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. 2017 Jul 31;2017(7):CD010914. doi: 10.1002/14651858.CD010914.pub2

Miller 2001.

Methods Single‐blind RCT.
Participants Number screened: 29.
Number included: 20.
Number followed up: 20.
Number of withdrawals: 2 from treatment, 1 did not complete all testing.
Diagnosis of DCD: by a physician.
Presence and absence of comorbid conditions: excluded children with medical diagnosis of a specific neurological disorder or a physical or sensory deficit causing the motor problem.
Regarding participants completing the study
Age (mean ± SD): CO‐OP: 8.90 ± 1.52 years (range 7 to 12 years), CTA: 9.20 ± 0.92 years (range 7 to 12 years).
Sex: 14 boys, 6 girls.
Ethnicity: no information.
Country: Canada.
Setting: Cloverleaf Research and Treatment Clinic in School of Occupational Therapy at University of Western Ontario.
Sociodemographics: no information.
Inclusion criteria
  1. Aged 7 years 0 month to 12 years 11 months.

  2. Clinical identification of movement problems or DCD diagnosis.

  3. Normal intelligence quotient ≥ 85 on at least 1 of the overall or performance scales of Kaufman Brief Intelligence Test.

  4. Normal or corrected to normal hearing and vision.

  5. Child and parental consent and agreement to participant.


Exclusion criteria
  1. Previous or present exposure to a cognitive‐based treatment for motor problems.

  2. Medical diagnosis of a specific neurological disorder or a physical or sensory deficit causing the motor problem.

Interventions Comparison: CO‐OP vs CTA.
Intervention schedule: 50 min for 10 sessions, no frequency information.
Duration of intervention: no information.
Mode of delivery: face‐to‐face individual sessions.
Intervention material: CO‐OP: GPDC strategy and its application to target tasks; CTA: target tasks practise under skill direction and corrections.
Intervention procedure: CO‐OP: self‐talk and problem‐solving strategies are used to solve motor problems and applied to new situations; CTA: children were instructed in the performance of the task and the therapist actively provided skill direction and corrective instructions for problematic motor components.
Intervention provider: 1 therapist experienced in the administration of CO‐OP and 2 therapists experienced in the administration of CTA.
Place of intervention: Cloverleaf Research and Treatment Clinic in School of Occupational Therapy at University of Western Ontario.
Intervention compliance: monitored by investigators. 1 mid‐point treatment session was video‐taped to check adherence of treatment protocol.
Outcomes Primary
  1. BOTMP.

  2. Development Test of Visual‐Motor Integration ‐ Revised.


Secondary
  1. Canadian Occupation Performance Measure.

  2. Performance Quality Rating Scale.

  3. Vineland Adaptive Behaviour Scales.

  4. Self‐Perception Profile for Children.


Adverse effects or events: no adverse effect.*
Measures of participation: not reported.
Notes Study start date: not available.
Study completion date: not available.
Sample calculation: to be conducted based on the pilot study.
Ethics approval: no information.
Comments from study authors
Limitations:
    1. small number;

    2. no inactive control;

    3. internal validity:

      1. difficult to evaluate self‐talk, global strategy, and guided discovery process in CO‐OP;

      2. confounding of verbal ability.


Key conclusions of study authors
CO‐OP more effective than CTA.
Comment from review authors
A high dropout rate (> 10%) with no explanation as to reasons and group affiliations.
* Email correspondence with study authors: May 2016. We wrote to the study authors twice to request supplementary information on data and obtained supplementary information.
Follow‐up data obtained for 8 participants in CO‐OP group and 7 in CTA group. Follow‐up intervals varied from 7.5 months to 13 months. No inactive control group.
Risk of bias
Bias Authors' judgement Support for judgement
Random sequence generation (selection bias) Low risk System of random envelopes.
Allocation concealment (selection bias) Unclear risk Not stated.
Blinding of participants and personnel (performance bias) 
 All outcomes High risk Impossible to blind participants.
Blinding of outcome assessment (detection bias) 
 All outcomes Low risk 3 independent assessors.
Incomplete outcome data (attrition bias) 
 All outcomes High risk 3 dropouts from intervention, 1 did not complete all required testing.
Selective reporting (reporting bias) Low risk No protocol obtained. All prespecified outcomes of interest reported.
Other bias Low risk Funding: research funded by a research grant from the Hospital for Sick Children Foundation Toronto, Ontario.
Conflicts of interest: no information available.
Small numbers.