Using an App to monitor postoperative pain at home in pediatric patients

Utilizing Digital Tools for Self-Report Symptom Assessment and Management in Pediatric Oncology: A Systematic Review

CONTEXT

The evaluation of digital tools for measuring self-reported symptoms in children and adolescents undergoing cancer treatment is a critical area of research with significant implications for clinical practice and patient outcomes.

OBJECTIVE

This study aims to identify, evaluate, and summarize evidence on digital tools that enable self-reported symptom assessment and management for pediatric oncology patients.

METHODS

Seven academic databases, including PubMed, Cochrane Library, Scopus, Web of Science, CINAHL, and Medline (OVID), were searched systematically from inception until February 28, 2024. Inclusion criteria were the following: (a) study subjects were pediatric oncology patients and young adults, (b) using digital tools, (c) self-report symptom assessment and management, (d) employed either qualitative or quantitative study design, (e) written in English (f) published in peer-reviewed journals. This is a systematic review, and its protocol was registered in PROSPERO (ID: CRD42024528285). The study was conducted following the PRISMA statement.

RESULTS

Twenty-seven studies were included in this systematic review. All included studies were conducted to develop digital tools for assessing and managing the symptoms. Eight of these studies focused only on the pain; three were only for nausea and vomiting, one for nausea, and the other 15 for all symptoms. The studies' quality ranged from low to high, with overall scores ranging between 4 and 24 out of 28.

CONCLUSION

It shows that studies have generally focused on developing digital tools to address pain, nausea, vomiting, and other symptoms commonly experienced by pediatric oncology patients. While the quality of the included studies ranged from low to high, the overall findings show promise for the effectiveness and usability of these digital tools for symptom assessment and management in pediatric oncology care.

Identifying postoperative complications after inguinal hernia repair with a smartphone application: a comparative cohort study

PURPOSE

The Q1.6 Inguinal Hernia application continuously measures patient-reported outcomes (PROs) by sampling experiences through brief, digital and condition-specific questions, utilising micro-moments. This can overcome the limitations of current paper questionnaires and give real-time insight into patient recovery. This exploratory study compares data from the application with retrospective data from electronic medical records (EMRs) to provide information on its accuracy in detecting postoperative complications after inguinal hernia repair.

METHODS

Patients were asked to use the application in addition to their usual care. The application employs twitch crowdsourcing to gather PROs. Questions from validated and frequently used questionnaires were integrated. A retrospective assessment of EMRs was combined with an additional telephone interview. The primary endpoints were the sensitivity and specificity of the application in detecting chronic postoperative inguinal pain, recurrence and surgical-site infection (SSI).

RESULTS

A total of 215 patients were analysed. The sensitivity and specificity for detecting chronic postoperative inguinal pain were 100% (95% CI [47.8%, 100%]) and 93.7% (95% CI [88.3%, 97.1%]), respectively. For recurrence, the sensitivity was 77.8% (95% CI [40.0%, 97.2%]), and the specificity was 81.3% (95% CI [75.0%, 86.5%]). For SSI, the sensitivity and specificity were 75.0% (95% CI [19.4%, 99.4%]) and 89.8% (95% CI [84.8%, 93.6%]), respectively.

CONCLUSION

This study demonstrates satisfactory measurement capabilities of the Q1.6 Inguinal Hernia application for identifying postoperative complications following inguinal hernia repair. However, certain aspects require further improvement, such as addressing error-prone questions, enhancing long-term compliance, and validating (pain) measurements through prospective control data.

TRAIL REGISTRATION NUMBER

NL7813 (Dutch Trial Registry), 19 May 2019.

Digital health interventions for postoperative recovery in children: a systematic review

BACKGROUND

Digital health interventions offer a promising approach for monitoring during postoperative recovery. However, the effectiveness of these interventions remains poorly understood, particularly in children. The objective of this study was to assess the efficacy of digital health interventions for postoperative recovery in children.

METHODS

A systematic review was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, with the use of automation tools for searching and screening. We searched five electronic databases for randomised controlled trials or non-randomised studies of interventions that utilised digital health interventions to monitor postoperative recovery in children. The study quality was assessed using Cochrane Collaboration's Risk of Bias tools. The systematic review protocol was prospectively registered with PROSPERO (CRD42022351492).

RESULTS

The review included 16 studies involving 2728 participants from six countries. Tonsillectomy was the most common surgery and smartphone apps (WeChat) were the most commonly used digital health interventions. Digital health interventions resulted in significant improvements in parental knowledge about the child's condition and satisfaction regarding perioperative instructions (standard mean difference=2.16, 95% confidence interval 1.45-2.87; z=5.98, P<0.001; I2=88%). However, there was no significant effect on children's pain intensity (standard mean difference=0.09, 95% confidence interval -0.95 to 1.12; z=0.16, P=0.87; I2=98%).

CONCLUSIONS

Digital health interventions hold promise for improving parental postoperative knowledge and satisfaction. However, more research is needed for child-centric interventions with validated outcome measures. Future work should focus development and testing of user-friendly digital apps and wearables to ease the healthcare burden and improve outcomes for children.

SYSTEMATIC REVIEW PROTOCOL

PROSPERO (CRD42022351492).

'Do you feel well or unwell?' A study on children's experience of estimating their nausea using the digital tool PicPecc

Research with childhood cancer has progressed greatly in recent years, resulting in much improved treatment that is more intensive. However, with this new treatment children often experience negative symptoms, and research shows that nausea is a symptom that most affects them. Pictorial support in person-centred care for children (PicPecc) is a digital picture-based tool for children who undergo treatment due to their cancer diagnosis and helps them more effectively communicate and self-report their symptoms and emotions. The aim of the study was to investigate children's experience of (i) using mHealth in nausea management and (ii) their acceptability of using an application (App). Semi-structured interviews were conducted with eight children aged five to fifteen years. Data were analysed with qualitative content analysis. The findings were presented in three categories: 1) Communicating feelings, 2) Playfulness generated in motivation and 3) App adaptable to children's capabilities. Using an App contributed to new opportunities for the children to participate in their care. They experienced their treatment in different ways and used different strategies to manage and distract themselves from their symptoms. Using the PicPecc App can increase healthcare staff's understanding of how children experience nausea when they undergo chemotherapy.

Commentary: Pediatric Pain Measurement, Assessment, and Evaluation

PEDIATRIC PAIN MEASUREMENT, ASSESSMENT, AND EVALUATION

Renee C.B. Manworren, Jennifer Stinson Seminars in Pediatric Neurology Volume 23, Issue 3, August 2016, Pages 189-200 Assessment provides the foundation for diagnosis, selection of treatments, and evaluation of treatment effectiveness for pediatric patients with acute, recurrent, and chronic pain. Extensive research has resulted in the availability of a number of valid, reliable, and recommended tools for assessing children's pain. Yet, evidence suggests children's pain is still not optimally measured or treated. In this article, we provide an overview of pain evaluation for premature neonates to adolescents. The difference between pain assessment and measurement is highlighted; and the key steps to follow are identified. Information about self report and behavioral pain assessment tools appropriate for children are provided; and fac tors to be considered when choosing a specific 1 are outlined. Finally, we preview future approaches to personalized pain medicine in pediatrics that include harnessing the use of potential digital health technologies and genomics.