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  • br Inclusion exclusion criteria br Quality assessment All st

    2022-09-09


    Inclusion/exclusion criteria
    Quality assessment All studies included in the qualitative synthesis were evaluated using the Quality Assessment Tool for Quantitative Studies (QATQS), which allows to determine their methodological quality. QATQS assesses 8 sections: selection bias, study design, confounders, blinding, data collection methods, withdrawals and dropouts, intervention integrity, analysis. Each section may be classified as ‘weak’, ‘moderate’ or ‘strong’, according to a reviewer’s dictionary. If one section is evaluated as ‘weak’, the entire study is deemed ‘moderate’, if more than one section is ‘weak’, the study is automatically ‘weak’, and if neither section is ‘weak’, the study is evaluated as ‘strong’. The assessments were performed independently by two authors (TT and BP). If agreement on the quality assessment could not be reached by two authors, the third author was consulted (EZ).
    Data extraction and analysis The meta – analysis was performed on the summary results of the Vineland Adaptive Behavior Scales (VABS)16and their results in Social subscale and Communication subscale in the form of standardized mean differences (SMDs). Three studies,17, 18, 19 which used that igf 1 inhibitor tool to evaluate the effects of the therapy and presented the results in a way which facilitated a comparison were analyzed. A standard χ2 test was used to test the heterogeneity between trial results. The I2 parameter was used to measure igf 1 inhibitor inconsistency between the results. For the χ2 statistic, the p-value of <0.10 was considered to indicate significant heterogeneity. The I2 statistic value of ≥50% was considered to indicate significant heterogeneity. If significant heterogeneity existed between the studies, a random-effects model of analysis was used. Otherwise, a fixed-effects model was used. Publication bias was assessed visually by funnel plots and statistically by Egger’s test.
    Results The search results and the flow diagram of the study selection are summarized in Fig. 1. A total of 15 studies were included. More than one test to assess the effects of HPOT was used in most (10 out of 15) studies. Domains associated with psychosocial functioning (socialization, communication, engagement, stereotypical behaviors) were evaluated in 14 studies,18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28,, cortisol levels in saliva - 1,execution of daily activities - 5,,,,, gait parameters - 1, and motor functions - 6.15, 16, 17,, Using QATQS, 6 studies were deemed to be ‘strong’, 6 – ‘moderate’ and 3 – ‘weak’. Detailed results are presented in Table 1. Data collection methods section and blinding section were awarded the highest and the lowest number of points, respectively. The results for individual sections are presented in Fig. 2.
    Patient characteristics and study design A total of 390 participants (aged: 3–16 years, mean: 5.14–10.2 years) from 15 articles were included in the study. The subjects were predominantly male (308 (79%) – males, 72 (21%) – females). All participants were diagnosed with ASD. In 7 studies,,,,,, they had to meet the DSM IV – TR (Diagnostic and Statistical Manual of Mental Disorders 4th edition, text revision) criteria, whereas in the remaining studies the criteria for ASD diagnosis were either not presented,,22, 23, 24,, or ICD-10 criteria for ASD were used. Patient characteristics for individual study groups are presented in Table 2. TR was the intervention of choice in the clear majority of the studies,18, 19, 20, 21, 22, 23, 24, 25,,,29, 30, 31 and HPOT was used in only one study. The number of individual therapeutic sessions and their duration varied between the studies, with 30 min. for the shortest,, and 180 min. for the longest session. Duration of the session was not disclosed in 1 study. Detailed characteristics of the studies are presented in Table 3.
    Results of the therapeutic interventions The interaction between psychosocial functioning and EAAT was investigated in most studies included in our analysis. Borgi et al who used TR in ASD patients, reported improved socialization scores of the VABS as compared to controls who did not attend TR (change between baseline and final scores, mean ± SD, EAT: 0.72 ± 0.22, controls: 0.23 ± 0.21, ANOVA Time x Group interaction F(1,18) = 5.30, p = 0.034, Tukey test p < 0.01), and shorter reaction time in problem-solving situations (change between baseline and final scores using the Tower of London (TOL) test, mean ± SD, EAT: -20,7 ± 6,6, controls: -6.46 ± 5.2, ANOVA Time x Group interaction, F(1,19) = 5.85, p = 0.026; Tukey test p < 0.01).