Efficacy of occupational therapy using Ayres Sensory Integration®: A systematic review

The Paper
Schaaf, R. C., Dumont, R. L., Arbesman, M., & May-Benson, T. A. (2018). Efficacy of occupational therapy using Ayres Sensory Integration®: A systematic review. American Journal of Occupational Therapy, 72(1), 7201190010p1-7201190010p10.

The Problem
Ayres sensory integration (ASI) has a long and celebrated (though sometimessordid) history in the occupational therapy world. If you finished OT school within the last five years, then it’s likely you’ve had at least one argument about it in school.

Regardless, as one of the only OT-derived neurological and intervention theories, it’s done well for itself.  Also, while the exact theory and mechanisms of action may not be well established scientifically, it seems sensory integration therapies do have good results for many children.  

But should you use this treatment framework?

How The Author's Did It
To help OTs answer this the authors conducted a systematic review that sorted through all peer reviewed studies done from 2007-2015.

In the end, the authors included 5 studies in the final analysis. Even though there were many studies published in that timeframe that looked at sensory integration, the others were excluded due to not specifically using ASI, not being clear on the interventions used, or not using the necessary outcome measures.  *Research side note: a limited number of studies (i.e narrowing it way down to 5 papers) often happens in systematic reviews due to inclusion criteria.

Outcome measures used in the 5 studies varied, but a few used Goal Attainment Scaling (GAS) to develop parent goals.  

Four of the studies in this review looked at ASI treatment in relation to skill based treatment or “standard treatment” (like fine motor skills development and writing practice).

* Practice tools note: If you’re not familiar with GAS, it can be a helpful collaborative goal setting system that dispenses with the typical “all-or-nothing” style of goal attainment.

Key Findings
Overall, the kids who did ASI had better outcomes (depending on the measure used) than those in the control groups.

Nonetheless, the kids in the control group also improved (with the effect size in the ASI groups being statistically larger).

So should you use it?

Ultimately the research slightly favoured ASI, but given that both groups improved, it’s much harder to tell if you should use it over something else in your tool box.

The good new is that both groups improved, so you can be more confident knowing that you'll likely be helping your patient regardless of what you choose.

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Given that both the ASI and the control groups improved, was sensory integration just more fun, exciting, or meaningful to the kids?

Patient 'buy-in' with meaningful or novel activities can be a real and powerful force. Are you using as much patient 'buy-in' as you can?