Personal assistance for children and adolescents (0-18) with physical impairments: Cochrane systematic review
Assessed as up to date: 2005/06/28
There is a high and increasing prevalence of impairments among children and adolescents in the West. Many countries offer personal assistance in the form of individualised support for people living in the community by a paid assistant other than a healthcare professional for at least 20 hours per week.Objectives
To assess the effectiveness of personal assistance for children and adolescents with physical impairments, and the impacts of personal assistance on others, compared to other interventions.Search strategy
Electronic databases including CENTRAL, MEDLINE, EMBASE, CINAHL, PsycINFO, ERIC, Dissertation Abstracts International and a variety of specialist Swedish databases were searched from 1980 to June 2005; reference lists were checked; 345 experts, organisations, government bodies and charities were contacted in an attempt to locate relevant research.Selection criteria
Children and adolescents with physical impairments (0-18 years) living in the community who require assistance to perform tasks of daily living (e.g., bathing and eating) and participate in normal activities due to permanent impairments. Controlled studies of personal assistance in which participants were prospectively assigned to study groups and in which control group outcomes were measured concurrently with intervention group outcomes were included.Data collection and analysis
Titles and abstracts were examined by two reviewers. 130 full papers were examined. None met the inclusion criteria.Main results
No eligible studies were found.Authors' conclusions
Research in this field is limited. When implementing new programmes, recipients could be randomly assigned to different forms of assistance. While advocates may support personal assistance for myriad reasons, this review demonstrates that further studies are required to determine which models of personal assistance are most effective and efficient for particular people.
Mayo-Wilson Evan, Montgomery Paul, Dennis Jane A
Studies urgently needed to assess effects of Personal Assistance for children and teens with physical impairments
Personal assistance is here defined as paid support of at least 20 hours per week for people with impairments. This review investigated the effectiveness of personal assistance versus any other form of care for children and adolescents with physical impairments. A literature search identified no studies that met the inclusion criteria. This review is part of a series of reviews; evidence from related reviews about different populations might be informative to researchers and practitioners.
Implications for practice
No randomised, quasi-randomised, or controlled prospective studies were found. Consequently, no studies could be included in this review. Several related reviews found evidence about the effectiveness of personal assistance for other groups. There is no reliable evidence about the effectiveness of personal assistance for children and adolescents with physical impairments.
Implications for research
In 1986, Ratzka noted that 'there has been surprisingly little in the way of policy evaluation. The work that has been done in this area is restricted to gathering descriptive statistics on number of hours provided by one type of service, number of consumers, staff, and expenditures'. This is as true for children and adolescents as it was twenty years ago. It would be possible to compare personal assistance to other services or to different forms of personal assistance in locations implementing new programmes. Similarly, new users might be assigned to new models of personal assistance in places with long-standing personal assistance services.
Services for children and adolescents with impairments are organised differently around the world. While advocates may support personal assistance for myriad reasons, this review demonstrates that further studies are required to determine (i) what marginal benefits are gained from personal assistance (i.e. the added value compared to other services that exist today), (ii) at what total relative cost and (iii) which models of personal assistance are most effective and efficient for particular people.Get full text at The Cochrane Library
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