An Examination of a Yoga Intervention With Pediatric Burn Survivors:

"It's a big trauma for the family": A qualitative insight into the psychological trauma of paediatric burns from the perspective of mothers

BACKGROUND

Despite the medical and surgical improvements of paediatric burn injuries, burn injuries can be a painful and traumatic experience for the child and their family. It is therefore important to explore the experiences of caregivers who support their child throughout the burn journey. Thus, the purpose of this study was to explore the traumatic nature of paediatric burns on the family from a caregiver's perspective.

METHODS

This study used a descriptive qualitative approach to conduct online semi-structured interviews with caregivers (18 years and older) of children (aged four to 17 years) that had previously been admitted with an unintentional acute burn injury to a paediatric burns unit in Western Australia. Interviews explored the child's and caregiver's experiences throughout the burn journey from the perspective of the caregiver and were digitally recorded and transcribed verbatim. Transcripts were analysed using Braun and Clarke's six stages of reflexive thematic analysis.

RESULTS

Eleven mothers participated in the interviews and identified a range of poor psychological and psychosocial outcomes that themselves and their child experienced. Three overarching themes were elaborated from the interviews: Child and caregiver mental health difficulties during and after the burn (including medical trauma, mental health outcomes and caregiver guilt); Lifestyle and physical changes following the burn (including disruptions to routine, appearance concerns and puberty); and factors supporting or inhibiting the recovery journey (including personality factors, coping strategies, family dynamics and support).

FINAL CONSIDERATIONS

This study has presented the difficulties that children, young people, and their family face throughout a paediatric burn injury, which makes the implementation of timely and effective family centred interventions imperative. Meeting the needs and supporting these families with their mental health throughout this traumatic recovery journey, can ensure positive psychosocial outcomes and adaptive coping strategies are adopted early on.

Psychosocial Interventions for Children and Young People With Visible Differences Resulting From Appearance-Altering Conditions, Injury, or Treatment Effects: An Updated Systematic Review

OBJECTIVE

Children and young people with visible differences can experience psychosocial difficulties, such as anxiety and teasing by others. Interventions targeting difficulties have previously been reviewed by Jenkinson et al. This review aimed to identify and critically assess recent studies evaluating the effectiveness of psychosocial interventions for children and young people with visible differences on psychosocial wellbeing, self-esteem, and social experiences and compare the findings with Jenkinson et al. using a replacement review process.

METHODS

Inclusion criteria are as follows: studies with participants aged 0-18 years with visible differences; investigating a psychosocial intervention; including comparison with an alternative intervention, control group, or pre- and post-intervention; and including a quantitative measure assessed pre- and post-intervention. Exclusion criteria are as follows: participants with body dysmorphic disorder or appearance changes due to eating disorders or obesity and studies not written in English. MEDLINE, AMED, and PsycInfo were searched and grey literature was included. Results were reviewed against eligibility criteria, data were extracted, and studies were evaluated using the Cochrane Risk of Bias 2 tool.

RESULTS

Using Jenkinson et al. as one source of studies, 24 studies were included evaluating a range of interventions such as social interaction skills training, residential social camps, and cognitive behavioral therapy. Risk of bias was high in 20 studies and of some concern in four studies.

CONCLUSION

There is some evidence of the effectiveness of hypnotherapy, a relaxation response resiliency program, integrative body-mind-spirit group, and therapeutic patient education, but more rigorous research is needed to confirm their impact on psychosocial outcomes.

Adjunctive Nonpharmacologic Interventions for the Management of Burn Pain: A Systematic Review

BACKGROUND

The conventional way of treating burn victims with mainstream pain control modalities is costly and has many negative side effects. In this study, the authors aim to present the findings from the major clinical trials on three nonpharmacologic interventions-hypnosis, virtual/augmented reality, and yoga-as supplements to conventional pain regimens for burn management.

METHODS

A computerized literature search was conducted of the PubMed and ClinicalTrials.gov databases in April of 2020. The online screening process was performed by two independent reviewers with the Covidence tool. The protocol was reported using the Preferred Reporting Items for Systematic Review and Meta-Analyses, and it was registered at the International Prospective Register of Systematic Reviews of the National Institute for Health Research.

RESULTS

The search yielded 254 articles from 1955 to 2020. Fifty-eight studies met the authors' inclusion criteria. Yoga reduced cognitive and somatic anxiety in burn survivors, and improved body image. Virtual reality is effective in pain reduction in both the pediatric and the adult burn population, and in faster burn wound reepithelialization. Hypnosis has similar results regarding reducing pain quality and anxiety in burn patients undergoing burn wound care and dressing changes but was not found to significantly accelerate the healing process.

CONCLUSIONS

Nonpharmacologic interventions are not a substitute for conventional analgesics; however, they could help patients have better control over their pain, greater self-esteem, and less postburn traumatic experiences. Burn care centers should consider nonpharmacologic interventions to improve patient satisfaction and their participation in the treatment and rehabilitation process.

The psychological impact of paediatric burn injuries: a systematic review

OBJECTIVE

To review and synthesise qualitative literature regarding the psychological outcomes following paediatric burn injuries, and to determine if children and adolescents who experience a burn injury have elevated risk of psychopathology following the injury.

DESIGN

Systematic review of quantitative and qualitative studies.

DATA SOURCES

Informit health, Medline, Embase, and PsycINFO were searched from January 2010 to December 2020.

DATA EXTRACTION AND SYNTHESIS

Two reviewers screened articles, and one reviewer extracted data (with cross-checking from another reviewer) from the included studies and assessed quality using an established tool. Narrative synthesis was used to synthesise the findings from the quantitative studies, and thematic synthesis was used to synthesise the findings of included qualitative studies.

RESULTS

Searches yielded 1240 unique titles, with 130 retained for full-text screening. Forty-five studies from 17 countries were included. The psychological outcomes included in the studies were mental health diagnoses, medication for mental illness, depression, anxiety, stress, fear, post-traumatic stress, post-traumatic growth, emotional issues, self-harm, self-esteem, self-concept, stigmatisation, quality of life, level of disability, resilience, coping, and suicidality.

CONCLUSIONS

Our findings highlight paediatric burn patients as a particularly vulnerable population following a burn injury. Studies suggest elevated anxiety and traumatic stress symptoms, and higher rates of psychopathology in the long-term. Further research is recommended to determine the psychological outcomes in the other mental health domains highlighted in this review, as findings were mixed. Clinical care teams responsible for the aftercare of burn patients should involve psychological support for the children and families to improve outcomes.

Rehabilitation Exercise Increases Physical Activity Levels in Severely Burned Children While Improving Aerobic Exercise Capacity and Strength

This study tested the hypothesis that participation in a rehabilitation exercise program following hospital discharge would increase the level of physical activity in burned children than that seen in free-living nonburned children. Thirty-one severely burned children (12 ± 3 years, 144 ± 18 cm, 42 ± 17 kg, 48 ± 12% TBSA burns) were matched to 31 nonburned children (12 ± 3 y, 147 ± 17 cm, 45 ± 15 kg) based on age and sex. Pedometers were used to track minutes and steps in burned children during their exercise rehabilitation and nonburned children under free-living conditions (healthy control). We found that the average minutes of activity per day was lower in burned children (56 ± 25minutes) than in nonburned children (74 ± 28 minutes, P < .05). However, no difference was detected for average steps per day or week or maximal minutes in 1 day or week. At discharge, burn children had peak torque and mean power values that were 61% of nonburned values, and exercise training improved these by 27 and 28%, respectively (88 and 89% of nonburned values; each P ≤ .0001). Likewise, cardiorespiratory fitness at discharge was 72% of nonburned values, and exercise training improved fitness by 10% (82% of nonburned values, P < .05). Percentage TBSA burned was inversely associated with steps (r = -0.54, P = .001) and minutes of activity (r = -0.53, P = .002), accounting for 28-29% of the variability in burned children. These results show that, at discharge, burned children are capable of matching steps of physical activity levels seen in nonburned healthy children. Physical activity monitoring may be a viable option for continued improvement of physical exercise capacity when burned children are under free-living conditions.

Yoga as an Intervention for the Reduction of Symptoms of Anxiety and Depression in Children and Adolescents: A Systematic Review

Purpose: The purpose of this review is to evaluate the implementation and effectiveness of yoga for the reduction of symptoms of anxiety and depression in youth. To our knowledge, there are no systematic reviews to date looking at the reduction of symptoms of both anxiety and depression. Methods: Numerous scientific databases were searched up to November 2018 for experimental studies assessing changes in symptoms of anxiety and/or depression in youths following yoga interventions. Quality and level of evidence were assessed, and information was synthesized across studies. Results: Twenty-seven studies involving youth with varying health statuses were reviewed. Intervention characteristics varied greatly across studies revealing multiple factors that may impact intervention efficacy, however 70% of the studies overall showed improvements. For studies assessing anxiety and depression, 58% showed reductions in both symptoms, while 25% showed reductions in anxiety only. Additionally, 70% of studies assessing anxiety alone showed improvements and 40% of studies only assessing depression showed improvements. Conclusion: The studies reviewed, while of weak to moderate methodological quality, showed that yoga, defined by the practice of postures, generally leads to some reductions in anxiety and depression in youth regardless of health status and intervention characteristics.