Association of medical play therapy with psychological resilience during chemotherapy in children with malignant lymphoma: a propensity score-weighted retrospective cohort study.
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Medical play therapy (MPT) prepares children for medical procedures, but its association with psychological resilience during chemotherapy is unknown. This retrospective cohort included children aged 4-17 years with lymphoma treated at a Chinese tertiary children's hospital in 2019-2023. Children receiving nurse-delivered MPT during an index chemotherapy cycle were compared with those receiving usual care. The primary outcome was the end-of-cycle Connor-Davidson Resilience Scale (CD-RISC) score; secondary outcomes included quality of life, procedural distress, emotional stabilization time, nursing adherence and length of stay. Analyses used overlap weighting on 12 baseline covariates with baseline CD-RISC adjustment, sensitivity analyses and E-values. Of 231 children, 103 received MPT and 128 usual care. MPT was associated with a higher follow-up CD-RISC score (adjusted difference, 5.03 points; 95% CI, 2.29 to 7.76; standardized difference, 0.40). The estimate was similar in children who self-completed the scale (5.49 points; 95% CI, 1.71 to 9.27); the E-value was 2.22. MPT was also associated with better quality of life (4.06 points; 95% CI, 1.48 to 6.64), lower procedural distress (-1.04 points; 95% CI, -1.46 to -0.62), shorter stabilization time (ratio of means, 0.81; 95% CI, 0.70 to 0.93) and more frequent good adherence (risk ratio, 1.29; 95% CI, 1.05 to 1.58), but not with length of stay. In this single-center cohort, MPT was associated with modestly higher resilience during a chemotherapy cycle. Because outcomes were assessed without blinding and residual confounding is possible, prospective controlled studies are needed before MPT is recommended to support resilience.