Ren Yuxi, Jia Shuqi, Liu Cong, Li Shufan, Long Yueyu
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The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.</p><p><strong>Results: </strong>A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), <i>P</i> < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, <i>P</i> < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, <i>P</i> < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, <i>P</i> < 0.05) was most effective in improving on social communication deficits of ASD children.</p><p><strong>Discussion: </strong>The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. 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Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.</p><p><strong>Results: </strong>A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), <i>P</i> < 0.001]. 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引用次数: 0
摘要
目的探讨沙盘游戏疗法在干预自闭症谱系障碍(ASD)儿童社交沟通障碍方面的疗效,以及这种疗效是否受儿童年龄和沙盘游戏疗法干预剂量的影响:按照 PICOS 原则,从七个数据库中检索了与沙盘游戏疗法治疗 ASD 儿童社交沟通障碍相关的随机对照试验(RCT):PubMed、WOS、The Cochrane Library、Embase、CNKI、万方和VIP,检索时间从各数据库建立之初至2023年11月10日。两名实验员独立进行研究筛选,排除了伴有疾病、数据不完整、无法提取数据和非随机对照试验的研究。方法学质量评估采用 PEDro 量表,证据质量评估采用 GRADEprofiler 方法。Stata17软件用于荟萃分析、亚组分析、敏感性分析和发表偏倚测试。采用标准化平均差(SMD)和95%置信区间(CI)作为效应统计:结果:共纳入了 12 项 RCT(791 个病例)。沙盘游戏疗法对 ASD 儿童的社交沟通障碍有积极影响[SMD = -1.42, 95%CI (-1.79, -1.04), P P P P 讨论:本研究的证据质量被评为高,具有良好的方法学质量,其中包括 12 项质量较好且无检测偏倚风险的研究。该研究的异质性较高,通过亚组分析可归因于测量工具和干预持续时间,未发现不一致性。此外,没有发现与不精确、发表偏倚或间接性有关的降级因素。总之,沙盘游戏疗法是改善ASD儿童社会交往障碍的有效措施,目前的证据建议采用个体沙盘游戏疗法或综合沙盘游戏疗法干预方案进行早期干预,每周一次,持续22-28周,可作为循证临床指导。系统综述注册:www.crd.york.ac.uk,标识符(CRD420234821750)。
A systematic review of the effect of sandplay therapy on social communication deficits in children with autism spectrum disorder.
Objective: To explore the efficacy of sandplay therapy in intervening social communication deficits in children with autism spectrum disorders (ASD), and whether this efficacy is influenced by the age of the children and the dosage of sandplay therapy intervention.
Methods: Following the PICOS principle, randomized controlled trials (RCTs) related to sandplay therapy for social communication deficits in ASD children were retrieved from seven databases: PubMed, WOS, The Cochrane Library, Embase, CNKI, Wanfang, and VIP, from the inception of each database to November 10, 2023. Two experimenters independently conducted study screening and excluded studies with concomitant diseases, incomplete data, unextractable data, and non-randomized controlled trials. The PEDro scale was used for methodological quality assessment, and the GRADEprofiler method was employed to evaluate the quality of evidence. Stata17 software was used for meta-analysis, subgroup analysis, sensitivity analysis, and publication bias testing. The standardized mean difference (SMD) and 95% confidence interval (CI) were used as the effect statistics.
Results: A total of 12 RCTs (791 cases) were included. Sandplay therapy had a positive impact on the social communication deficits of ASD children [SMD = -1.42, 95%CI (-1.79, -1.04), P < 0.001]. Subgroup analysis revealed that sandplay therapy administered during the early school age (449 cases, SMD = -1.44, P < 0.05), for a duration of 22-28 weeks (208 cases, SMD = 1.69, P < 0.05), and with a frequency of once per week (218 cases, SMD = -1.67, P < 0.05) was most effective in improving on social communication deficits of ASD children.
Discussion: The quality of evidence in this study was rated as high, with good methodological quality, including 12 studies with better quality and no detection of bias risk. The study had high heterogeneity, which was attributed to the measurement tools and intervention duration through subgroup analysis, with no inconsistency found. Additionally, no downgrade factors related to imprecision, publication bias, or indirectness were identified. In conclusion, sandplay therapy is an effective measure to improve social communication deficits in children with ASD, and current evidence recommends early intervention using an individual sandplay therapy or integrated sandplay therapy intervention program once a week for 22-28 weeks, which can serve as evidence-based clinical guidance.
期刊介绍:
Frontiers in Pediatrics (Impact Factor 2.33) publishes rigorously peer-reviewed research broadly across the field, from basic to clinical research that meets ongoing challenges in pediatric patient care and child health. Field Chief Editors Arjan Te Pas at Leiden University and Michael L. Moritz at the Children''s Hospital of Pittsburgh are supported by an outstanding Editorial Board of international experts. This multidisciplinary open-access journal is at the forefront of disseminating and communicating scientific knowledge and impactful discoveries to researchers, academics, clinicians and the public worldwide.
Frontiers in Pediatrics also features Research Topics, Frontiers special theme-focused issues managed by Guest Associate Editors, addressing important areas in pediatrics. In this fashion, Frontiers serves as an outlet to publish the broadest aspects of pediatrics in both basic and clinical research, including high-quality reviews, case reports, editorials and commentaries related to all aspects of pediatrics.