School-based allied health interventions for children and young people affected by neurodisability: a systematic evidence map

To systematically map available evidence for school-based interventions led by allied health (i.e., occupational therapy, physiotherapy, and/or speech and language therapy). We searched for studies in pre-school, primary, secondary, or post-secondary settings, published 2004–2020. We coded study, population, and intervention characteristics. Outcomes were coded inductively, categorised, and linked to the International Classification of Functioning, Disability, and Health. We included 337 studies (33 countries) in an interactive evidence map. Participants were mainly pre-school and primary-aged, including individuals with neurodisability and whole-school populations. Interventions targeted wide-ranging outcomes, including educational participation (e.g., writing, reading) and characteristics of school environments (e.g., educators’ knowledge and skills, peer support). Universal, targeted, and intensive interventions were reported in 21.7%, 38.9%, and 60.2% of studies, respectively. Teachers and teaching assistants delivered interventions in 45.4% and 22.6% of studies, respectively. 43.9% of studies conducted early feasibility testing/piloting and 54.9% had ≤30 participants. Sixty-two randomised controlled trials focused on intervention evaluation or implementation. In the United Kingdom, future research should take forward school-based allied health interventions that relate directly to agreed research priorities. Internationally, future priorities include implementation of tiered (universal, targeted, intensive) intervention models and appropriate preparation and deployment of the education workforce. IMPLICATIONS FOR REHABILITATIONAllied health professionals (occupational therapists, physiotherapists, and speech and language therapists) work in schools supporting children and young people affected by neurodisability but the content, impact, and cost-effectiveness of their interventions are not well-understood.We systematically mapped the available evidence and identified that allied health school-based interventions target highly diverse health-related outcomes and wider determinants of children and young people’s health, including educational participation (e.g., literacy) and characteristics of the school environment (e.g., educators’ knowledge and skills).Our interactive evidence map can be used to help stakeholders prioritise the interventions most in need of further evaluation and implementation research, including tiered models of universal, targeted, and intensive allied health support.Teachers and teaching assistants play a central role in delivering allied health interventions in schools – appropriate preparation and deployment of the education workforce should therefore be a specific priority for future international allied health research. Allied health professionals (occupational therapists, physiotherapists, and speech and language therapists) work in schools supporting children and young people affected by neurodisability but the content, impact, and cost-effectiveness of their interventions are not well-understood. We systematically mapped the available evidence and identified that allied health school-based interventions target highly diverse health-related outcomes and wider determinants of children and young people’s health, including educational participation (e.g., literacy) and characteristics of the school environment (e.g., educators’ knowledge and skills). Our interactive evidence map can be used to help stakeholders prioritise the interventions most in need of further evaluation and implementation research, including tiered models of universal, targeted, and intensive allied health support. Teachers and teaching assistants play a central role in delivering allied health interventions in schools – appropriate preparation and deployment of the education workforce should therefore be a specific priority for future international allied health research.

本研究旨在系统梳理由联合健康（allied health）从业者，即作业治疗师、物理治疗师及言语语言治疗师主导的校园干预相关现有证据。我们检索了2004年至2020年间发表于学前、小学、中学及高等教育阶段的相关研究，对研究本身、研究人群及干预特征进行编码；结局指标采用归纳法完成编码与分类，并与《国际功能、残疾和健康分类》（International Classification of Functioning, Disability and Health, ICF）进行关联。

本交互式证据图谱共纳入337项研究，覆盖33个国家。研究对象以学前及小学年龄段人群为主，涵盖神经发育障碍患者及全体在校学生群体。

干预措施覆盖的结局范围广泛，包括教育参与（如书写、阅读能力）及校园环境特征（如教育工作者的知识与技能、同伴支持体系）。按干预层级划分，普适性、针对性及强化型干预分别占研究总数的21.7%、38.9%及60.2%；由教师及教学辅助人员实施的干预分别占45.4%与22.6%。43.9%的研究开展了早期可行性测试或预试验，54.9%的研究参与者数量≤30人。另有62项随机对照试验聚焦于干预效果评估或实施研究。

在英国境内，未来研究应聚焦于与既定研究优先级直接相关的校园联合健康干预项目。国际层面的未来研究优先级则包括分层（普适性、针对性、强化型）干预模型的落地实施，以及教育从业者的合理培养与配置。

【康复领域启示】
联合健康从业者（作业治疗师、物理治疗师、言语语言治疗师）会在校园中为受神经发育障碍影响的儿童与青少年提供支持，但目前学界对其干预方案的内容、实施效果及成本效益仍缺乏充分认知。
本研究系统梳理了现有证据，发现校园联合健康干预所针对的健康相关结局及儿童青少年健康的更广范围决定因素均呈现高度多样性，其中包括教育参与（如读写能力）及校园环境特征（如教育工作者的知识与技能）。
本交互式证据图谱可协助利益相关方优先确定最需开展进一步评估与实施研究的干预项目，包括普适性、针对性及强化型联合健康支持的分层模型。
教师与教学辅助人员在校园联合健康干预的实施中发挥核心作用，因此合理培养与配置教育从业者应成为未来国际联合健康研究的特定优先级方向。

联合健康从业者（作业治疗师、物理治疗师、言语语言治疗师）会在校园中为受神经发育障碍影响的儿童与青少年提供支持，但目前学界对其干预方案的内容、实施效果及成本效益仍缺乏充分认知。
本研究系统梳理了现有证据，发现校园联合健康干预所针对的健康相关结局及儿童青少年健康的更广范围决定因素均呈现高度多样性，其中包括教育参与（如读写能力）及校园环境特征（如教育工作者的知识与技能）。
本交互式证据图谱可协助利益相关方优先确定最需开展进一步评估与实施研究的干预项目，包括普适性、针对性及强化型联合健康支持的分层模型。
教师与教学辅助人员在校园联合健康干预的实施中发挥核心作用，因此合理培养与配置教育从业者应成为未来国际联合健康研究的特定优先级方向。