Best evidence statement (BESt) The use of interactive metronome in improving attention, timing, rhythm, motor planning and sequencing


Guideline Developer(s)

Cincinnati Children's Hospital Medical Center

Date Released

2012 Sep 28

Evidence Supporting the Recommendations

References Supporting the Recommendations

Bartscherer ML, Dole RL. Interactive metronome training for a 9-year-old boy with attention and motor coordination difficulties. Physiother Theory Pract. 2005 Oct-Dec;21(4):257-69. PubMed
Cosper SM, Lee GP, Peters SB, Bishop E. Interactive Metronome training in children with attention deficit and developmental coordination disorders. Int J Rehabil Res. 2009 Dec;32(4):331-6. PubMed
Interactive metronome: IM certified provider training and resource binder. 2003.
Koomar J, Burpee JD, DeJean V, Frick S, Kawar MJ, Fischer DM. Theoretical and clinical perspectives on the Interactive Metronome: a view from occupational therapy practice. Am J Occup Ther. 2001 Mar-Apr;55(2):163-6. [13 references] PubMed
Shaffer RJ, Jacokes LE, Cassily JF, Greenspan SI, Tuchman RF, Stemmer PJ Jr. Effect of interactive metronome training on children with ADHD. Am J Occup Ther. 2001 Mar-Apr;55(2):155-62. PubMed
Taub GE, McGrew KS, Keith TZ. Improvements in interval time tracking and effects on reading achievement. Psychol Sch. 2007;44(8):849-63.

Type of Evidence Supporting the Recommendations

The type of supporting evidence is identified and graded for each recommendation (see the "Major Recommendations" field).

Implementation of the Guideline

Description of Implementation Strategy

An implementation strategy was not provided.

Implementation Tools

Audit Criteria/Indicators
Resources

Benefits/Harms of Implementing the Guideline Recommendations

Potential Benefits

Improved occupational performance including attention, timing, rhythm, motor planning and/or sequencing

Potential Harms

Not stated

Rating Scheme for the Strength of the Recommendations

Table of Language and Definitions for Recommendation Strength

Language for Strength Definition
It is strongly recommended that…

It is strongly recommended that… not…
When the dimensions for judging the strength of the evidence are applied, there is high support that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations).
It is recommended that…

It is recommended that… not…
When the dimensions for judging the strength of the evidence are applied, there is moderate support that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

Qualifying Statements

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.

Methodology

Methods Used to Collect/Select the Evidence

Searches of Electronic Databases

Description of Methods Used to Collect/Select the Evidence

Search Strategy

  • Databases: Medline, Cinahl, Cochrane Reviews, Pubmed, AOTA, AOTA, APTA's Hooked on Evidence, APTA Section of Pediatrics, Can Child, CATS, PEDro, Pediatric PT, SPD Foundation, Spiral Foundation, TRIP, IM Website
  • Search Terms: Interactive Metronome, Metronome, Motor Planning, ADHD, Coordination
  • Limits, Filters: English language only
  • Search Dates: Date ranges from 1980-2012
  • Date Search done: May 2012
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

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

This Best Evidence Statement has been reviewed against quality criteria by two independent reviewers from the Cincinnati Children's Hospital Medical Center (CCHMC) Evidence Collaboration.

Identifying Information and Availability

Bibliographic Source(s)

Cincinnati Children's Hospital Medical Center. Best evidence statement (BESt). The use of interactive metronome in improving attention, timing, rhythm, motor planning and sequencing. Cincinnati (OH): Cincinnati Children's Hospital Medical Center; 2012 Sep 28. 6 p. [13 references]

Adaptation

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

Source(s) of Funding

Cincinnati Children's Hospital Medical Center

Guideline Committee

Not stated

Composition of Group That Authored the Guideline

Group/Team Members: Kristen Brevoort, MOT, OTR/L (Team Leader), Division of Occupational Therapy and Physical Therapy; Amy Brennan, MS, OTR/L, Division of Occupational Therapy and Physical Therapy; Victoria McQuiddy, MHS, OTR/L, Division of Occupational Therapy and Physical Therapy

Ad Hoc Members, Division of Occupational Therapy and Physical Therapy: Angela Bates, OTD, OTR/L; Megan L Cappel, MHS, OTR/L; Shannon Teeters OTR/L; Jen Thompson, M. Ed., OTR/L

Ad Hoc Advisor: Michelle Kiger, MHS, OTR/L, Division of Occupational Therapy and Physical Therapy

Financial Disclosures/Conflicts of Interest

Conflict of interest declaration forms are filed with the Cincinnati Children's Hospital Medical Center Evidence-based Decision Making (CCHMC EBDM) group. No financial or intellectual conflicts of interest were found.

Guideline Status

This is the current release of the guideline.

Guideline Availability

Electronic copies: Available from the Cincinnati Children's Hospital Medical Center.

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.

In addition, suggested process or outcome measures are available in the original guideline document.

Patient Resources

None available

NGC Status

This NGC summary was completed by ECRI Institute on January 25, 2013.

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) 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
  • 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.

Scope

Disease/Condition(s)

Decreased occupational performance related to attention, timing, rhythm, or motor and praxis skills

Guideline Category

Management
Treatment

Clinical Specialty

Family Practice
Pediatrics
Physical Medicine and Rehabilitation

Intended Users

Advanced Practice Nurses
Nurses
Occupational Therapists
Physical Therapists
Physician Assistants
Physicians

Guideline Objective(s)

To evaluate, in children ages 6 years and older demonstrating decreased occupational performance, if the Interactive Metronome (IM) program versus standard care improves attention, timing, rhythm, motor planning and/or sequencing

Target Population

Child who:

  • Presents with decreased occupational performance related to attention, timing, rhythm, or motor and praxis skills
  • Is at least 6 years of age
  • Is able to follow simple directions
  • Is able to tolerate participating in an one-hour therapy session at least three times a week
  • Is able to tolerate wearing equipment

Note: Children with atypical movement patterns and/or limited range of motion which render them incapable of approximating program exercises are excluded.

Interventions and Practices Considered

Interactive Metronome (IM) program*

*The Interactive Metronome Program is a computer-based intervention tool that combines auditory feedback and movement exercises to promote improved motor planning and sequencing.

Major Outcomes Considered

Occupational performance including attention, timing, rhythm, motor planning and/or sequencing

Recommendations

Major Recommendations

The strength of the recommendation (strongly recommended, recommended, or no recommendation) and the quality of the evidence (1a‒5b) are defined at the end of the "Major Recommendations" field.

  1. It is recommended that an interactive metronome (IM) program be considered as a treatment modality to improve the following skills:
    1. Motor control (Shaffer et al., 2001 [2b]; Koomar et al., 2001 [5b])
    2. Timing and rhythm (Taub et al., 2007 [2b]; Koomar et al., 2001 [5b])
    3. Visuomotor control (Cosper et al., 2009 [4b])
    4. Visual choice reaction time (Cosper et al., 2009 [4b])
    5. Attention (Shaffer et al., 2001 [2b])

    (Local Consensus, 2012 [5])

  2. It is recommended that the IM program be completed:
    1. 3 to 5 times per week (Taub et al., 2007 [2b]; Shaffer et al., 2001 [2b]; Bartscherer & Dole, 2005 [5a]; Interactive Metronome, 2003 [5b])
    2. Over 15 treatment sessions (Shaffer et al., 2001 [2b]; Bartscherer & Dole, 2005 [5a]; Interactive Metronome, 2003 [5b])
    3. With a session length of 1 hour (Taub et al., 2007 [2b]; Shaffer et al., 2001 [2b]; Bartscherer & Dole, 2005 [5a])

    (Local Consensus, 2012 [5])

Definitions:

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

Table of Language and Definitions for Recommendation Strength

Language for Strength Definition
It is strongly recommended that…

It is strongly recommended that… not…
When the dimensions for judging the strength of the evidence are applied, there is high support that benefits clearly outweigh risks and burdens (or visa-versa for negative recommendations).
It is recommended that…

It is recommended that… not…
When the dimensions for judging the strength of the evidence are applied, there is moderate support that benefits are closely balanced with risks and burdens.
There is insufficient evidence and a lack of consensus to make a recommendation…

Note: See the original guideline document for the dimensions used for judging the strength of the recommendation.

Clinical Algorithm(s)

None provided

Institute of Medicine (IOM) National Healthcare Quality Report Categories

IOM Care Need

Getting Better

IOM Domain

Effectiveness

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