Systematic review protocol examining the effectiveness of hospital clowns for symptom cluster management in paediatrics

BMJ Open. 2019 Jan 21;9(1):e026524. doi: 10.1136/bmjopen-2018-026524.


Introduction: Clown intervention may playing an important complementary role in paediatric care and recovery. However, data on its utility for symptom cluster management of hospitalised children and adolescents in acute and chronic disorders are yet to be critically evaluated. As clinicians strive to minimise the psychological burden during hospitalisation, it is important that they are aware of the scientific evidences available regarding clown intervention for symptom management. We aim to provide quality evidence for the effectiveness of clown intervention on symptom cluster management in paediatric inpatients, both in acute and chronic conditions.

Methods and analysis: A systematic review of randomised controlled trials (RCTs) and non-randomised controlled trials (NRCTs) will be conducted. MEDLINE, Web of Science, Cochrane Library, Science Direct, PsycINFO, CINAHL, LILACS and SciELO databases will be searched from January 2000 to December 2018. Primary outcomes will include measures related with the effect of clown intervention on symptom cluster of paediatric inpatients (anxiety, depression, pain, fatigue, stress and psychological, emotional responses and perceived well-being). Study selection will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, and the methodological appraisal of the studies will be assessed by the Jadad Scale as well as Cochrane Risk-of-Bias Tool for RCTs, and Risk-of-Bias In Non-Randomized Studies Tool for NRCTs. A narrative synthesis will be conducted for all included studies. Also, if sufficient data are available, a meta-analysis will be conducted. The effect sizes will be generated using Hedges' g score for both fixed and random effect models. I 2 statistics will be used to assess heterogeneity and identify their potential sources.

Ethics and dissemination: As it will be a systematic review, without human beings involvement, there will be no requirement for ethical approval. Findings will be disseminated widely through peer-reviewed publication and in various media, for example, conferences, congresses or symposia.

Trial registration number: CRD42018107099.

Keywords: adolescent; child; clown intervention; pediatrics; symptom clusters; symptom management.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acute Disease / psychology
  • Anxiety / prevention & control*
  • Chronic Disease / psychology
  • Hospitalization
  • Humans
  • Laughter Therapy*
  • Pediatrics*
  • Randomized Controlled Trials as Topic
  • Research Design
  • Stress, Psychological / therapy*
  • Systematic Reviews as Topic