Education Institute, Royal Children's Hospital, Parkville, Australia.
Murdoch Childrens Research Institute, Parkville, Australia.
Cochrane Database Syst Rev. 2023 Feb 8;2(2):CD011538. doi: 10.1002/14651858.CD011538.pub2.
Chronic health conditions in children and adolescents can have profound impacts on education, well-being and health. They are described as non-communicable illnesses that are prolonged in duration, do not resolve spontaneously, and rarely cured completely. Due to variations in the definition of chronic health conditions and how they are measured prevalence estimates vary considerably and have been reported to be as high as 44% in children and adolescents. Of young people with a chronic health condition, an estimated 5% are affected by severe conditions characterised by limitations to daily activities impacting their ability to attend school. School attendance is important for academic and social skill development as well as well-being. When children and adolescents are absent from school due to a chronic health condition, school engagement can be affected. Disengagement from school is associated with poorer academic achievement, social-emotional functioning and career choices. Education support services for children and adolescents with chronic health conditions aim to prevent disengagement from school, education and learning during periods where their illness caused them to miss school. However, there is limited evidence on the effectiveness of educational support interventions at improving school engagement and educational/learning outcomes for children and adolescents with chronic health conditions.
To describe the nature of educational support interventions for children and adolescents with a chronic health condition, and to examine the effectiveness of these interventions on school engagement and academic achievement.
We searched eight electronic databases which span the health/medical, social sciences and education disciplines between 18 and 25 January 2021: Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE (Ovid), Embase (Ovid). CINAHL (EBSCO), PsycINFO (EBSCO), ERIC (Education Resources Information Center), Applied Social Sciences Index and Abstracts: ASSIA (ProQuest), and PubMed (from 2019). We also searched five grey literature trials registers and databases between 8 and 12 February 2021 to identify additional published and unpublished studies, theses and conference abstracts, as well as snowballing reference lists of included studies.
Randomised controlled trials (RCTs), controlled before-and-after studies and interrupted time series studies that met the inclusion criteria were selected. Other inclusion criteria were: participants - must include children or adolescents (aged four to 18 years) with a chronic health condition, intervention - must include educational support, outcomes - must report the primary outcomes (i.e. school engagement or academic achievement) or secondary outcomes (i.e. quality of life, transition to school/school re-entry, mental health or adverse outcomes).
Two people independently screened titles and abstracts, and full-text articles, to identify included studies. Where disagreements arose between reviewers, the two reviewers discussed the discrepancy. If resolution was unable to be achieved, the issues were discussed with a senior reviewer to resolve the matter. We extracted study characteristic data and risk of bias data from the full texts of included studies using a data extraction form before entering the information into Review Manager 5.4.1. Two people independently extracted data, assessed risk of bias of individual studies and undertook GRADE assessments of the quality of the evidence. Meta-analysis was not possible due to the small number of studies for each outcome. Our synthesis, therefore, used vote-counting based on the direction of the effect/impact of the intervention.
The database searches identified 14,202 titles and abstracts. Grey literature and reference list searches did not identify any additional studies that met the inclusion criteria. One hundred and twelve full-text studies were assessed for eligibility, of which four studies met the eligibility criteria for inclusion in the review. All studies were randomised controlled studies with a combined total of 359 participants. All included studies were disease-specific; three studies focused on children with cancer, and one study focused on children with Attention Deficit Hyperactivity Disorder (ADHD). There was evidence that education support improved school engagement with three of four studies favouring the intervention. Three studies measured academic achievement but only two studies provided effect estimates. Based on the vote-counting method, we found contradictory results from the studies: one study showed a positive direction of effect and the other study showed a negative direction of effect. One study measured transition back to school and found a positive impact of education support favouring the intervention (SMD 0.18, 95% CI -0.46 to 0.96, no P value reported). The result came from a single study with a small sample size (n = 30), and produced a confidence interval that indicated the possibility of a very small or no effect. The overall certainty of evidence for these three outcomes was judged to be 'very low'. Two of four studies measured mental health (measured as self-esteem). Both studies reported a positive impact of education support interventions on mental health; this was the only outcome for which the overall certainty of evidence was judged to be 'low' rather than 'very low'. No studies measured or reported quality of life or adverse effects. Risk of bias (selection, performance, detection, attrition, reporting and other bias) was assessed using the Cochrane risk of bias tool for randomised trials (version 1). Overall risk of bias for all studies was assessed as 'high risk' because all studies had at least one domain at high risk of bias.
AUTHORS' CONCLUSIONS: This review has demonstrated the infancy of quality research on the effectiveness of education support interventions for children and adolescents with chronic health conditions. At best, we can say that we are uncertain whether education support interventions improve either academic achievement or school engagement. Of the secondary outcomes, we are also uncertain whether education support interventions improve transition back to school, or school re-entry. However, we suggest there is some evidence that education support may slightly improve mental health, measured as self-esteem. Given the current state of the evidence of the effectiveness of education support interventions for children and adolescents with chronic health conditions, we highlight some important implications for future research in this field to strengthen the evidence that can inform effective practice and policy.
儿童和青少年的慢性健康状况会对教育、福祉和健康产生深远影响。这些疾病被描述为非传染性疾病，持续时间长，不会自发缓解，也很少能完全治愈。由于慢性健康状况的定义和测量方式存在差异，患病率估计值差异很大，有报道称儿童和青少年的患病率高达 44%。在患有慢性健康状况的年轻人中，估计有 5%受到严重疾病的影响，这些疾病的特点是日常活动受限，影响他们上学的能力。上学对于学术和社交技能的发展以及福祉都很重要。当儿童和青少年因慢性健康状况缺课时，他们的学校参与度可能会受到影响。脱离学校与较差的学业成绩、社会情感功能和职业选择有关。针对患有慢性健康状况的儿童和青少年的教育支持服务旨在预防因疾病缺课而导致的学校脱离、教育和学习。然而，目前关于教育支持干预措施在提高患有慢性健康状况的儿童和青少年的学校参与度和学业成绩方面的有效性的证据有限。
描述针对患有慢性健康状况的儿童和青少年的教育支持干预措施的性质，并研究这些干预措施对学校参与度和学业成绩的有效性。
我们检索了涵盖健康/医学、社会科学和教育学科的八个电子数据库，检索时间为 2021 年 1 月 18 日至 25 日：Cochrane 对照试验中心注册库（CENTRAL）、MEDLINE（Ovid）、Embase（Ovid）、CINAHL（EBSCO）、PsycINFO（EBSCO）、ERIC（教育资源信息中心）、应用社会科学索引和摘要：ASSIA（ProQuest）以及 PubMed（来自 2019 年）。我们还于 2021 年 2 月 8 日至 12 日检索了五个灰色文献试验登记处和数据库，以确定已发表和未发表的研究、论文和会议摘要以及纳入研究的参考文献列表的额外内容，从而识别额外的已发表和未发表研究。
选择符合纳入标准的随机对照试验（RCT）、对照前后研究和中断时间序列研究。其他纳入标准为：参与者-必须包括患有慢性健康状况的儿童或青少年（年龄 4 至 18 岁）；干预-必须包括教育支持；结果-必须报告主要结果（即学校参与度或学业成绩）或次要结果（即生活质量、重返学校/重返学校、心理健康或不良结果）。
两位研究人员独立筛选标题和摘要以及全文文章，以确定纳入的研究。当评审员之间存在分歧时，两位评审员将讨论差异。如果无法解决分歧，则将问题提交给资深评审员以解决问题。我们使用数据提取表从纳入研究的全文中提取研究特征数据和偏倚风险数据，然后将信息输入 Review Manager 5.4.1。两位研究人员独立提取数据，评估个体研究的偏倚风险，并对证据质量进行 GRADE 评估。由于每个结局的研究数量较少，因此无法进行荟萃分析。因此，我们的综合分析使用基于干预影响的方向的票数计数。
数据库搜索共确定了 14202 篇标题和摘要。灰色文献和参考文献搜索未发现任何符合纳入标准的其他研究。对 112 篇全文进行了资格评估，其中 4 篇研究符合纳入标准。所有研究均为随机对照研究，总共有 359 名参与者。所有纳入的研究均为特定疾病研究，其中 3 项研究针对患有癌症的儿童，1 项研究针对患有注意力缺陷多动障碍（ADHD）的儿童。有证据表明，教育支持提高了学校参与度，其中 4 项研究中的 3 项研究结果支持干预措施。三项研究测量了学业成绩，但只有两项研究提供了效果估计。基于票数计数法，我们从研究中发现了相互矛盾的结果：一项研究显示出积极的影响方向，另一项研究显示出消极的影响方向。一项研究测量了重返学校的情况，发现教育支持对重返学校产生了积极影响，有利于干预措施（SMD 0.18，95%CI -0.46 至 0.96，未报告 P 值）。该结果来自一项样本量较小（n = 30）的单研究，产生的置信区间表明可能存在很小或没有效果。这三个结局的总体证据确定性被判定为“非常低”。四项研究中的两项研究测量了心理健康（以自尊衡量）。两项研究都报告了教育支持干预对心理健康的积极影响；这是唯一一项总体证据确定性被判定为“低”而不是“非常低”的结果。没有研究测量或报告生活质量或不良影响。使用 Cochrane 偏倚风险工具（版本 1）评估偏倚（选择、实施、检测、失访、报告和其他偏倚）。由于所有研究至少有一个领域存在高偏倚风险，因此所有研究的总体偏倚风险均被评估为“高风险”。
本综述表明，针对患有慢性健康状况的儿童和青少年的教育支持干预措施有效性的高质量研究仍处于起步阶段。我们最多可以说，我们不确定教育支持干预措施是否能提高学业成绩或学校参与度。在次要结局方面，我们也不确定教育支持干预措施是否能改善过渡回校或重返学校。然而，我们认为有一些证据表明，教育支持可能会略微改善心理健康，以自尊衡量。鉴于目前关于针对患有慢性健康状况的儿童和青少年的教育支持干预措施有效性的证据状况，我们强调了该领域未来研究的一些重要意义，以加强可以为有效实践和政策提供信息的证据。
