Authors: Ghasemifard F, Mirzaie H, Jafari Oori M, Riazi A.
Geographical coverage: The USA, the UK, the Netherlands, Ukraine
Equity focus: Children and adolescents
Study population: Children and adolescents (0-21 years) with visual impairment.
Review type: Effectiveness review
Quantitative synthesis method: Not applicable
Qualitative synthesis method: Described by authors as “traditional content analysis”.
Background: Visual impairment can hinder achieving developmental markers in children. Various studies have examined the effectiveness of play therapy in children with visual impairment. However, no comprehensive review exists that examines the characteristics and overall effectiveness of these interventions.
Objectives: To provide strong evidence on the characteristics and efficacy of play therapy interventions in children and adolescents (0-21 years) with visual impairment.
Overall, this study found that all interventions were effective in improving cognitive, visual, physical, communicative and vestibular skills of the children.
From 1,763 articles, nine met the inclusion criteria. The sample size of the nine studies totalled 448 children under 21 years old. The design of all studies was quasi-experimental. The range of quality scores among studies was 14-25.
The key findings of this review were categorised into participants, implementation, measurements, and intervention effectiveness. Participants were visually impaired individuals without significant physical or cognitive impairments. The play interventions involved children, either independently or with their caregivers or parents. The interventions took two forms: computer/video games and games involving a child and a therapist or parent. These were carried out in various environments that mirrored home, school, or sports camp settings. Data was collected through researcher observations and children’s reports using various questionnaires. All interventions proved effective in enhancing the children’s cognitive, visual, physical, communicative, and vestibular skills. Given the authors’ findings that play therapy interventions can promote the development of visually impaired and blind children and reduce functional delays, they propose the following recommendations: To boost the children’s social engagement, group play interventions should be implemented. Additionally, greater emphasis should be placed on adapting the environment and employing compensatory techniques.
Despite the comprehensive efficacy of play therapy intervention in children with visual impairments, few studies have been conducted in this field. Considering multi-biases such as missing control of confounders, authors note that more high-quality standard studies are needed to further evaluate the effectiveness of play therapy in children with visual impairments.
All interventional play therapy with random or non-random, quasi-experimental, or pre-test and post-test designs were included in this study. The study population consisted of school-age participants under the age of 21 whose main disability was visual dysfunction or blindness. The interventions of interest included any form of play therapy. The non-interventional or observational studies, letters and articles with outcome measures of visual acuity, visual field and evaluation related to eye structure disorders like amblyopia were excluded.
The systematic review was conducted according to studies published in national and international journals in English and Persian languages until May 2020. The Cochrane Library, PubMed, Scopus, Web of Science, Magiran, Iran Medex, Iranian Archive for Scientific Documents Center (IASD), and Iranian National Library (INL), Google Scholar and Google were assessed. Reference lists of primary studies were also searched by hand.
Two researchers critically evaluated titles and abstracts of studies, and for related ones, the full-texts were assessed. Any doubt between two analysts was solved by argument and agreement. A data form was used to extract data, including author’s name, year of study, the visual status of the studied children, sample size, age, setting, intervention, duration, measurement, main finding, follow-up and quality score.
The modified Downs and Black checklist with acceptable validity and inter-rater reliability was used to assess study quality.
The text data of primary studies was analysed using conventional content analysis. After repeated evaluation of the results, primary codes were recognised and classified in different groupings according to degree of likeness.
Applicability/external validity: The authors highlight that the inclusion of a limited number of studies, which had quality shortcomings, leads to a degree of uncertainty in their conclusions. The authors also acknowledge that their search was confined to two languages and that the diverse measurement methods used in the individual studies precluded any comparison of results.
Geographic focus: Only one of eight included studies was conducted in a low- and middle-income country (Ukraine).
Summary of quality assessment:
The approaches undertaken to identifying, including and critically appraising studies were generally robust, with two authors undertaking all key tasks. However, the search was restricted to two languages and no attempts were made to include unpublished material or to access relevant experts. While the approach to the analysis of the data was reasonably robust, little detail was provided as to what “conventional content analysis” involved in practice. Furthermore, while the risks of bias associated with different studies were acknowledged, no attempt was made to analyse their results in relation to this. For this reason, we have medium confidence in the findings of this review.