SynthesisSystematic reviews2019
Clowning in children undergoing potentially anxiety-provoking procedures: a systematic review and meta-analysis.
Synthesis in Systematic reviews, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 4 of them syntheses that pooled it.
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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.
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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.
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Who cites it
10 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Nonpharmacological interventions for decreasing anxiety during anesthesia induction in children: a systematic review and Bayesian network meta-analysis.BMC anesthesiology · 2025Pooled it
- Medical clowning in hospitalized children: a meta-analysis.World journal of pediatrics : WJP · 2023Pooled it
- Clown therapy for procedural pain in children: a systematic review and meta-analysis.European journal of pediatrics · 2022Pooled it
- Effectiveness of hospital clowns for symptom management in paediatrics: systematic review of randomised and non-randomised controlled trials.BMJ (Clinical research ed.) · 2020Pooled it
- Effectiveness of a multicomponent perioperative preparation programme incorporating culturally familiar clown-themed components for alleviating preoperative anxiety in preschool children.Frontiers in pediatrics · 2026Article
- Management of preoperative anxiety with non-pharmacological methods in pediatric patients in resource-limited settings: a literature review.Annals of medicine and surgery (2012) · 2025Review
- Family participatory clown therapy in venipuncture in hospitalized children: A non-randomized controlled trial.PloS one · 2024Article
- Effectiveness of Preoperative Therapeutic Play on Anxiety Among Children Undergoing Invasive Procedure: a Systematic Review and Meta-analysis.Indian journal of surgical oncology · 2022Review
- A feasibility study of the use of medical clowns as hand-hygiene promoters in hospitals.PloS one · 2022Article
- Assessment of potential predictors affecting preoperative anxiety in Indian children- A prospective observational study.Journal of anaesthesiology, clinical pharmacologyArticle
Corrections and comments
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Authors and funding
4 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundThe operation areas of clowns in the medical context are multifaceted. Clowning in children undergoing surgery has been shown to be able to lessen children's anxiety. Hence, our aim was to assess the effectiveness of clowning on anxiety in children undergoing potentially anxiety-provoking procedures.
methodsWe searched MEDLINE, CENTRAL, and EMBASE for randomized controlled trials (RCTs) in December 2018. The primary outcome was children's anxiety. We used the Cochrane risk of bias tool to assess risk of bias of the included studies.
resultsWe found eleven RCTs including 733 children. Their risk of bias was relatively high. Children undergoing clowning were significantly less anxious in preoperative time compared to parental presence or no intervention (mean difference (MD) - 7.16; 95% CI - 10.58, - 3.75) and in operation, induction, or patient room (MD - 20.45; 95% CI - 35.54, - 5.37), but not during mask application or physician examination (MD 2.33; 95% CI - 4.82, 9.48). Compared with midazolam, children's anxiety was significantly lower in preoperative time (MD - 7.60; 95% CI - 11.73, - 3.47), but not in the induction room (MD - 9.63; 95% CI - 21.04, 1.77).
conclusionsClowning seems to lower children's anxiety, but because of the increased risk of bias of included studies and the very low quality of evidence, these results should be considered with caution. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42016039045.
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