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Expressive art for the social and community integration of adolescents with acquired brain injuries: a systematic review |
Goyal A, Keightley ML |
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CRD summary This review concluded that drama therapy could improve psychological health, emotional intelligence, cognitive function, social integration, but not necessarily community integration, in populations with difficulties in psychological, social, emotional, or cognitive functioning. Evidence in adolescents with acquired brain injuries was lacking. Potential methodological limitations of the review methods and data, suggest that these conclusions are not reliable. Authors' objectives The aim of the review was to assess the effectiveness of expressive art therapy for the social and community integration of adolescents with acquired brain injury. Also, given an anticipated lack of data, the review assessed evidence from a much broader population including individuals with social, emotional, cognitive or physical difficulties. Searching AMED, CINAHL, EMBASE, MEDLINE, OT Seeker, PsycINFO, PubMed, REHABDATA, Scholars Portal, Sirius, Web of Science and the Cochrane Library were searched for studies published in English from January 1995 to May 2007. Search terms were reported. Study selection Studies that assessed the effects of drama-based expressive arts therapies on social or community integration skills, in populations of individuals with social, emotional, cognitive or physical functioning difficulties, were eligible for inclusion in the review.
Both quantitative and qualitative studies were included in the review; the majority were uncontrolled. Interventions varied between the studies, but most involved programmes that were carried out in group settings within hospitals, community schools or dedicated institutions for the performing arts. Further details are reported in the review. Participants were diagnosed with a variety of conditions including chronic pain, mental retardation, neuro-trauma, behavioural problems, mental health problems, and people with few perceived resources and supports. In all but one of the studies, the participants had chronic, acquired or congenital symptoms. Where reported, mean ages of participants ranged from 11.4 years to 80 years; 60% of studies included only youths. Numerous different outcomes and measures were reported, the majority relating to the assessment of psychological health; emotional intelligence; cognitive function; and/or social integration. All of the included studies were from the USA, Canada and the UK.
The authors did not state how papers were selected for review or how many reviewers performed the selection. Assessment of study quality The authors did not state that they assessed validity. Data extraction No quantitative or statistical data were extracted, but the overall results, limitations and conclusions of the included studies were extracted.
The authors did not state how data were extracted for the review, or how many reviewers performed the data extraction. Methods of synthesis The studies were combined in a narrative synthesis, with accompanying tables of reported effects and study characteristics. Results of the review Data from ten studies (total number of participants was unclear) were reported. These included one randomised controlled trial (RCT; n=117 participants), one controlled trial, three uncontrolled experimental studies, two case studies, one methodological theory study and two descriptive studies. The majority of the studies were described as providing only a low level of evidence; many only reported anecdotal evidence.
Interventions varied in terms of their reported effects, but all of the studies reported positive effects of drama-based therapy, including benefits in: psychological health (four studies); emotional intelligence (six studies); cognitive function (two studies); and social integration (nine studies including one RCT). Only two studies (one methodological theory study and one case series) reported a lack of effect for the intervention in one or more participants. None of the studies reported any harmful or negative effects associated with drama-based therapies. Authors' conclusions This review found evidence to support the effectiveness of drama therapy in improving psychological health, emotional intelligence, cognitive function, social integration, but not necessarily community integration, in populations with difficulties in psychological, social, emotional, or cognitive functioning; however, evidence to support the effectiveness of drama therapy in adolescents with acquired brain injury was lacking. CRD commentary This review answered a clearly defined research question, using a broad range of study designs and populations. The main population of interest was adolescents with acquired brain injuries. However, in view of the anticipated lack of evidence, the reviewers evaluated adolescents with social, emotional, cognitive and physical problems that were likely to have similar problems. The authors discussed a number of potential limitations in using this data to extrapolate effects in adolescents with acquired brain injuries, so it was unclear how applicable these findings would be. There was also a risk that relevant data may have been missed through the inclusion of only studies published in English within a defined 12 year period; justification for limiting the start date of the searches was not provided. Further poor reporting of the review methods made it difficult to assess the risk of reviewer error and bias. The absence of any assessment of study validity also made it difficult to assess the reliability of the data, but the types of study designs included in the review and the authors' comments, suggested that the overall quality of the data was poor and often anecdotal. Some study characteristics were described and the differences in interventions, populations, study designs and outcomes suggested that included studies showed considerable heterogeneity. The use of narrative synthesis methods was appropriate, but it would have been helpful to have reported quantitative data where available, and also to have provided an indication of whether the findings were statistically or clinically significant. Overall, potential methodological limitations of both the review methods and the data suggest that the authors' conclusions are not reliable. Implications of the review for practice and research Practice: The authors stated that adolescents with acquired brain injuries may benefit from theatre skills training to facilitate their social and community integration skills, and that drama therapy should be considered as a rehabilitative approach during the recovery process.
Research: The authors stated that further well-conducted studies are required to assess the effectiveness of drama therapy for adolescents with acquired brain injuries and their rehabilitation, with particular reference to their effects on community integration and social integration skills. Bibliographic details Goyal A, Keightley ML. Expressive art for the social and community integration of adolescents with acquired brain injuries: a systematic review. Research in Drama Education 2008; 13(3) : 337-352 Indexing Status Subject indexing assigned by CRD MeSH Brain Injuries; Humans; Occupational Therapy; Rehabilitation; Social Adjustment AccessionNumber 12009105715 Date bibliographic record published 05/08/2009 Date abstract record published 11/11/2009 Record Status This is a critical abstract of a systematic review that meets the criteria for inclusion on DARE. Each critical abstract contains a brief summary of the review methods, results and conclusions followed by a detailed critical assessment on the reliability of the review and the conclusions drawn. |
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