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Guideline Summary
Guideline Title
Best evidence statement (BESt). Use of a weighted or pressure device to modify behavior in children with a sensory processing disorder.
Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Use of a weighted or pressure device to modify behavior in children with a sensory processing disorder. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2012 Feb 9. 6 p. [14 references]
Guideline Status

This is the current release of the guideline.

Scope

Disease/Condition(s)

Sensory processing difficulties

Guideline Category
Management
Clinical Specialty
Family Practice
Pediatrics
Psychology
Intended Users
Advanced Practice Nurses
Nurses
Physician Assistants
Physicians
Psychologists/Non-physician Behavioral Health Clinicians
Guideline Objective(s)

To evaluate in children with sensory processing difficulties over the age of one if the use of a therapeutic weighted or pressure device (passive input) compared to no passive input is effective in improving a child's behavior (self-stimulatory behaviors and attention to task) or arousal level

Target Population

Children over the age of one year old with sensory processing difficulties

Exclusions:

  • Therapeutic weighted device: children with compromised posture, children with poor postural endurance, children with poor skin integrity
  • Therapeutic pressure device: children with poor skin integrity
Interventions and Practices Considered

Therapeutic weighted vest or pressure device

Major Outcomes Considered
  • Child's behavior (self-stimulatory behaviors and attention to task)
  • Arousal level

Methodology

Methods Used to Collect/Select the Evidence
Searches of Electronic Databases
Description of Methods Used to Collect/Select the Evidence

Search Strategy

  • Articles: Eleven articles were found to be appropriate for review.
  • Search Engines: OVID MEDLINE, OVID CINAHL, OVID EBM Reviews (Cochrane), PubMed Clinical Queries, AOTA, APTA's Hooked on Evidence, APTA Section of Pediatrics, Can Child, CATS, PEDro, Pediatric PT, SPD Foundation, Spiral Foundation, TRIP
  • Search Terms: Compression, Compression+garment, Pressure Devices, Benik, Theratogs, Miracle belt, Body sock, Lycra shirts, Bear hug, Weighted vest, Weighted belt, Weighted lap pad, Weighted hats, Weighted gloves, Weighted balls, Weighted backpack alone, and as Boolean phrase: +sensory integration, +Autism, +ADHD, +Occupational Therapy, +Children, +Behavior, +Self-stimulation
  • Search Limits: English language, year: 1980 through July 2011
Number of Source Documents

Eleven articles were found to be appropriate for review.

Methods Used to Assess the Quality and Strength of the Evidence
Weighting According to a Rating Scheme (Scheme Given)
Rating Scheme for the Strength of the Evidence

Table of Evidence Levels

Quality Level Definition
1a or 1b Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5a or 5b General review, expert opinion, case report, consensus report, or guideline
5 Local consensus

a = good quality study; b = lesser quality study

Methods Used to Analyze the Evidence
Systematic Review
Description of the Methods Used to Analyze the Evidence

Not stated

Methods Used to Formulate the Recommendations
Expert Consensus
Description of Methods Used to Formulate the Recommendations

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Recommendation Strength

Strength Definition
It is strongly recommended that…
It is strongly recommended that… not…
There is consensus that benefits clearly outweigh risks and burdens (or vice versa for negative recommendations).
It is recommended that…
It is recommended that… not…
There is consensus that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

Cost Analysis

A formal cost analysis was not performed and published cost analyses were not reviewed.

Method of Guideline Validation
Peer Review
Description of Method of Guideline Validation

The Best Evidence Statement has been reviewed against quality criteria by 3 independent reviewers from the Cincinnati Children's Hospital Medical Center (CCHMC) Evidence Collaboration.

Recommendations

Major Recommendations

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5b) are defined at the end of the "Major Recommendations" field.

  1. It is recommended that the decision to use therapeutic weighted devices be determined by clinical judgment of the therapist with consideration of child and family preferences for children with sensory processing difficulties who present with:
    1. Poor attention to task (VandenBerg, 2001 [3b]; Fertel-Daly, Bedell, & Hinojosa, 2001 [4b])
    2. Self-stimulatory behaviors (VandenBerg, 2001 [3b]; Fertel-Daly, Bedell, & Hinojosa, 2001 [4b])
    3. Increased arousal level (Local Consensus [5])
    4. Sensory modulation difficulties (Local Consensus [5])

      Note: Low level evidence suggests that weight and pressure inputs provide both tactile and proprioceptive input to the body that is theorized to be calming to the central nervous system (Stephenson & Carter, 2009 [1b]; Fertel-Daly, Bedell, & Hinojosa, 2001 [4b]; Grandin, 1992 [4b]).

  1. It is recommended that when applying a therapeutic weighted vest:
    1. Weights be distributed evenly around the vest (Local Consensus [5])
    2. Total weight for initial application is recommended to be 5% of body weight; modifications may be made based on therapist's clinical reasoning (Local Consensus [5]; Olson & Moulton, "Occupational," 2004 [5b]; Olson & Moulton, "Use," 2004 [5b])
  1. It is recommended that the decision to use therapeutic devices that provide pressure be determined by clinical judgment of the therapist with consideration of child and family preferences for children with sensory processing difficulties who present with:
    1. Increased arousal level (Edelson et al., 1999 [4b])
    2. Anxiety (Edelson et al., 1999 [4b])
    3. Poor attention to task (Local Consensus [5])
    4. Sensory modulation difficulties (Local Consensus [5])
    5. Postural control difficulties (Local Consensus [5])
  1. It is recommended that when applying a pressure vest:
    1. Pressure level be adjusted to the child's preference
    2. Skin integrity be assessed after wearing for 20 minutes
    3. Skin integrity be assessed with signs of discomfort
    4. Child be monitored for signs of overheating

    (Local Consensus [5])

  1. It is recommended, when using with children who have a background of trauma such as physical abuse, that caution be used when applying therapeutic weighted or pressure devices (Local Consensus [5]).
  2. There is insufficient evidence and a lack of consensus to make a recommendation on the length of time (minutes) therapeutic weighted and pressure devices may be used.

Definitions:

Table of Evidence Levels

Quality Level Definition
1a or 1b Systematic review, meta-analysis, or meta-synthesis of multiple studies
2a or 2b Best study design for domain
3a or 3b Fair study design for domain
4a or 4b Weak study design for domain
5a or 5b General review, expert opinion, case report, consensus report, or guideline
5 Local consensus

a = good quality study; b = lesser quality study

Table of Recommendation Strength

Strength Definition
It is strongly recommended that…
It is strongly recommended that… not…
There is consensus that benefits clearly outweigh risks and burdens (or vice versa for negative recommendations).
It is recommended that…
It is recommended that… not…
There is consensus that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

Clinical Algorithm(s)

None provided

Evidence Supporting the Recommendations

References Supporting the Recommendations
Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Improving a child's behavior (self-stimulatory behaviors and attention to task) or arousal level

Potential Harms
  • Potential risks of weighted device use include muscular fatigue, skin irritation, discomfort, and overheating.
  • Potential risks of pressure devices include skin irritation, discomfort, and overheating.

Qualifying Statements

Qualifying Statements

This Best Evidence Statement addresses only key points of care for the target population; it is not intended to be a comprehensive practice guideline. These recommendations result from review of literature and practices current at the time of their formulation. This Best Evidence Statement does not preclude using care modalities proven efficacious in studies published subsequent to the current revision of this document. This document is not intended to impose standards of care preventing selective variances from the recommendations to meet the specific and unique requirements of individual patients. Adherence to this Statement is voluntary. The clinician in light of the individual circumstances presented by the patient must make the ultimate judgment regarding the priority of any specific procedure.

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need
Getting Better
Living with Illness
IOM Domain
Effectiveness

Identifying Information and Availability

Bibliographic Source(s)
Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Use of a weighted or pressure device to modify behavior in children with a sensory processing disorder. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2012 Feb 9. 6 p. [14 references]
Adaptation

Not applicable: The guideline was not adapted from another source.

Date Released
2012 Feb 9
Guideline Developer(s)
Cincinnati Children's Hospital Medical Center - Hospital/Medical Center
Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Best Evidence Statement (BESt) Development Team

Composition of Group That Authored the Guideline

BESt Development Team: Kristen Brevoort, MOT, OTR/L, Team Leader, Division of Occupational Therapy and Physical Therapy; Amy Brennan, MS, OTR/L, Division of Occupational Therapy and Physical Therapy; Victoria McQuiddy, MHS, OTR/L, Division of Occupational Therapy and Physical Therapy

Senior Clinical Director: Rebecca D. Reder, OTD, OTR/L, Division of Occupational Therapy and Physical Therapy

James M. Anderson Center for Health Systems Excellence: Karen Vonderhaar, MS, RN, Methodologist, Guidelines Program Administrator

Ad hoc Advisors: Mary Gilene, MBA, Division of Occupational Therapy and Physical Therapy; Michelle Kiger, OTR/L, Division of Occupational Therapy and Physical Therapy

Financial Disclosures/Conflicts of Interest

All Team Members and Clinical Effectiveness support staff have signed a conflict of interest declaration.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center Web site External Web Site Policy.

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Availability of Companion Documents

The following are available:

Print copies: For information regarding the full-text guideline, print copies, or evidence-based practice support services contact the Cincinnati Children's Hospital Medical Center Health James M. Anderson Center for Health Systems Excellence at EBDMInfo@cchmc.org.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on May 8, 2012.

Copyright Statement

This NGC summary is based on the original full-text guideline, which is subject to the following copyright restrictions:

Copies of this Cincinnati Children's Hospital Medical Center (CCHMC) External Web Site Policy Best Evidence Statement (BESt) are available online and may be distributed by any organization for the global purpose of improving child health outcomes. Examples of approved uses of the BESt include the following:

  • Copies may be provided to anyone involved in the organization's process for developing and implementing evidence based care
  • Hyperlinks to the CCHMC website may be placed on the organization's website
  • The BESt may be adopted or adapted for use within the organization, provided that CCHMC receives appropriate attribution on all written or electronic documents
  • Copies may be provided to patients and the clinicians who manage their care

Notification of CCHMC at EBDMInfo@cchmc.org for any BESt adopted, adapted, implemented or hyperlinked by the organization is appreciated.

Disclaimer

NGC Disclaimer

The National Guideline Clearinghouse™ (NGC) does not develop, produce, approve, or endorse the guidelines represented on this site.

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