School of Occupational Therapy

Touro University Nevada

OCCT 643 Systematic Reviews in Occupational Therapy

CRITICALLY APPRAISED TOPIC (CAT) WORKSHEET
Focused Question:
For children with autism, does physical exercise reduce self-stimulatory behaviors?
Prepared By:
Austin Lepper, OTS and Kerielle Williams, OTS
Department of Occupational Therapy
Touro University of Nevada
874 American Pacific Drive
Henderson, NV 89014
Date Review Completed:
10-13-2014
Clinical Scenario:
Many children seen for occupational therapy (OT) services have some form of Autism
Spectrum Disorder (ASD)
Summary of Key Findings:
Summary of Levels I, II and III:
The results of the repeated measures ANOVAs showed that there were significant and
marginally significant Time (Pre vs. Post) by Group.
Results indicate that the environment provided enables individuals to develop physical
skills within the intervention process and enhances their behavioral and social skills in
the future.
The aquatic program used in this
study resulted in a significant increase in all subtests of physical fitness and aquatic

skills except subtest of body composition

Both aerobic and muscular strength-training programs produce positive fitness gains.
Results indicated that students with and without ASD spent a larger percentage of time
in MVPA during physical education compared with recess period, relative to the amount
of time spent in those settings.
Significant overall group differences were found on muscular strength and endurance as
well as aquatic skills.
The participants overall scores increased significantly on the push-up and pull-up tests.
The benefits of engaging individuals with ASD in an individually-tailored, highintensity exercise program improves all physical fitness and behavioral outcomes for
cardiorespiratory fitness and abdominal strength as well as positive behaviors in
physical activity

Summary of Level IV:

The results suggest that interventions
can be developed to promote sustained participation in physical
activity for individuals with autism.

Contributions of Qualitative Studies:

Not included in this review

Adapted from AOTA Evidence-Based Literature Review

Project/7 CAT Worksheet.5-05

Bottom Line for Occupational Therapy Practice:

The clinical and community-based practice of OT:

Program development:
Societal Needs:
Healthcare delivery and policy:
Education and training of OT students:
Refinement, revision, and advancement of factual knowledge or theory:

Review Process:

Topic was selected by two second year students in masters program

Focused question was developed by student with input and submitted for approval from
course instructor
Key terms for Patient Population, Intervention, and Outcome were developed by student
Student conducted a comprehensive literature search of databases
Abstracts which matched the P, I, O criteria were included in literature search
Full-text copies of articles identifies as relevant were located and saved for review
Databases were searched individually to ensure all relevant research was included in
literature search
Course instructor reviewed literature search for completeness
Based on this review, some articles were eliminated as they did not meet inclusion
criteria
Articles that met all inclusion criteria were included in the Evidence Table and analyzed
Evidence table was submitted for approval from course instructor
Completed CAT based on information from evidence table and supporting articles found
during comprehensive literature search
CAT was submitted to course instructor for final approval.

Procedures for the Selection and appraisal of articles:

Inclusion Criteria:

Research articles published in peer review journals

Articles written in English
Research articles fit the population, intervention, and outcome

Exclusion Criteria:

Qualitative data was excluded from this critical analysis

Dissertations, thesis papers, and articles not written in English
Articles that included participants older than 21 years of age
Studies that were conducted prior to 2003

Search Strategies:
Categories
Patient/Client Population

Key Search Terms

Child, adolescence, Autism Spectrum Disorder

Intervention

Physical exercise

Outcomes

Strength, motor, performance, endurance, activity

Adapted from AOTA Evidence-Based Literature Review

Project/7 CAT Worksheet.5-05

Databases and Sites Searched

EBSCO, PsychInfo, Google Scholar
Quality Control/Peer Review Process:

Search terms were developed in consultation with the instructor of record for OCCT 643
Systematic Reviews of the Literature in Occupational Therapy
Search terms were expanded through EBSCO Host
Searches of all relevant databases were conducted
Literature review was submitted to instructor of record to ensure all relevant literature
was identified and included in the study
Instructor of record confirmed correct identification of levels of evidence

An evidence table was completed using all articles relevant to focused question
Evidence table was submitted to instructor of record for review of thoroughness and
inconsistencies
Students completed the CAT and submitted for final instructor of record approval

Results of Search:
Summary of Study Designs of Articles Selected for Appraisal:

Level of
Evidence
I
II
III
IV
V
Other

Study Design/Methodology of Selected Articles

Randomized Control Trial (RCT)
Experimental Repeated Measure, Repeated Measures,
Non-randomized Control Trial
Cohort, Case-Control, Convenience Sample???
Changing Conditions
Qualitative Studies

Number of Articles
Selected
1
3
3
1
0
0

TOTAL:
Limitations of the Studies Appraised:
Levels I, II, and III

Levels IV

Other

Adapted from AOTA Evidence-Based Literature Review

Project/7 CAT Worksheet.5-05

Articles Selected for Appraisal:

Aksay, E., & Alp, A. (2014). The effects of a physical activity rehabilitation program on the
motor skill and physical performance of children with autism spectrum disorder (ASD):
Movement therapy and ASD. International Journal of Academic Research, 6 (1). 12-19.
Chan, A. S., Sze, S. L., Siu, N. Y., Lau, E. M., Cheung, M., & Fatemi, H. (2013). A Chinese
Mind-Body Exercise Improves Self-Control of Children with Autism: A Randomized
Controlled Trial. PLoS ONE, 8(7), e68184.
Fragala-Pinkham, M., Haley, S., ONeil, M., (2011). Group swimming and aquatic exercise
programme for children with autism spectrum disorders: A pilot study. Developmental
Neurorehabiliatation, 14(4). 230-241.
Lochbaum, M. (2003). Viability of Cardiorespiratory and Muscular Strength Programs for the
Adolescent with Autism. Complementary Health Practice Review, 8(3), 225-233.
Magnusson, J., Cobham, C., McLeod, R. (2012). Beneficial Effects of Clinical Exercise
Rehabilitation for Children and Adolescents with Autism Spectrum Disorder (ASD).
Journal of Exercise PhysiologyOnline 15(2), 71-79.
Pan, C. (2010). Effects of water exercise swimming program on aquatic skills and social
behaviors in children with autism spectrum disorders. SAGE Publications and The
National Autistic Society, 9(28). 9-28
Pan, C., (2008). School time physical activity of students with and without autism spectrum
disorders during PE and recess. Adapted Physical Activity Quarterly, 25(2). 308-321.

Pan, C. (2010). The efficacy of an aquatic program on physical fitness and aquatic skills in
children with and without autism spectrum disorders. Research in Autism Spectrum
Disorders 5(2011). 657-665.
Srinivasan, S., Pescatello, L., & Bhat, A. (2014). Current Perspectives on Physical
Activity
and Exercise Recommendations for Children and Adolescents With Autism Spectrum
Disorders. Physical Therapy, 94(6), 875-886.
Todd, T. & Reid, G., (2006). Increasing physical activity in individuals with autism. Focus on
autism and other developmental disabilities, 21(3). 167-176.

Other References:

Adapted from AOTA Evidence-Based Literature Review

Project/7 CAT Worksheet.5-05