Effects of Multisensory Therapy on Behaviour of Adult Clients with Developmental Disabilities.
OBJECTIVE
The objective of this review was to present the best available evidence on the effect of multisensory therapy in adult clients with developmental disabilities on the frequency of challenging behaviour, the frequency of stereotypic self-stimulating behaviour, and the frequency of relaxing behaviour INCLUSION CRITERIA: The review summarised all the relevant studies relating to the multisensory therapy intervention.


METHODS
Trials which included adult clients (aged 18-60) diagnosed with mental retardation according to the criteria of the Diagnostic and Statistical Manual of Mental Disorders: IV Classification or those with an Intelligence Quotient < 70 and who stayed in institutions.Types of interventions: Multisensory therapy/ multisensory environment/ SnoezelenTypes of outcomes measures: Outcome measures of interest were challenging behaviour, stereotypic self-stimulating behaviour and relaxing behaviour.Types of studies: This study considered any randomized or quasi-randomized controlled trials that investigated the effectiveness of multisensory therapy on adult clients with developmental disabilities. Due to a limited number of high quality RCT's on this subject, papers using other experimental or observational designs were also included.


METHODS
Electronic databases were used to search for primary publications. The reference lists and bibliographies of retrieved articles were reviewed to identify research not located through other search strategies.
Two reviewers assessed all identified abstracts and full reports were retrieved for all studies that met the inclusion criteria of the review. Studies identified from bibliography searches were assessed on the study title. Methodological quality was assessed by two reviewers using a checklist. Disagreements between reviewers were resolved by discussion with a third reviewer.


METHODS
Data were extracted independently by two reviewers using a data extraction tool. A third reviewer dealt with disagreements.


RESULTS
In all studies percentages of clients in each category and/or change in group mean score for outcomes were reported. If appropriate, results from comparable groups of studies were pooled in statistical meta-analysis using Review Manager Software from the Cochrane Collaboration. Odds ratio (for categorical outcome data) or weighted mean differences (for continuous data) and their 95% confidence intervals were calculated for each analysis. Heterogeneity between combined studies was tested using standard chi-square test. For the purpose of this review, where possible, intention to treat and/or completer analysis were performed. Where statistical pooling was not appropriate or possible, the findings were summarised in narrative form.


RESULTS
130 publications were identified through the various database searches and review of reference list and bibliographies. However, only 15 English publications were included in the review. The present evidence showed that multisensory therapy promoted participants' positive emotions and they reported being happier and more relaxed. Evidence also indicated that participants' had displayed more positive emotions and less negative emotions after therapy sessions.


CONCLUSIONS
This systematic review demonstrated a beneficial effect of multisensory therapy in promoting participants' positive emotions. Out of the 15 reviewed studies, 12 studies had a single treatment group only. While the reviewers acknowledge the difficulty in carrying out randomised controlled trial in people with developmental disabilities and challenging behaviour, the lack of trial-derived evidence makes it difficult to produce a strong conclusion to show the effectiveness of the multisensory therapy.
1 Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong 2 Professor, Department of Health Sciences/ Department of Cardiovascular Sciences, University of Leicester 3 Associate Professor, The Nethersole School of Nursing, The Chinese University of Hong Kong 4 Post-doctoral Fellow, School of Public Health, The University of Hong Kong 5 Formerly Research Assistant, The Nethersole School of Nursing, The Chinese University of Hong Kong.
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