Effectiveness of paediatric occupational therapy for children with disabilities: A systematic review.
Iona Novak, Ingrid Honan
PMID 30968419WHAT IT FOUND
Top-down, activity-based interventions like CO-OP and CIMT have strong evidence for children with disabilities, while bottom-up approaches like NDT and sensory integration lack it.
Parent-led home programs are as effective as therapist-delivered care.
Key findings
01Activity-level, top-down interventions (e.g., CO-OP, CIMT, Goal-Directed Training) had the highest proportion of 'Green Light' (effective) ratings compared to body-structure or environmental levels.
02Parent-delivered interventions and home programs were rated equally effective to therapist-delivered interventions, with 13% of reviewed interventions targeting parents directly.
03Neurodevelopmental Therapy (NDT) and Sensory Integration (SI) showed inconsistent or weak evidence, with most negative ratings falling on bottom-up approaches at the body-structure level.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
The review only included SRs and RCTs, potentially excluding other rigorous study designs that might support interventions with no trial history. Search terms focused on 'occupational therapy', which may have missed effective interventions used by OTs but published under other names (e.g., Triple P). This is an overview of secondary data, so it is subject to publication bias (positive results are more likely to be published). The paper does not provide implementation details or training protocols for the specific interventions, only their efficacy ratings.
Declared interests
The study was unfunded. The authors declared no conflicts of interest.
The easy way to misread this
Do not interpret the 'Red Light' rating for NDT or SI as a mandate to stop all therapy at the body-structure level. The authors note that these ratings apply to specific historical trial designs and that many clinicians use these frameworks with 'top-down' modifications that were not separately analyzed in older studies.