巴西圣埃斯皮里图联邦大学Luís Carlos Lopes-Júnior团队研究了医疗小丑对儿科症状管理的有效性。2020年12月16日，该研究发表在《英国医学杂志》上。

为了评估医疗小丑对因急慢性疾病住院的儿童和青少年的一系列症状群的有效性，研究组在Medline、Science Direct、Scopus等大型数据库中检索随机和非随机对照试验，包括对急慢性疾病入院的儿童和青少年使用医疗小丑与标准治疗的比较研究，以及评估医疗小丑对住院儿童和青少年症状管理的影响，并将其作为主要结果的研究。

共有24项研究（n=1612）符合数据提取和分析的纳入标准，其中13项为随机对照试验。最常分析的症状是焦虑（13项），其次是疼痛（9项）、心理和情感反应以及幸福感（4项）、压力（4项）、癌症相关疲劳（3项）和哭泣（2项）。有五项研究使用了生物标志物，主要是皮质醇，来评估医疗小丑表演后患儿的压力或疲劳结局。

大多数随机对照试验（11项：85％）被评为有一定关联，而两项试验被认为具有较高的偏倚风险。大多数非随机对照试验（6项，55%）被评为中等偏倚风险。研究表明，无论是否有家长在场，当医疗小丑出现时，儿童和青少年在一系列医疗过程中表现出的焦虑程度显著降低，心理适应能力也有所改善。三项评估慢性疾病的研究显示，医疗小丑的干预效果良好，能显著减轻儿童和青少年患者的压力、疲劳、疼痛和痛苦。

研究结果表明，在医疗程序、术前手术室麻醉诱导以及作为慢性疾病常规治疗的一部分，医疗小丑的存在可能有益于管理某些症状群。与那些只接受标准治疗的儿童和青少年相比，医疗小丑可能有助于改善患有急慢性疾病的住院儿童和青少年的心理健康。

附：英文原文

Title: Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials

Author: Luís Carlos Lopes-Júnior, Emiliana Bomfim, Karin Olson, Eliane Tatsch Neves, Denise Sayuri Calheiros Silveira, Michelle Darezzo Rodrigues Nunes, Lucila Castanheira Nascimento, Gabriela Pereira-da-Silva, Regina Aparecida Garcia Lima

Issue&Volume: 2020/12/16

Abstract:

Objective To evaluate evidence from randomised controlled trials and non-randomised controlled trials on the effectiveness of hospital clowns for a range of symptom clusters in children and adolescents admitted to hospital with acute and chronic conditions.

Design Systematic review of randomised and non-randomised controlled trials.

Data sources Medline, ISI of Knowledge, Cochrane Central Register of Controlled Trials, Science Direct, Scopus, American Psychological Association PsycINFO, Cumulative Index to Nursing and Allied Health Literature, and Latin American and Caribbean Health Sciences Literature.

Study selection Randomised and non-randomised controlled trials were peer reviewed using the following eligibility criteria: children and adolescents who were admitted to hospital for acute conditions or chronic disorders, studies comparing use of hospital clowns with standard care, and studies evaluating the effect of hospital clowns on symptom management of inpatient children and adolescents as a primary outcome.

Data extraction and synthesis Two investigators independently screened studies, extracted data, and appraised the risk of bias. Methodological appraisal was assessed by two investigators independently using the Jadad scale, the revised Cochrane risk-of-bias tool for randomised controlled trials (RoB 2), and the risk of bias in non-randomised studies (ROBINS-I) tool for non-randomised controlled trials.

Results 24 studies (n=1612) met the inclusion criteria for data extraction and analysis. Most studies were randomised controlled trials (n=13). Anxiety was the most frequently analysed symptom (n=13), followed by pain (n=9), psychological and emotional responses and perceived wellbeing (n=4), stress (n=4), cancer related fatigue (n=3), and crying (n=2). Five studies used biomarkers, mainly cortisol, to assess stress or fatigue outcome following hospital clowns. Most of the randomised controlled trials (n=11; 85%) were rated as showing some concerns, and two trials were rated with a high risk of bias. Most non-randomised controlled trials (n=6; 55%) were rated with a moderate risk of bias according to ROBINS-I tool. Studies showed that children and adolescents who were in the presence of hospital clowns, either with or without a parent present, reported significantly less anxiety during a range of medical procedures, as well as improved psychological adjustment (P<0.05). Three studies that evaluated chronic conditions showed favourable results for the intervention of hospital clowns with significant reduction in stress, fatigue, pain, and distress (P<0.05).

Conclusions These findings suggest that the presence of hospital clowns during medical procedures, induction of anaesthesia in the preoperative room, and as part of routine care for chronic conditions might be a beneficial strategy to manage some symptom clusters. Furthermore, hospital clowns might help improve psychological wellbeing in admitted children and adolescents with acute and chronic disorders, compared with those who received only standard care.

DOI: 10.1136/bmj.m4290

Source: https://www.bmj.com/content/371/bmj.m4290