ArticleBMJ open2013
The Sydney Multisite Intervention of LaughterBosses and ElderClowns (SMILE) study: cluster randomised trial of humour therapy in nursing homes.
Article in BMJ open, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 2 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 2 syntheses or guidelines pooled it, 107 citations in OpenAlex.
- Elder Clowning Interventions for Persons With Dementia in Long-Term Care: A Systematic Review and Metasynthesis of Qualitative Research.Dementia (London, England) · 2026Pooled it
- The impact of humor therapy on people suffering from depression or anxiety: An integrative literature review.Brain and behavior · 2023Pooled it
- Trial
- Study protocol: translating and implementing psychosocial interventions in aged home care the lifestyle engagement activity program (LEAP) for life.BMC geriatrics · 2013Trial
- 'Our role is to listen more than entertain': A qualitative study of techniques used by Laughter Care Specialists with people who have dementia in long-term care.Australasian journal on ageing · 2025Article
- The Implementation of Infant Anoesis and Adult Autonoesis in the Retrogenesis and Staging System of the Neurocognitive Disorders: A Proposal for a Multidimensional Person-Centered Model.Geriatrics (Basel, Switzerland) · 2025Review
- The Impacts of a Clown Doctor Program on an Adolescent Psychiatric Unit: A Mixed Methods Investigation.Child psychiatry and human development · 2025Article
- The impact of an Activation-Socialisation Intervention Programme on the emotionality and loneliness of older adults in Slovak elderly care facilities: a pilot study.Health psychology report · 2025Article
- "I made you a small room in my heart": how therapeutic clowns meet the needs of older adults in nursing homes.International journal of qualitative studies on health and well-being · 2023Article
- Intervention and application of clown care in nursing homes: a scoping review.Aging clinical and experimental research · 2023Article
- Evaluation of a Study Protocol of the Application of Humor Interventions in Palliative Care Through a First Pilot Study.Palliative medicine reports · 2023Article
- Social Connection in Long-Term Care Homes: A Scoping Review of Published Research on the Mental Health Impacts and Potential Strategies During COVID-19.Journal of the American Medical Directors Association · 2021Article
- The Use of Virtual and Immersive Technology in Creating Personalized Multisensory Spaces for People Living With Dementia (SENSE-GARDEN): Protocol for a Multisite Before-After Trial.JMIR research protocols · 2019Article
- Approaches to Deprescribing Psychotropic Medications for Changed Behaviours in Long-Term Care Residents Living with Dementia.Drugs & aging · 2019Review
- Are Humor Styles of People With Dementia Linked to Greater Purpose in Life?The Gerontologist · 2018Article
- Impact of social relationships on income-laughter relationships among older people: the JAGES cross-sectional study.BMJ open · 2018Article
- A novel method of proxy reporting questionnaire based measures of health-related quality of life of people with dementia in residential care: a psychometric evaluation.Patient related outcome measures · 2018Article
- Humor Assessment and Interventions in Palliative Care: A Systematic Review.Frontiers in psychology · 2018Article
- Presence redefined: The reciprocal nature of engagement between elder-clowns and persons with dementia.Dementia (London, England) · 2017Article
- Strategies for diversity: medical clowns in dementia care - an ethnographic study.BMC geriatrics · 2016Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
9 authors at 4 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectivesTo determine whether humour therapy reduces depression (primary outcome), agitation and behavioural disturbances and improves social engagement and quality-of-life in nursing home residents.
designThe Sydney Multisite Intervention of LaughterBosses and ElderClowns study was a single-blind cluster randomised controlled trial of humour therapy.
setting35 Sydney nursing homes.
participantsAll eligible residents within geographically defined areas within each nursing home were invited to participate.
interventionProfessional 'ElderClowns' provided 9-12 weekly humour therapy sessions, augmented by resident engagement by trained staff 'LaughterBosses'. Controls received usual care. MEASUREMENTS: Depression scores on the Cornell Scale for Depression in Dementia, agitation scores on the Cohen-Mansfield Agitation Inventory, behavioural disturbance scores on the Neuropsychiatric Inventory, social engagement scores on the withdrawal subscale of Multidimensional Observation Scale for Elderly Subjects, and self-rated and proxy-rated quality-of-life scores on a health-related quality-of-life tool for dementia, the DEMQOL. All outcomes were measured at the participant level by researchers blind to group assignment. RANDOMISATION: Sites were stratified by size and level of care then assigned to group using a random number generator.
resultsSeventeen nursing homes (189 residents) received the intervention and 18 homes (209 residents) received usual care. Groups did not differ significantly over time on the primary outcome of depression, or on behavioural disturbances other than agitation, social engagement and quality of life. The secondary outcome of agitation was significantly reduced in the intervention group compared with controls over 26 weeks (time by group interaction adjusted for covariates: p=0.011). The mean difference in change from baseline to 26 weeks in Blom-transformed agitation scores after adjustment for covariates was 0.17 (95% CI 0.004 to 0.34, p=0.045).
conclusionsHumour therapy did not significantly reduce depression but significantly reduced agitation.
trial registrationAustralian New Zealand Clinical Trials Registry -ACTRN12611000462987.
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.