46 / 64
156
JCPSLP
Volume 17, Number 3 2015
Journal of Clinical Practice in Speech-Language Pathology
problem-solving, maths, science, and computer skills. A
large number of studies were included in the analysis and
both fixed and random effects statistical models yielded
similar findings. This gives confidence in the finding that
guided play-based learning was more effective than
didactic or free play. Specifically, children achieved better
educational outcomes when engaged in learning via
scaffolded play that involved teacher support and
encouraged learners to explain their ideas (elicited
explanation). This style of learning yielded better outcomes
than any other form of instruction (free play or explicit
instruction), and led to superior results for all learning
outcomes including language (verbal and social tasks).
However, caution is required when interpreting the findings
with regard to children in early primary education, given that
the authors did not assess the quality of the included
studies, and included studies pertaining to learners of all
ages (43% of included studies related to child population).
The randomised controlled trial by Blanco and Ray (2011)
compared academic achievement outcomes of 41 first
grade children (aged 6–7 years) in the United States who
were randomly assigned to either a 2 x ½ hour play therapy
group or a waiting list control group. During sessions, the
facilitator followed the child’s lead and responded to the
child’s play following a protocol of verbal and non-verbal
behaviours intended to communicate connection and
caring. Although the study did not specifically evaluate
play-based learning in an educational setting, this article
was included due to the relevance of its findings regarding
enhancement of educational outcomes including spoken
language, reading, writing, and maths as a direct result of
play, as measured by the Young Children’s Achievement
Eight studies met the inclusion criteria. Four articles
were selected for individual critical appraisal on the basis
of their relevance to the clinical question, level of evidence
and recency (see Table 1). The level and strength of
evidence based on methodological rigour was assessed
independently by the first two authors using standardised
critical appraisal checklists tailored to speech pathology
and/or allied health evidence appropriate to each study
type (Joanna Briggs Institute, 2014; Schlosser et al., 2008).
An additional four studies (Miller & Almon, 2009; Van Oers &
Duijkers, 2012; Walsh, McGuinness, Sproule, & Trew, 2010;
Walsh, Sproule, McGuinness, & Trew, 2011), although
relevant to our question, were excluded on the basis of their
comparatively lower levels of evidence.
The strength of evidence for each article was rated using
Millar, Light, and Schlosser’s (2006) levels of certainty. Each
appraised article was rated as “preponderant” due to minor
flaws with respect to design, dependent variable reliability,
or treatment integrity (Millar et al., 2006). This strength of
evidence indicates that the outcomes were more likely than
not to have occurred as a result of the intervention (Millar
et al., 2006). The following is a summary of the critical
appraisal for each of the four selected articles.
Findings
The meta-analysis by Alfieri, Brooks, Aldrich, and
Tenenbaum (2011) directly compared two levels of play
(“unassisted discovery-learning” [free play] and “enhanced
discovery-learning” [guided play]) with explicit/didactic
teaching methods. This comparison provided useful insight
into different types of play-based learning and their effects
on educational outcomes including verbal/social skills,
Sarahlouise
White (top) and
Sue McAllister
Table 1. Summary of appraised articles, key findings, strength of evidence and levels of evidence
Source/title of evidence
Level of evidence (JBI, 2014)
and critical appraisal checklist
used
Strength of evidence
(Millar et al., 2006)
Key findings
Does discovery-based instruction
enhance learning? (Alfieri et al.,
2011)
Level 1
(Meta-analysis)
EVIDAAC rating scale for
systematic reviews (Schlosser et
al., 2008)
Preponderant
1
Unassisted discovery learning methods do
not benefit learners, whereas enhanced
discovery learning methods (including
feedback and scaffolded play) were found
to enhance learning outcomes.
Play therapy in elementary
schools: A best practice for
improving academic achievement.
(Blanco & Ray, 2011)
Level 2
(Randomised controlled trial)
JBI MAStARI: RCTs or non-
RCT group intervention studies
appraisal checklist (JBI, 2014)
Preponderant
Child centred play therapy (CCPT)
can significantly increase academic
achievement for 1st grade academically
at-risk children (compared to waitlist
control group).
Play, language and social skills
of children attending a play-
based curriculum school and a
traditionally structured classroom
curriculum school in low
socioeconomic areas. (Reynolds et
al., 2011)
Level 2
(Pre-test post-test quasi-
experimental/ observational cohort
study)
JBI MAStARI: cohort or case
control studies appraisal checklist
(JBI, 2014)
Preponderant
A play-based curriculum was more
effective than a traditionally structured
classroom curriculum in increasing
children’s play, social skills, and narrative
language.
End-of-phase 2, Report 4:
Outcomes for pupils over time
.
(Sproule et al., 2009)
Level 3
(Longitudinal cohort study)
JBI MAStARI: cohort or case
control studies appraisal checklist
(JBI, 2014)
Preponderant
Children participating in a play-based
curriculum had more positive attitudes
towards learning than children in
traditional classrooms. No long-term
differences in educational outcomes.
1
Preponderant: study had minor flaws with respect to: design, dependent variable reliability OR treatment integrity, e.g., “outcomes were more
likely than not to have occurred as a result of the intervention” (Millar et al., 2006, p. 251)