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Tsetlina V, Stanford RA, Syrkin G, Ibanez K. Steroid myopathy and rehabilitation in patients with cancer. PM R 2024; 16:908-918. [PMID: 38381659 DOI: 10.1002/pmrj.13133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2023] [Revised: 10/26/2023] [Accepted: 12/11/2023] [Indexed: 02/23/2024]
Abstract
Steroids are broadly used in oncology, despite known adverse events such as glucocorticosteroid-induced myopathy (SM). To date there are no accepted guidelines on the diagnosis and treatment of SM. The purpose of this review is to provide up-to-date information regarding SM with emphasis on neuro-oncology and hematopoietic stem cell transplant patients, given they are at high risk of experiencing SM following routine treatment with steroids. Our work is a combination of a comprehensive narrative review regarding etiology, pathogenesis, incidence, clinical presentation and treatment options for SM and a scoping review on exercise therapy for SM. We have identified 24 in vivo studies of different exercise modalities in the settings of glucocorticosteroid treatment. Twenty of 24 studies demonstrated decreased muscle catabolism with exercise training. Both endurance and resistance exercises at mild to moderate intensity were beneficial. The value of high-intensity activities remains questionable as it may worsen muscle atrophy. Rehabilitation interventions, along with pharmacologic and dietary considerations, may be beneficial in preventing or reversing SM. Potential adverse events of some of these interventions and expected caveats in translating findings in preclinical models to human settings warrant caution and demand controlled clinical studies.
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Affiliation(s)
- Vera Tsetlina
- Department of Rehabilitation and Regenerative Medicine, NewYork-Presbyterial Columbia Irving Medical Center, New York, New York, USA
| | - Ray A Stanford
- Physical Medicine and Rehabilitation Department, Phoenix Children's Hospital, Phoenix, Arizona, USA
| | - Grigory Syrkin
- Department of Neurology, Rehabilitation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Katarzyna Ibanez
- Department of Neurology, Rehabilitation Service, Memorial Sloan Kettering Cancer Center, New York, New York, USA
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Oncological Children and Well-Being: Occupational Performance and HRQOL Change after Fine Motor Skills Stimulation Activities. Pediatr Rep 2021; 13:383-400. [PMID: 34287368 PMCID: PMC8293420 DOI: 10.3390/pediatric13030046] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Revised: 05/24/2021] [Accepted: 06/29/2021] [Indexed: 11/30/2022] Open
Abstract
Cancer children experience long periods of hospitalization, which are associated with limited performance in several developmental domains and participation restrictions in age appropriate occupations. Fine motor abilities represent building blocks in performing daily life skills and have been found to be closely connected with later academic success. Moreover, medical and psychological sequelae for cancer inpatients may result in diminished daily activities functioning, poor perceived health related quality of life (HRQOL), and increase the likelihood of long-term impairments. This study examines the variations in the occupational performance of children hospitalized for acute lymphoblastic leukemia (ALL) after their participation to a stimulation program designed to enhance fine motor skills. Parents reported significant gains in children's motor functioning, a slight improvement in overall occupational performance related to an increase in the area of productivity and self-care, and a better quality of life perception following the stimulation activities. Feasibility of the stimulation program in a health care setting are discussed evaluating its benefits for cancer children and their families.
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Miranda Pereira M, Befi-Lopes DM, Soares AJC, Sassi FC, de Andrade CRF. Linguistic-Cognitive Outcomes in Children with Acute Lymphoid Leukemia: An Exploratory Study. J Multidiscip Healthc 2021; 14:1285-1295. [PMID: 34103929 PMCID: PMC8179787 DOI: 10.2147/jmdh.s313795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Accepted: 05/12/2021] [Indexed: 11/24/2022] Open
Abstract
Background Acute lymphoid leukemia (ALL) is the most prevalent cancer of childhood. Impairment in linguistic and memory skills is a possible late sequela in cancer survivors that can limit their quality of life and the overall performance of the individual in society. There is evidence that survivors of ALL treated exclusively with chemotherapy demonstrate significant differences in long-term linguistic and memory functions and also changes in neuroanatomical integrity. However, most studies described do not count on a speech-language pathologist in their team, which we consider important to discuss. Thus, the objective of the present study was to assess memory and vocabulary skills in the pediatric population diagnosed with acute lymphoid leukemia during chemotherapy treatment. Materials and Methods An observational cohort study was conducted over a 1.8-year period. Participants of this research were children diagnosed with ALL. All participants were assessed on their linguistic-cognitive skills (ie, vocabulary, short-term memory and lexical access). All data underwent statistical analyses. Results The results of the current study found no major significant difference in the linguistic-cognitive performance of children with ALL and their healthy controls. Regarding the linguistic variables, we believe that there should be a differentiation between the effects of the drugs and the effects of social communication skills on performance. Conclusion This first characterization of the linguistic-cognitive abilities of children with ALL did not identify differences between these children and their healthy peers, although we were able to identify variables regarding the multidisciplinary team and social communication that should be considered in future studies.
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Coombs A, Schilperoort H, Sargent B. The effect of exercise and motor interventions on physical activity and motor outcomes during and after medical intervention for children and adolescents with acute lymphoblastic leukemia: A systematic review. Crit Rev Oncol Hematol 2020; 152:103004. [PMID: 32580035 PMCID: PMC8359930 DOI: 10.1016/j.critrevonc.2020.103004] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 05/08/2020] [Accepted: 05/18/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Children with acute lymphoblastic leukemia (ALL) experience detrimental effects on motor function during and after chemotherapy. The objective of this systematic review was to evaluate the effect of exercise and motor interventions on physical activity and motor outcomes of children with ALL during and after chemotherapy. METHODS Ten databases were searched. Nineteen studies were included: 11 randomized clinical trials (RCT), 2 controlled clinical trials (CCT), and 6 cohort studies. RESULTS Participants included 508 children with ALL. Between-group results from RCTs and CCTs supported that exercise and motor intervention improved: fatigue during acute chemotherapy; physical activity, range of motion (ROM), strength, bone mineral density, aerobic capacity, and fatigue during maintenance chemotherapy; functional mobility, ROM, strength, and aerobic capacity during post-treatment survivorship; and participation, physical activity, ROM, strength, and coordination during multiple-phase interventions. CONCLUSION Low quality evidence supports the efficacy of motor and exercise interventions for children and adolescents with ALL.
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Affiliation(s)
- Alison Coombs
- Children's Hospital Los Angeles, Division of Pediatric Rehabilitation Medicine, 4650 Sunset Blvd., Los Angeles, CA, 90027, United States; University of Southern California, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles, CA, United States.
| | - Hannah Schilperoort
- University of Southern California, Norris Medical Library, Los Angeles, CA, United States
| | - Barbara Sargent
- University of Southern California, Division of Biokinesiology and Physical Therapy, Herman Ostrow School of Dentistry, Los Angeles, CA, United States
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Taverna L, Tremolada M, Tosetto B, Dozza L, Renata ZS. Impact of Psycho-Educational Activities on Visual-Motor Integration, Fine Motor Skills and Name Writing among First Graders: A Kinematic Pilot Study. CHILDREN-BASEL 2020; 7:children7040027. [PMID: 32252298 PMCID: PMC7231227 DOI: 10.3390/children7040027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Revised: 03/06/2020] [Accepted: 03/31/2020] [Indexed: 12/22/2022]
Abstract
This pilot study presents the effects on acquisition of pre-writing skills of educational activities targeting visual-motor integration and fine motor skills on a convenient sample of first graders. After a 10-week intervention program, visual perceptual skills and fine motor control were tested on 13 six-year-old aged children. Participants completed the Beery-Buktenica VMI and the manual dexterity scale of the Movement ABC-2 at baseline (T1), after the intervention program (T2), and one month after the end of the educational activities (T3). Children's writing pressure, frequency, and automaticity were measured using a digitizer during the administration of name writing test at T1, T2, and T3. The purpose of the study was to investigate changes in visual-perceptual abilities and fine motor skills after the intervention program and examine correlational effects on children's kinematic writing performances. Findings reveal that educational activities impacted positively on children's visual motor coordination component of writing improving VMI scores. No statistically significant difference was detected across the three time points on students' manual dexterity skills. Measurement of writing kinematics allows to report and document variations in children's writing during intervention. This pilot study discusses these findings and their implications for the field on early childhood acquisition of foundational skills for handwriting. It also proposes potential topics for future research on this field.
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Affiliation(s)
- Livia Taverna
- Faculty of Education, Free University of Bozen-Bolzano, 39042 Brixen-Bressanone, Italy; (L.D.); (Z.S.R.)
- Correspondence: ; Tel.: +39-0472014029
| | - Marta Tremolada
- Department of Development and Social Psychology and Department of Child and Woman Health, University of Padua, 35100 Padua, Italy;
- Department of Women and Child’s Health, Pediatric Hematology, Oncology and Stem Cell Transplant Center, University of Padua, 35100 Padua, Italy
| | - Barbara Tosetto
- Medical School for Health Professions, “Claudiana”, 39100 Bozen, Italy;
| | - Liliana Dozza
- Faculty of Education, Free University of Bozen-Bolzano, 39042 Brixen-Bressanone, Italy; (L.D.); (Z.S.R.)
| | - Zanin Scaratti Renata
- Faculty of Education, Free University of Bozen-Bolzano, 39042 Brixen-Bressanone, Italy; (L.D.); (Z.S.R.)
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Taverna L, Tremolada M, Dozza L, Zanin Scaratti R, Ulrike D, Lallo C, Tosetto B. Who Benefits from An Intervention Program on Foundational Skills for Handwriting Addressed to Kindergarten Children and First Graders? INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E2166. [PMID: 32214003 PMCID: PMC7142437 DOI: 10.3390/ijerph17062166] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/10/2020] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 01/01/2023]
Abstract
This study examined the effectiveness of a 10-wk intervention program based on occupational therapy principles on visual-motor integration skills and fine motor abilities in kindergartners and first graders. We recruited 55 students tested three times with the Visual-Motor Integration Test (VMI) and Movement Assessment Battery for Children-2 (MABC-2): before the intervention (T1), post-intervention (T2) and one month later (T3). Research findings: Significant improvements were found on VMI between T1 and T2, particularly for kindergartners. Neither group of children demonstrated changes on manual dexterity scores. The present study showed that the intervention program led to different changes in the at-risk of motor impairment group than in the not at-risk children. Results indicated that games and stimulation activities helped children below the 16th percentile over time in the manual dexterity domain. A gender effect was observed, with female children increasing their abilities over time more than male peers. Future research should concentrate on stimulating fine motor skills in hand manipulation and test how these abilities influence graphomotor skills and handwriting over time. Finally, more research is needed to determine the impact of activities and games carried out in educational settings.
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Affiliation(s)
- Livia Taverna
- Faculty of Education, Free University of Bozen-Bolzano, 39042 Brixen-Bressanone, Italy; (L.D.); (R.Z.S.)
| | - Marta Tremolada
- Department of Developmental Psychology and Socialization, University of Padua, 35100 Padua, Italy;
- Department of Women and Child’s Health, Pediatric Hematology, Oncology and Stem Cell Transplant Center, University of Padua, 35100 Padua, Italy
| | - Liliana Dozza
- Faculty of Education, Free University of Bozen-Bolzano, 39042 Brixen-Bressanone, Italy; (L.D.); (R.Z.S.)
| | - Renata Zanin Scaratti
- Faculty of Education, Free University of Bozen-Bolzano, 39042 Brixen-Bressanone, Italy; (L.D.); (R.Z.S.)
| | - Domahs Ulrike
- Institute for German Linguistics, University of Marburg, 35032 Marburg, Germany;
| | - Carlo Lallo
- Department of Law, University of Roma Tre, 00154 Rome, Italy;
| | - Barbara Tosetto
- Medical School for Health Professions “Claudiana”, 39100 Bozen, Italy;
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The Developmental Pathways of Preschool Children with Acute Lymphoblastic Leukemia: Communicative and Social Sequelae One Year after Treatment. CHILDREN-BASEL 2019; 6:children6080092. [PMID: 31412554 PMCID: PMC6721313 DOI: 10.3390/children6080092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Revised: 08/02/2019] [Accepted: 08/11/2019] [Indexed: 11/20/2022]
Abstract
Early childhood is considered to be a period of rapid development, with the acquisition of abilities predicting future positive school competences. Motor, cognitive, and social difficulties related to cancer therapies heavily impact the development of children with cancer. This study focused on two main aims: To assess the developmental pathways of preschool children with acute lymphoblastic leukemia one year post-treatment and to compare these abilities both with those of a control group of healthy peers and with Italian norms. Forty-four children and their families, recruited through the Hematology-Oncologic Clinic of the Department of Child and Woman Health (University of Padua), agreed to participate in this study. The children’s mean age was 4.52 years (SD = 0.94, range = 2.5–6 years), equally distributed by gender, all diagnosed with acute lymphoblastic leukemia. Matched healthy peers were recruited through pediatricians’ ambulatories. Each family was interviewed adopting the Vineland adaptive behavior scales. Paired sample Wilcoxon tests revealed that children were reported to have significantly more developmental difficulties than their healthy peers. When compared with Italian norms, they scored particularly low in verbal competence, social, and coping skills. No significant association was found between treatment variables and developmental abilities. These findings suggest that the creation of specialized interventions, both for parents and children, may fill the possible delays in children’s development probably due to stress, lack of adequate stimulation, or difficult adaptation.
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The Impact of Hematologic Cancer and Its Treatment on Physical Activity Level and Quality of Life Among Children in Mainland China. Cancer Nurs 2018; 42:492-500. [DOI: 10.1097/ncc.0000000000000661] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Meyer R, Bar-Yosef O, Barzilay E, Hoffman D, Toussia-Cohen S, Zvi E, Achiron R, Katorza E. Neurodevelopmental outcome of fetal isolated ventricular asymmetry without dilation: a cohort study. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:467-472. [PMID: 29607569 DOI: 10.1002/uog.19065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Revised: 02/10/2018] [Accepted: 03/23/2018] [Indexed: 06/08/2023]
Abstract
OBJECTIVE Fetal isolated ventricular asymmetry (IVA) is a relatively common finding in pregnancy, but data regarding its effect on neurodevelopmental outcome are scarce and founded principally on ultrasound-based studies. The purpose of this study was to assess the neurodevelopmental outcome of IVA cases in a magnetic resonance imaging (MRI)-based study. METHODS Cases referred for fetal brain MRI as part of the assessment of IVA without ventriculomegaly (lateral ventricular atrial diameter ≤ 10 mm), identified during routine ultrasound examination, were assessed for possible inclusion. Asymmetry was defined as a difference in width of ≥ 2 mm between the two lateral ventricles. Forty-three cases were included in the study group and compared with a control group of 94 normal cases without IVA. Children were assessed at ages 13-74 months using the Vineland-II Adaptive Behavior Scales (VABS-II). RESULTS VABS-II scores were within normal range. There was no significant difference in composite VABS-II score between the study and control groups (106.5 vs 108.0; P = 0.454). VABS-II scores did not differ between the groups when matched for gender and age at VABS-II interview (109.6 in study group vs 107.8 in control group; P = 0.690). CONCLUSION In cases of IVA without ventriculomegaly on MRI, neurodevelopmental test scores were normal and did not differ from cases without IVA. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- R Meyer
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - O Bar-Yosef
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
- Pediatric Neurology Unit, The Chaim Sheba Medical Center, Ramat-Gan, Israel
| | - E Barzilay
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - D Hoffman
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - S Toussia-Cohen
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - E Zvi
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - R Achiron
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
| | - E Katorza
- Department of Obstetrics and Gynecology, The Chaim Sheba Medical Center, Ramat-Gan, Israel
- Sackler School of Medicine, Tel Aviv University, Tel Aviv-Yafo, Israel
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Tremolada M, Bonichini S, Basso G, Pillon M. Adolescent and young adult cancer survivors narrate their stories: Predictive model of their personal growth and their follow-up acceptance. Eur J Oncol Nurs 2018; 36:119-128. [PMID: 30322502 DOI: 10.1016/j.ejon.2018.09.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2016] [Revised: 09/07/2018] [Accepted: 09/09/2018] [Indexed: 01/22/2023]
Abstract
PURPOSE Few studies have captured the unique ways in which cancer affects the growth and development of adolescent and young adult cancer survivors. This paper illustrates the daily life of childhood cancer survivors who are now adolescents and young adults, their post-traumatic growth and follow-up perceptions, adopting a narrative approach. METHODS One thousand adolescent and young adult cancer survivors, mean age at diagnosis being 9.26 years old (SD = 4.29) and current mean age of 19.28 (SD = 2.96), were interviewed in depth using a new version of Ecocultural Family Interview-Cancer (EFI-C), which has proved to be a psychometrically reliable instrument. RESULTS Post-traumatic growth was predicted directly by age at diagnosis and, indirectly, by the mediation of the health medical staff-patient relationship during the illness, hospitalization memories, and patient's narrating skills. Positive feelings towards follow-up visits were predicted by the health staff-patient relationship during the illness (Chi-Square = 2.87; df = 3, p-value = 0.41; RMSEA = 0.0001). CONCLUSION Adolescent and young adult cancer survivors who were older and had established strong relationships with health professionals at the clinic were more able to narrate their experiences, display a positive comprehension of the events with a pragmatic acceptance of the follow-up procedures. Relationships with health professionals should therefore be monitored and improved, both during the cancer treatment and in the off-therapy period. The narrative technique allows adolescent and young adult cancer survivors to reorganize and give shape to their traumatic experience.
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Affiliation(s)
- Marta Tremolada
- Department of Developmental and Social Psychology, University of Padua, Italy.
| | - Sabrina Bonichini
- Department of Developmental and Social Psychology, University of Padua, Italy.
| | - Giuseppe Basso
- Department of Child and Woman's Health, Oncology Hematology Division, University Hospital of Padua, Italy.
| | - Marta Pillon
- Department of Child and Woman's Health, Oncology Hematology Division, University Hospital of Padua, Italy.
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Tremolada M, Bonichini S, Taverna L, Basso G, Pillon M. Health-related quality of life in AYA cancer survivors who underwent HSCT compared with healthy peers. Eur J Cancer Care (Engl) 2018; 27:e12878. [DOI: 10.1111/ecc.12878] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2017] [Revised: 03/16/2018] [Accepted: 06/08/2018] [Indexed: 12/20/2022]
Affiliation(s)
- Marta Tremolada
- Department of Developmental and Social Psychology; University of Padua; Padua Italy
| | - Sabrina Bonichini
- Department of Developmental and Social Psychology; University of Padua; Padua Italy
| | - Livia Taverna
- Faculty of Education; Free University of Bozen-Bolzano; Brixen-Bressanone Italy
| | - Giuseppe Basso
- Department of Child and Woman's Health, Oncology Hematology Division; University Hospital of Padua; Padua Italy
| | - Marta Pillon
- Department of Child and Woman's Health, Oncology Hematology Division; University Hospital of Padua; Padua Italy
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Wong CL, Ip WY, Kwok BMC, Choi KC, Ng BKW, Chan CWH. Effects of therapeutic play on children undergoing cast-removal procedures: a randomised controlled trial. BMJ Open 2018; 8:e021071. [PMID: 29980545 PMCID: PMC6042539 DOI: 10.1136/bmjopen-2017-021071] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To examine (1) the effectiveness of therapeutic play in reducing anxiety and negative emotional manifestations among children undergoing cast-removal procedures and (2) the satisfaction of parents and cast technicians with cast-removal procedures. DESIGN A randomised controlled trial. SETTING An orthopaedic outpatient department of a regional teaching hospital in Hong Kong. PARTICIPANTS Children (n=208) aged 3-12 undergoing cast-removal procedure were invited to participate. INTERVENTIONS Eligible children were randomly allocated to either the intervention (n=103) or control group (n=105) and stratified by the two age groups (3-7 and 8-12 years). The intervention group received therapeutic play intervention, whereas the control group received standard care only. Participants were assessed on three occasions: before, during and after completion of the cast-removal procedure. OUTCOME MEASURES Children's anxiety level, emotional manifestation and heart rate. The satisfaction ratings of parents and cast technicians with respect to therapeutic play intervention were also examined. RESULTS Findings suggested that therapeutic play assists children aged 3-7 to reduce anxiety levels with mean differences between the intervention and control group was -20.1 (95% CI -35.3 to -4.9; p=0.01). Overall, children (aged 3-7 and 8-12) in the intervention groups exhibited fewer negative emotional manifestations than the control group with a mean score difference -2.2 (95% CI -3.1 to -1.4; p<0.001). Parents and technicians in the intervention group also reported a higher level of satisfaction with the procedures than the control group with a mean score difference of 4.0 (95% CI -5.6 to 2.3; p<0.001) and 2.6 (95% CI 3.7 to 1.6; p<0.001), respectively. CONCLUSION Therapeutic play effectively reduces anxiety and negative emotional manifestations among children undergoing cast-removal procedures. The findings highlight the importance of integrating therapeutic play into standard care, in particular for children in younger age. TRIAL REGISTRATION NUMBER ChiCTR-IOR-15006822; Pre-results.
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Affiliation(s)
- Cho Lee Wong
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Wan Yim Ip
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Kai Chow Choi
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
| | - Bobby King Wah Ng
- Faculty of Medicine, Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong, China
| | - Carmen Wing Han Chan
- Faculty of Medicine, The Nethersole School of Nursing, The Chinese University of Hong Kong, Hong Kong, China
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