Effectiveness of clown therapy on procedural pain in children with cerebral palsy. A meta-analysis

Luca Giuseppe Re; Viviana Fusetti

doi:10.54103/dn/18716

Autori

Luca Giuseppe Re ASST Grande Ospedale Metropolitano Niguarda https://orcid.org/0000-0003-1755-6892
Viviana Fusetti Fondazione IRCCS Istituto Nazionale dei Tumori, Milano

DOI:

https://doi.org/10.54103/dn/18716

Parole chiave:

clown terapia, dolore procedurale, bambini, paralisi cerebrale

Abstract

INTRODUZIONE:
Quasi il 10% del dolore che colpisce i bambini con paralisi cerebrale (PC) deriva da una procedura medica. La clownterapia è una diffusa tecnica di distrazione per ridurre il dolore; alcune revisioni sistematiche valutano l'efficacia di questo intervento in ambito pediatrico, ma nessuna su bambini con PC.

OBIETTIVO:
Valutare l'effetto della clown terapia sul dolore procedurale nei bambini con PC.

METODI:
Revisione sistematica con meta-analisi di trial clinici con gruppo di controllo. Reperimento degli studi tramite interrogazione di database biomedici, risorse online e registri di trial. La clown terapia è stata confrontata con le cure standard. L'esito primario era il livello di dolore dopo l'intervento. Il rischio di bias è stato valutato con RoB 2. La dimensione d'effetto è stata calcolata con un modello a effetti casuali.

RISULTATI
Tre studi con 164 pazienti sono stati inclusi. Il rischio di bias è alto per due studi e solleva qualche dubbio per uno. Tutti gli studi hanno analizzato l'effetto della clown terapia sul dolore procedurale dopo l'iniezione di tossina botulinica. È stata rilevata una riduzione statisticamente non significativa del dolore nel gruppo di intervento rispetto a quello di controllo (DSM: -0,20, IC 95%: -0,56, 0,17). L'eterogeneità tra gli studi è elevata.

CONCLUSIONE:
La clown terapia per il dolore procedurale da iniezioni di tossina botulinica nei bambini con PC sembra efficace ma i limiti metodologici degli studi non consentono un giudizio definitivo. Mancano studi che valutino l'effetto dell’intervento su altre procedure a cui si sottopongono periodicamente i bambini con PC

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