Effectiveness of play therapy in enhancing psychosocial outcomes in children with chronic illness: A systematic review

To examine the nature, quality, and effectiveness of Play Therapy (PT) interventions in children with chronic health conditions (CHC) and to identify the measures used to evaluate psychosocial outcomes.Systematic searches of the databases: Medline complete, PsycINFO, CINHAL, Embase and Sport Discuss were conducted to identify peer reviewed papers reporting original studies published in English between January1990 - April 2020. Studies testing any type of PT or Filial Therapy (FT) with children with CHC aged between 3 and 11 years, or their parents if FT, where outcomes were primarily psychosocial were eligible.The title and abstract search identified 6742 papers and six studies (three each for PT and FT) including two randomized control trials were identified as eligible for review. All FT interventions involved group-based training, while only one PT study used a group format. Outcomes for children included emotional and behavioural issues including anxiety, depression, and self-concept and while constructs were broadly comparable across studies, the measures used differed. Sample size ranged between 4 and 58. Two studies suggested positive impact of PT on depression, with one finding improvements in self-concept. Three studies with sample sizes less than 30 found no effect.With varied study designs, and small sample sizes, current evidence regarding the effectiveness of PT in improving psychosocial outcomes for children with chronic illnesses is inconclusive.The field should move from small underpowered studies to randomized trials with comprehensive protocols and larger sample sizes.