of intervention (Miller 2001; Thornton 2016). Miller 2001 reported that the differential intervention effect between the CO‐OP and the contemporary treatment approach (defined as a variety of approaches) was significant on the satisfaction subscale only, which had a considerable baseline difference between the 2 groups. Thornton 2016 reported the significant pre‐post improvement in the CO‐OP group only; the change in the control group is not reported. | Not estimable | 40 (2 RCT) | ⊕⊝⊝⊝ | Important outcome to accumulate data for future evidence synthesis. | |
| Measures of participation | 2 trials measured participation in physical activities by self‐made questionnaires only after the intervention (Hillier 2010; Pless 2000b). Hillier 2010 administered a participation questionnaire after the intervention and found no group difference between the intervention and the control group. Pless 2000b found no group difference in practising motor tasks at home. | Not estimable | 49 (2 RCTs) | ⊕⊝⊝⊝ | Important outcome to accumulate data for future evidence synthesis. | |
| * The risk in the intervention group (and its 95% CI) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). | ||||||
| GRADE Working Group grades of evidence | ||||||
| 1 Downgraded two levels for very serious imprecision (small sample size) and one level for study limitations (concerns with allocation concealment in Green 2008, Pless 2000b, Tsai 2009, Tsai 2012, and Wilson 2016, which comprise 92.90% of the total number of participants included in the meta‐analysis). | ||||||
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Movement Assessment Battery for Children (MABC): Total score Show forest plot | 6 | Mean Difference (IV, Random, 95% CI) | Subtotals only | |
| 1.1 RCTs and quasi‐RCTs | 6 | 169 | Mean Difference (IV, Random, 95% CI) | ‐3.63 [‐5.88, ‐1.39] |
| 1.2 RCTs only | 2 | 51 | Mean Difference (IV, Random, 95% CI) | ‐2.34 [‐7.50, 2.83] |
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
| 1 Movement Assessment Battery for Children (MABC): Total score Show forest plot | 6 | Mean Difference (IV, Fixed, 95% CI) | Subtotals only | |
| 1.1 RCTs and quasi‐RCTs | 6 | 169 | Mean Difference (IV, Fixed, 95% CI) | ‐4.06 [‐5.63, ‐2.50] |
| 1.2 RCTs only | 2 | 51 | Mean Difference (IV, Fixed, 95% CI) | ‐2.11 [‐6.00, 1.78] |
