Author
ZIVIANI Jenny; et al.;
Systematic review of early intervention programmes for children from birth to nine years who have a physical disability.
Journal citation/publication details
Australian Occupational Therapy, 57(4), August 2010, pp.210-223.
Summary
Ten early intervention programmes with a wide range of intervention types, participants, and outcome measures, were included in this systematic review. A number of positive outcomes, both child-related and family-related, were reported but further analysis was prevented due to methodological limitations. The need for more, well-designed studies that include baseline data, long-term follow-up and standardised outcome measures is emphasised.
Context
Early intervention programmes for children with physical disabilities typically include occupational therapy, physiotherapy, and speech therapy, all of which tend to focus on family involvement, and early classroom-based special education programmes. The aim of this systematic review was to evaluate the effectiveness of broader, multi-disciplinary, early intervention strategies rather than the specific early intervention services that have been examined in the past.
Methods
What sources were searched?
The following electronic databases were searched for articles published between 1990 and April 2008: ERIC, Web of Science, Medline, CINAHL, EMBASE, Cochrane Register of Controlled Trials, PubMed, Health Source: Nursing/Academic Edition, Australasian Medical Index, Social Services Abstracts, Australian Family and Society Plus, and Scopus. Reference lists of relevant studies and key journals were scanned and known authors were contacted for additional material.
What search terms/strategies were used?
A search strategy using keywords for physical disability, children, early interventions and effectiveness is detailed in the text.
What criteria were used to decide on which studies to include?
Broad-based and multi-disciplinary early intervention programmes measuring the effects of intervention on children with a primary physical disability, or their parents, were eligible for inclusion. At least 30% of participants had to be children with a physical disability and at least 45% had to be aged up to nine years. Study designs such as randomised control trials, quasi-randomised or non-randomised control trials, and cohort or cross-sectional studies were acceptable. The focus was on social, developmental and emotional, rather than educational outcomes. Studies were limited to those published in peer-reviewed journals.
Who decided on their relevance and quality?
Articles were independently assessed by two named authors for both relevance and quality. Quality was rated using an adapted version of DuRant’s checklist and the PEDro scale.
How many studies were included and where were they from?
A total of 355 unique records were retrieved from the database search and three studies were identified from other sources. The screening process, including reasons for exclusion at each stage, is outlined in Figure 1. Ten studies were included in the review; the geographical settings are not reported.
How were the study findings combined?
The review is narrative. The findings are presented in the text and in Table 3 under the following headings: family-related outcomes - parent satisfaction, family-centred service provision, met and unmet needs, and parent skill development; child-related outcomes - child development, and; goal attainment. Study characteristics are reported in Table 1.
Findings of the review
Studies varied considerably in terms of participants, intervention types and outcome measures. Methodological quality was generally moderate. No randomised controlled studies were included in the review. Three broad categories of intervention were identified: multidisciplinary therapy and family support; parent-education and parent-implemented intervention, and; therapy, medical care and education support.
Positive outcomes relating to parent satisfaction with early intervention programmes, the ability of parents to care for their disabled child, and goal attainment were reported in some studies. Parents’ perceptions of the family-centredness of services was measured in three studies, with mixed results. Studies measuring families’ needs found different levels of unmet needs but similarities in the types of unmet needs identified. Lack of provision of information on their child’s condition was a commonly reported theme. Four out of five studies reporting child development outcomes found significant positive changes.
Authors' conclusions
‘Existing studies on early intervention programmes for children with physical disabilities and their families have reported that programmes create positive outcomes for both children and their families. However, the methodological weaknesses of these studies mean that they provide inconclusive evidence of the effectiveness of these programmes’.
Implications for policy or practice
None are discussed.