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  • Guideline Summary
  • NGC:008677
  • 2011 Aug 25

Best evidence statement (BESt). Craniosacral therapy for children with autism and/or sensory processing disorder.

Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Craniosacral therapy for children with autism and/or sensory processing disorder. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Aug 25. 5 p. [13 references]

View the original guideline documentation External Web Site Policy

This is the current release of the guideline.

Major Recommendations

There is insufficient evidence and a lack of consensus to make a recommendation on using craniosacral therapy (CST) to improve the behavior of children with autism and sensory processing disorder.

Note: Concerns are raised in the literature about the validity of the tools used to measure the craniosacral rhythm, identify craniosacral dysfunction and efficacy of craniosacral treatment (Green et al., 1999 [1a]; Levy & Hyman, 2005 [5b]).

Clinical Algorithm(s)

None provided

Disease/Condition(s)

  • Autism spectrum disorder
  • Sensory processing disorder

Guideline Category

Treatment

Clinical Specialty

Family Practice

Internal Medicine

Neurology

Pediatrics

Psychiatry

Psychology

Intended Users

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Guideline Objective(s)

To evaluate, among children with autism spectrum disorder or sensory processing disorder, if the use of craniosacral therapy (CST) compared to standard care without CST improves behavior

Target Population

Children (ages 3 and up) with autism spectrum disorder (ASD) and/or sensory processing disorder (SPD)

Interventions and Practices Considered

Craniosacral therapy (CST) compared to standard care without CST

Major Outcomes Considered

Behavior

Methods Used to Collect/Select the Evidence

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

Search Strategy

Databases: Ovid-Cochrane, Medline, EBSCO-CINAHL, Health Watch

Keywords: Craniosacral therapy, craniosacral, autism, autism spectrum disorder, sensory integration disorder, sensory integration, sensory processing disorder, SPD, alternative treatments, CAM therapies, CAM, massage therapy, integrative therapies, anxiety, ADD/ADHD, tantrums, behavior issues, behavior problems, behavior, safety, efficacy

Limits: None, all dates included

Retrieved: September 2010-July 2011

Number of Source Documents

Not stated

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
"Strongly recommended" There is consensus that benefits clearly outweigh risks and burdens (or vice-versa for negative recommendations).
"Recommended" There is consensus that benefits are closely balanced with risks and burdens.
No recommendation made There is a lack of consensus to direct development of a recommendation.
Dimensions: In determining the strength of a recommendation, the development group makes a considered judgment in a consensus process that incorporates critically appraised evidence, clinical experience, and other dimensions as listed below.
  1. Grade of the body of evidence
  2. Safety/harm
  3. Health benefit to the patients (direct benefit)
  4. Burden to patient of adherence to recommendation (cost, hassle, discomfort, pain, motivation, ability to adhere, time)
  5. Cost-effectiveness to healthcare system (balance of cost/savings of resources, staff time, and supplies based on published studies or onsite analysis)
  6. Directness (the extent to which the body of evidence directly answers the clinical question [population/problem, intervention, comparison, outcome])
  7. Impact on morbidity/mortality or quality of life

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

Reviewed against quality criteria by 2 independent reviewers.

References Supporting the Recommendations

Green C, Martin CW, Bassett K, Kazanjian A. A systematic review of craniosacral therapy: biological plausibility, assessment reliability and clinical effectiveness. Complement Ther Med. 1999 Dec;7(4):201-7. [46 references] PubMed External Web Site Policy

Levy SE, Hyman SL. Novel treatments for autistic spectrum disorders. Ment Retard Dev Disabil Res Rev. 2005;11(2):131-42. [189 references] PubMed External Web Site Policy

Type of Evidence Supporting the Recommendations

Current evidence was found to be mostly descriptive studies, which was considered insufficient to make a recommendation.

Potential Benefits

  • An open label (n=68) observational study of craniosacral therapy (CST) and acupuncture treatments in adults with asthma reported improved asthma quality of life scores and reduced medication usage.
  • Clinicians who practice CST with patients with ASD anecdotally observe a decrease in self-injurious behavior and improved social skills. Additionally, CST is often very relaxing and calming supporting overall health and wellness. However these benefits have not been generally studied and reported in the medical literature.
  • Parents report improvements in behavior, ability to focus and social skills.

Potential Harms

Not stated

Contraindications

Upledger craniosacral training programs state that acute intracranial hemorrhage, intracranial aneurysm, recent skull fracture and herniation of the medulla oblongata are contraindications for craniosacral therapy (CST). The theoretical basis for this is the potential to increase intracranial pressure with CST. Data to support this idea is not reported in the literature.

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.

Description of Implementation Strategy

An implementation strategy was not provided.

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Bibliographic Source(s)

Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). Craniosacral therapy for children with autism and/or sensory processing disorder. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2011 Aug 25. 5 p. [13 references]

Adaptation

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

Date Released

2011 Aug 25

Guideline Developer(s)

Cincinnati Children's Hospital Medical Center - Hospital/Medical Center

Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Group/Team Leader: Susan E. Gray, LMT, Holistic Health Specialist I

Support Personnel: Barbara K. Giambra, MS, RN, CPNP, Center for Professional Excellence Evidence Based Practice Mentor; Susan McGee, MSN, CNP, Center for Professional Excellence Evidence Based Practice Mentor

Consultants: Lois Bogenschutz, RSN, RN, CCRP, Integrative Care Clinical Research Nurse; Jenifer Hadley, CCLS, LMT, Integrative Care Clinical Manager; Sharon McLeod, MS, CCLS, CTRS, Integrative Care Clinical Director; Judy Molique, LMT, MA, Holistic Health Specialist II; Michelle Zimmer, MD, Integrative Care Medical Director

Financial Disclosures/Conflicts of Interest

Not stated

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 January 4, 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; and
  • 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.

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