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Sharpe L, Rooney T, Todd J, Michalski SC, Van Ryckeghem D, Crombez G, Colagiuri B. Attentional Processes in Pain: The Importance of Context and Attentional Alignment. THE JOURNAL OF PAIN 2024:104600. [PMID: 38866122 DOI: 10.1016/j.jpain.2024.104600] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 05/30/2024] [Accepted: 06/04/2024] [Indexed: 06/14/2024]
Abstract
The attentional bias literature has consistently failed to take context into account. We developed a novel paradigm in immersive virtual reality (VR) with pain stimuli where it would be adaptive or nonadaptive to attend to the stimuli. Participants had to indicate the location of the stimuli. Seventy participants were recruited. The VR-attention task assessed overall attentional bias (the tendency to prioritize pain compared with nonpain stimuli) and attentional alignment (the tendency to attend to pain more in adaptive than nonadaptive situations). Pain tolerance and threshold were measured using electrocutaneous stimulation and thermal pain. We conducted 2 (context: adaptive vs nonadaptive) × 2 (congruence: congruent vs incongruent) Analysis of Covariance, controlling for threat. Participants responded to pain probes more quickly in adaptive than nonadaptive contexts. There was an overall bias away from pain-related stimuli (avoidance) in reaction time to the target. There was also an interaction where avoidance was greater in nonadaptive contexts, indicative of attentional alignment. For gaze behavior, both attentional alignment and attentional bias were observed for latency to first fixation on the target, such that participants showed vigilance for pain particularly in the adaptive context. Attentional alignment was correlated with threshold and tolerance from electrocutaneous stimulation but not thermal pain. In conclusion, we found overall attentional biases indicating vigilance (latency to first fixation) and avoidance (response to target). We also found that participants evidenced a pattern of attention favoring adaptive over nonadaptive contexts (attentional alignment). It was attentional alignment, but not overall attentional bias, that predicted pain tolerance and threshold. PERSPECTIVE: The study explored attentional processes in pain through a novel paradigm designed in VR. The results found that positive attentional alignment, or the tendency to attend to pain more in adaptive contexts rather than nonadaptive contexts, predicted pain outcomes.
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Affiliation(s)
- Louise Sharpe
- School of Psychology A18, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia.
| | - Tessa Rooney
- School of Psychology A18, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Jemma Todd
- School of Psychology A18, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Stefan Carlo Michalski
- School of Psychology A18, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
| | - Dimitri Van Ryckeghem
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium; Department of Clinical Psychological Science, Maastricht University, Maastricht, The Netherlands; Department of Behavioural and Cognitive Sciences, University of Luxembourg, Esch-sur-Alzette, Luxembourg
| | - Geert Crombez
- Department of Experimental-Clinical and Health Psychology, Ghent University, Ghent, Belgium
| | - Ben Colagiuri
- School of Psychology A18, Faculty of Science, The University of Sydney, Sydney, New South Wales, Australia
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Antonovics E, Boitsios G, Saliba T. Use of virtual reality in children in a broad range of medical settings: a systematic narrative review of recent meta-analyses. Clin Exp Pediatr 2024; 67:274-282. [PMID: 38772412 DOI: 10.3345/cep.2023.00388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 08/01/2023] [Indexed: 05/23/2024] Open
Abstract
Virtual reality (VR) is an emerging method that can be used in many scenarios involving children. VR has been increasingly studied as it has become cheaper, more widely available, and of better quality. In this review of current meta-analyses on the use of VR in children in the medical setting, we examined its role in 5 broad settings where it is used to alleviate pain and anxiety as well as in therapeutic scenarios. The study scope was purposefully broad to highlight a wide range of cases. We searched the ScienceDirect, SpringerLink, Cochrane Library, PubMed, and PMC databases for meta-analyses using VR in pediatric populations in medical settings. The National Institutes of Health quality assessment tool and Quality of Reporting of Meta-analyses statement checklist were used to verify study quality. Six hundred fifty-three articles were retrieved; after the application of the inclusion and exclusion criteria, 11 remained. These meta-analyses included cerebral palsy (4 meta-analyses), attention deficit/hyperactivity disorder (2 meta-analyses), burn care (1 meta-analysis), preoperative anxiety (2 meta-analyses), and needle-involving procedures (2 meta-analyses). The meta-analyses showed broadly positive results, with VR being useful in the areas in which it was applied. This study had several limitations. The meta-analyses consistently highlighted a high level of heterogeneity, making it challenging to draw clear conclusions. Most meta-analyses across all fields yielded encouraging results. However, further studies are required to confirm these findings. Guidelines must be established for future experiments to provide a standard and uniform procedure for reducing the heterogeneity of experimental methods.
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Affiliation(s)
- Emily Antonovics
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
| | | | - Thomas Saliba
- Hôpital Universitaire des Enfants Reine Fabiola, Brussels, Belgium
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Olaizola S, Lalloo C, Vickers V, Kelenc L, Tariq S, Brown SC, Stinson JN. Art Therapy for Paediatric Pain: A Scoping Review. CHILDREN (BASEL, SWITZERLAND) 2024; 11:619. [PMID: 38929199 PMCID: PMC11202121 DOI: 10.3390/children11060619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/19/2024] [Revised: 05/08/2024] [Accepted: 05/17/2024] [Indexed: 06/28/2024]
Abstract
Pain is common in paediatric populations and is best treated with a multi-disciplinary approach. Art therapy interventions are gaining popularity in paediatrics; however, there is limited evidence on its impact on pain outcomes in children and adolescents. The objective of this scoping review is to map current research on art therapy's impact as an intervention in paediatric populations experiencing any type of pain (i.e., acute, recurrent, and chronic). Electronic searches were conducted by a medical librarian to identify studies that used art therapy interventions in paediatric populations with pain as an outcome measure. Four reviewers independently screened and selected articles for extraction using Covidence and data were extracted from articles using study objectives. There were five studies that met the inclusion criteria. Four of the five studies reported on pain intensity and all studies reported on emotional functioning. Findings suggest art therapy interventions can be helpful for reducing pain, anxiety, stress, and fear associated with treatment. Further, there is emerging evidence that art therapy can support the management of acute and procedural pain in children. Future research should examine the impacts of integrating art therapy interventions into the multidisciplinary management of paediatric pain.
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Affiliation(s)
- Sofia Olaizola
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, 686 Bay St., Toronto, ON M5G0A4, Canada; (S.O.); (C.L.)
| | - Chitra Lalloo
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, 686 Bay St., Toronto, ON M5G0A4, Canada; (S.O.); (C.L.)
| | - Victoria Vickers
- Toronto Art Therapy Institute, 8 Prince Arthur Ave., M5R 1A9, Toronto, ON M5R 1A9, Canada
| | - Lauren Kelenc
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, 686 Bay St., Toronto, ON M5G0A4, Canada; (S.O.); (C.L.)
| | - Sakib Tariq
- St. George’s University of London, Cranmer Terrace, London SW17 0RE, UK
| | - Stephen C. Brown
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 170 Elizabeth St., Toronto, ON M5G 1E8, Canada;
- Anesthesiology and Pain Medicine, University of Toronto, 123 Edward St., Toronto, ON M5G 1E2, Canada
| | - Jennifer N. Stinson
- Child Health Evaluative Sciences, SickKids Research Institute, The Hospital for Sick Children, 686 Bay St., Toronto, ON M5G0A4, Canada; (S.O.); (C.L.)
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College St. Rapid Prototype Centre, Toronto, ON M5T 1P8, Canada
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Huhtala S, Palomaa AK, Tuomikoski AM, Pölkki T. Effectiveness of distraction-based interventions for relieving anxiety, fear, and pain in hospitalized children during venous blood sampling: a systematic review protocol. JBI Evid Synth 2024; 22:889-895. [PMID: 37921627 PMCID: PMC11081472 DOI: 10.11124/jbies-22-00057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023]
Abstract
OBJECTIVE The aim of this review is to evaluate the effectiveness of active compared with passive distraction-based interventions for relieving anxiety, fear, and pain in hospitalized preschool and school-age children during venous blood sampling. INTRODUCTION Venous blood sampling remains the most common procedure that causes anxiety, fear, and pain among the pediatric population. It is important that health care professionals relieve a child's pain and the related emotions because untreated pain may have long-term effects on children's growth and development. It is necessary to determine which interventions are effective in relieving these outcomes in preschool and school-age children during blood sampling. INCLUSION CRITERIA This review will include randomized controlled trials and quasi-experimental studies that include active and passive distraction-based interventions for relieving hospitalized preschool and school-age children's anxiety, fear, and pain during venous blood sampling. METHODS CINAHL, PubMed, Scopus, and the Cochrane Library databases will be searched for published studies. MedNar, Google Scholar, and PsycEXTRA databases will be searched for in-progress and unpublished studies. Two independent researchers will perform critical appraisal and data extraction using the JBI methodology. Data describing randomized controlled trials and quasi-experimental studies will be pooled in a statistical meta-analysis. If statistical analysis is not possible, the findings will be reported narratively. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach will be used to assess certainty in the quality of evidence. REVIEW REGISTRATION PROSPERO CRD42023455617.
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Affiliation(s)
- Saija Huhtala
- Kajaani University of Applied Sciences, Kajaani, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
| | - Anna-Kaija Palomaa
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Anna-Maria Tuomikoski
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Nursing Research Foundation, Helsinki, Finland
| | - Tarja Pölkki
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Medical Research Center Oulu, University Hospital and University of Oulu, Oulu, Finland
- Finnish Centre for Evidence-Based Health Care: A JBI Centre of Excellence, Nursing Research Foundation, Helsinki, Finland
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Taşçı Ö, Özer N, Çoğaltay N. The Effect of Virtual Reality Application on Pain During Wound Care Dressing Change: A Systematic Review and Meta-analysis of Randomized Controlled Trials. Pain Manag Nurs 2024; 25:e99-e107. [PMID: 38092603 DOI: 10.1016/j.pmn.2023.11.008] [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: 06/07/2023] [Revised: 10/18/2023] [Accepted: 11/13/2023] [Indexed: 04/16/2024]
Abstract
OBJECTIVE To evaluate the effect of virtual reality application on pain during a wound care dressing change. DESIGN Systematic review and meta-analysis DATA SOURCES: PubMed, Cochrane Central Register of Controlled Trials, Web of Science, CINAHL (EBSCOhost), and YÖKTEZ REVIEW/ANALYSIS METHODS: The last screening of all databases was performed on 20.07.2022. Parallel-group RCTs suitable for the research subject were included in the study. The "Cochrane risk-of-bias tool" was used to measure the risk of bias. A heterogeneity test was done with the I2 value and the p value for the Q statistics. Five methods were employed to assess publication bias. Sensitivity analysis was performed for studies with a high risk of bias. RESULTS As a result of the screening, 13 RCTs involving 882 wound care patients were included in the study. It was determined that the virtual reality application reduced pain moderately during a wound care dressing change (SMD= -0.60; 95% CI= -0.73 and -0.46; p < .001). The fixed effect model was used because the value of heterogeneity (I2 = 0%, p = 0.796) was low in the analysis. No significant results were obtained in the moderator analysis. CONCLUSION It was found that the virtual reality application moderately reduced pain during a wound dressing change and was a reliable application. However, it was suggested that the virtual reality application alone was insufficient to reduce pain during wound care and should be applied together with analgesic or anesthetic drugs included in the standard wound care procedure.
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Affiliation(s)
- Ömer Taşçı
- From the Muş Alparslan University, Faculty of Health Sciences, Department of Nursing, Muş, Turkey.
| | - Nadiye Özer
- Ataturk University, Faculty of Nursing, Surgical Nursing Department, Erzurum, Turkey
| | - Nazım Çoğaltay
- Siirt University, Faculty of Education, Department of Educational Science, Siirt, Turkey
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Oulton K, Williams A, Gibson F. Acceptability of a novel device to improve child patient experience during venepuncture for blood sampling: Intervention with 'MyShield'. J Child Health Care 2024; 28:53-68. [PMID: 35544716 DOI: 10.1177/13674935221098297] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study aimed to explore the acceptability of a novel device ('MyShield'): a device used for distraction during clinical procedures. It is a cardboard cuff, designed to fit around the arm, either above the elbow or around the wrist and used to hide the procedure from view. This device was tested in practice, to establish acceptability to children, parents and clinical staff. Fifty-eight children tried 'MyShield' during a venepuncture procedure. Feedback from 54 children, 58 parents/carers and 16 clinical staff was collected using surveys and interviews. In 24 cases, observational data were also collected. A large majority of children (94%, n = 51) and parents (96%, n = 56) reported a positive experience when using 'MyShield'; saying they would likely use it again. Potential of 'MyShield' in promoting parent/clinician interaction with the child was highlighted. Data suggests that 'MyShield' may be a useful device for children undergoing venepuncture, when used in conjunction with standard care, and subject to individual preferences and choice. Further work is required to establish mechanism of action and whether use of 'MyShield' has any impact across a range of short- and long-term outcome measures relating to patient experience and effectiveness.
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Affiliation(s)
- Kate Oulton
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
| | | | - Faith Gibson
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability (ORCHID), Great Ormond Street Hospital for Children, NHS Foundation Trust, Great Ormond Street, London, UK
- School of Health Sciences, Faculty of Health and Medical Sciences, University of Surrey, Surrey, UK
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Wols A, Pingel M, Lichtwarck-Aschoff A, Granic I. Effectiveness of applied and casual games for young people's mental health: A systematic review of randomised controlled studies. Clin Psychol Rev 2024; 108:102396. [PMID: 38320420 DOI: 10.1016/j.cpr.2024.102396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 01/24/2024] [Accepted: 01/29/2024] [Indexed: 02/08/2024]
Abstract
Many youth experience mental health problems and digital games hold potential as mental health interventions. This systematic review provides an overview of randomised controlled studies assessing the effectiveness of digital applied and casual games for improving mental health in youth aged 6-24 years. A systematic search of PsycINFO, Web of Science and Pubmed yielded 145 eligible studies. Studies on (sub)clinical participant samples (n = 75) most often focused on attention-deficit/hyperactivity disorder (ADHD), autism and anxiety. Applied games were found most effective for improving social skills, verbal memory and anxiety, whereas casual games were found most effective for improving depression, anxiety and ADHD. Studies involving healthy youth (n = 70) were grouped into papers examining anxiety in medical settings, momentary effects on positive and negative affect, and papers employing a longitudinal design measuring mental health trait outcomes. Promising results were found for the use of games as distraction tools in medical settings, and for applied and casual games for improving momentary affect. Overall, our findings demonstrate the potential of digital games for improving mental health. Implications and recommendations for future research are discussed, such as developing evaluation guidelines, clearly defining applied games, harmonising outcome measures, including positive outcomes, and examining nonspecific factors that may influence symptom improvement as well.
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Affiliation(s)
- Aniek Wols
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands.
| | - Michelle Pingel
- Radboud University, Behavioural Science Institute, Nijmegen, the Netherlands
| | - Anna Lichtwarck-Aschoff
- Rijksuniversiteit Groningen, Department of Pedagogical & Educational Sciences, Groningen, the Netherlands
| | - Isabela Granic
- McMaster University, Health, Aging & Society, Hamilton, Ontario, Canada
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Utsumi S, Maiko S, Moriwaki T, Miyake H, Yuhei S, Kubota S, Uematsu S, Takehara K, Kubota M. Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure. Hosp Pediatr 2024; 14:e123-e131. [PMID: 38273770 DOI: 10.1542/hpeds.2023-007322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2024]
Abstract
CONTEXT Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers. OBJECTIVES We aimed to assess the benefits of NPD to medical providers. DATA SOURCES We searched 5 databases for relevant articles. STUDY SELECTION Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included. DATA EXTRACTION Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy. RESULTS We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff. CONCLUSIONS Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.
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Affiliation(s)
- Shu Utsumi
- Division of Emergency and Transport Services
| | | | | | - Hiromu Miyake
- Department of Pediatric Surgery, Shizuoka Children's Hospital, Shizuoka, Japan
| | - Shimada Yuhei
- School of Public Health, Department of Medicine, the University of Tokyo, Tokyo, Japan
| | - Shoko Kubota
- School of Public Health, Department of Medicine, the University of Tokyo, Tokyo, Japan
| | | | | | - Mitsuru Kubota
- General Medicine and Interdisciplinary Medicine, National Center for Child Health and Development, Tokyo, Japan
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Son S, Yoo BR, Jeong YM. Digital therapeutics-based lumbar core exercise for patients with low back pain: A prospective exploratory pilot study. Digit Health 2024; 10:20552076231218154. [PMID: 38205039 PMCID: PMC10777809 DOI: 10.1177/20552076231218154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 11/11/2023] [Indexed: 01/12/2024] Open
Abstract
Objective This study aimed to implement a digital therapeutics-based approach based on motion detection technology and analyze the clinical results for patients with chronic low back pain (LBP). Methods A prospective, single-arm clinical trial was conducted with 22 patients who performed mobile app-based sitting core twist exercise for 12 weeks. Clinical outcomes were assessed using the visual analog scale (VAS) for LBP, Oswestry Disability Index-Korean version (K-ODI), and EuroQol-5 dimension 5-level version (EQ-5D-5L) every 4 weeks after the initiation of treatment. Laboratory tests for factors associated with muscle metabolism, plain X-ray for evaluating sagittal balance, and magnetic resonance imaging for calculating cross-sectional area (CSA) of back muscles were performed at pretreatment and 12 weeks post-treatment. Results The study population included 20 female patients with an average age of 45.77 ± 15.45 years. The clinical outcomes gradually improved throughout the study period in the VAS for LBP (from 6.05 ± 2.27 to 2.86 ± 1.86), K-ODI (from 16.18 ± 6.19 to 8.64 ± 5.58), and EQ-5D-5L (from 11.09 ± 3.24 to 7.23 ± 3.89) (p < 0.001, respectively). The laboratory test results did not show significant changes. Pelvic incidence (from 53.99 ± 9.70° to 50.80 ± 9.20°, p = 0.002) and the mismatch between pelvic incidence and lumbar lordosis (from 8.97± .67° to 5.28 ± 8.57°, p = 0.027) decreased significantly. Additionally, CSA of erector spinae and total back muscles increased by 5.20% (p < 0.001) and 3.08% (p = 0.013), respectively. Conclusions The results of this study suggest that the efficacy of digital therapy-based lumbar core exercise for LBP is favorable. However, further large-scale randomized controlled studies are necessary.
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Affiliation(s)
- Seong Son
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Byung Rhae Yoo
- Department of Neurosurgery, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
| | - Yu Mi Jeong
- Department of Radiology, Gil Medical Center, Gachon University College of Medicine, Incheon, South Korea
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Obersnel M, Nardin B, Canepari E, Torelli L, Rizzitelli P, Buchini S, Schreiber S, Barbi E, Cozzi G. Active production of music as distraction for venipuncture in children and adolescents: a randomized clinical trial. Eur J Pediatr 2023; 182:5455-5463. [PMID: 37773297 DOI: 10.1007/s00431-023-05227-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 09/14/2023] [Accepted: 09/17/2023] [Indexed: 10/01/2023]
Abstract
More than 50% of children report considerable pain during venipuncture or intravenous cannulation. Despite the tools and techniques may be employed to reduce pain and distress in everyday clinical practice, the care offered is frequently insufficient. Music's potential effect in healthcare settings has received increasing attention. This study aimed to verify if the active production of music with a Leap Motion Controller could help decreasing pain and distress during venipuncture in children and adolescents. We conducted an open-label randomized controlled clinical trial with parallel arms. Children aged 8 to 17 were enrolled at the blood-drawing center of the Institute for Maternal and Child Health IRCCS Burlo Garofolo of Trieste, Italy. We hypothesized that in order to demonstrate an adequate improvement in the pain score in the intervention group, at least 200 children, 100 in each group, were needed, with alpha 5% and 1-beta 80%. Differences between the groups were evaluated with the nonparametric Mann-Whitney U-test. The subjects were randomly assigned either to the active production of music group or to the standard of care group. The primary outcome was the median self-reported procedural pain score between experimental and standard of care group. Secondary outcomes were: the median pain and distress scores according to parental judgment and operators' judgment between the experimental and control group. Three hundred subjects entered the study and were randomized, 150 in the active production of music group and 150 in the standard of care group. Median self-reported pain scores were 1 (0-2) in the active production of music group and 2 (1-2) in the standard of care group and this difference was statistically significant (p = 0.0016). Median procedural distress was 1 (0-3) in the active production of music group and 3 (1-6) in the standard of care group, according to parental judgment, and this difference was statistically significant (p = 0.0000016). CONCLUSION This research showed that the active production of music is a valuable distraction technique to decrease venipuncture related pain and distress in children and adolescents. TRIAL REGISTRATION The study protocol was registered with ClinicalTrial.gov (June 28[th] 2022, NCT05441241) before the start of the subjects' enrolment. WHAT IS KNOWN • The benefits of music on pain and anxiety are well known and have been tested during different painful procedures. • The effect of active production of music has never been tested in children during venipuncture. WHAT IS NEW • In our study median self-reported pain scores and median procedural distress, according to parental judgment, were lower in the active production of music group than in the standard of care group and these differences were statistically significant.
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Affiliation(s)
- Marco Obersnel
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Bianca Nardin
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Elisa Canepari
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy.
| | - Lucio Torelli
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
| | - Patrizia Rizzitelli
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Sara Buchini
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Silvana Schreiber
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Egidio Barbi
- Clinical Department of Medical, Surgical and Health Sciences, University of Trieste, Trieste, Italy
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
| | - Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, Trieste, Italy
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Merino-Lobato C, Rodríguez-Gallego I, Pabón-Carrasco M, Romero-Castillo R, Jiménez-Picón N. Virtual reality vs. buzzy®. efficacy in pain and anxiety management during pediatric venipuncture. Systematic review and meta-analysis. J Pediatr Nurs 2023; 73:22-33. [PMID: 37603924 DOI: 10.1016/j.pedn.2023.08.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2023] [Revised: 08/13/2023] [Accepted: 08/13/2023] [Indexed: 08/23/2023]
Abstract
PROBLEM Non-pharmacological distraction methods are novel alternatives that can help to alleviate pain and anxiety generated by venipuncture in the pediatric population. The aim is to determine the effectiveness of virtual reality, compared to cold and vibration devices (Buzzy® device), as a distraction method used during venipuncture in the management of pain and anxiety in children. ELIGIBILITY CRITERIA Clinical trials, cohort and quasi-experimental studies, published between 2017 and 2022, in Spanish or English and pediatric age, found in Medline, the Cochrane Library, Scopus, Web Of Science, CINAHL and Embase databases. SAMPLE Twenty-one studies were included and ten met the criteria for meta-analysis. RESULTS Fifty-seven percent of the studies evaluate virtual reality, 33.3% the Buzzy® device and 9.5% both comparatively. The effectiveness of virtual reality in reducing pain (66.6%, n = 14) and anxiety (47.6%, n = 10) compared to standard care (control group), 95% CI = 1.53 [0.91-2.16], p < 0.001, I2 = 78% and 95% CI = 1.53 [1.16-1.90]), p < 0.001, I2 = 77% respectively is demonstrated. Similarly, the effectiveness of Buzzy® in reducing pain (42.9%, n = 9) and anxiety (23.8%, n = 5), 95% CI = 1.62 [0.90-2.34], p < 0.001, I2 = 94% and 95% CI = 1.40 [0.06-2.20, p < 0.001, I2 = 91% respectively is demonstrated. Comparatively, there is no significant difference between both methods 95% CI = 0.29 [-0.19-0.78], p = 0.24, I2 = 81%. CONCLUSIONS The methods studied are effective in relieving pain and anxiety during venipuncture. Further research is needed on the level of satisfaction, adverse effects and cost-benefit. IMPLICATIONS This study provides evidence of novel tools in daily practice to provide more humane, holistic and quality care.
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Affiliation(s)
| | - Isabel Rodríguez-Gallego
- Virgen del Rocio University Hospital, 41013, Seville, Spain; Centro Universitario de Enfermería Cruz Roja, adscrito a la Universidad de Sevilla, 41009 Seville, Spain.
| | | | - Rocío Romero-Castillo
- Departamento de Enfermería de la Universidad de Sevilla, Centro Universitario de Enfermería Cruz Roja, adscrito a la Universidad de Sevilla, 41009 Seville, Spain.
| | - Nerea Jiménez-Picón
- Centro Universitario de Enfermería Cruz Roja, adscrito a la Universidad de Sevilla, 41009 Seville, Spain.
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12
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Kerimaa H, Hakala M, Haapea M, Vähänikkilä H, Serlo W, He HG, Pölkki T. Effectiveness of a Mobile App Intervention for Preparing Preschool Children and Parents for Day Surgery: Randomized Controlled Trial. J Med Internet Res 2023; 25:e46989. [PMID: 37773624 PMCID: PMC10576237 DOI: 10.2196/46989] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Revised: 05/31/2023] [Accepted: 07/31/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND Day surgery allows families to return home quickly. Only a few approaches to preparing for day surgery have demonstrated how digital solutions can support families and children. OBJECTIVE This study aims to evaluate the effectiveness of a mobile app intervention on preschool children's fear and pain and parents' anxiety and stress in preparing children for day surgery. METHODS This study was conducted at the Pediatric Day Surgical Department of a university hospital in Finland between 2018 and 2020. Parents of children (aged 2-6 y) who were in a queue for elective day surgery were randomized into the intervention group (IG; n=36) and control group (CG; n=34). The CG received routine preparations, whereas the IG was prepared using a mobile app. Parents' and children's outcomes were measured using validated scales at 4 different points: at home (T1 and T4) and at the hospital (T2 and T3) before and after surgery. Group differences were analyzed using statistical methods suitable for the material. RESULTS Before surgery, parents in both groups experienced mild anxiety, which decreased after surgery. Parental anxiety did not differ between groups preoperatively (P=.78) or postoperatively (P=.63). Both groups had less anxiety at home after surgery compared with before. The IG showed a significant decrease (P=.003); the CG also improved (P=.002). Preoperatively at home, most parents in both groups experienced no stress or mild stress (P=.61). Preoperatively at the hospital, parents in both groups experienced mild stress; however, parents in the IG experienced more stress during this phase (P=.02). Parents in the IG experienced significantly less stress postoperatively than those in the CG (P=.05). Both groups showed decreased stress levels from before to after surgery (IG: P=.003; CG: P=.004) within each group. There were no significant differences in children's pain levels between the groups and measurement points. This was observed before surgery at home (P=.25), before surgery at the hospital (P=.98), and after surgery at the hospital (P=.72). Children's fear decreased more in the IG (P=.006) than in the CG (P=.44) comparing the phases before and after surgery at home. Fear did not differ between the IG and CG preoperatively at home (P=.20) or at the hospital (P=.59) or postoperatively at the hospital (P=.62) or at home (P=.81). CONCLUSIONS The mobile app intervention did not reduce anxiety or pain. However, it was observed that parents in the IG experienced substantially heightened stress levels before surgery at the hospital, which decreased significantly after surgery at home. In addition, fear levels in children in the IG decreased over time, whereas no significant change was observed in the CG. These results are important for developing health care service chains and providing families with innovative and customer-oriented preparation methods. TRIAL REGISTRATION ClinicalTrials.gov NCT03774303; https://classic.clinicaltrials.gov/ct2/show/NCT03774303.
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Affiliation(s)
- Heli Kerimaa
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
| | - Mervi Hakala
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
| | - Marianne Haapea
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Service Unit, Oulu University Hospital, Oulu, Finland
| | - Hannu Vähänikkilä
- Northern Finland Birth Cohorts, Arctic Biobank, Infrastructure for Population Studies, Faculty of Medicine, University of Oulu, Oulu, Finland
| | - Willy Serlo
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Division of Pediatric Surgery, Oulu University Hospital, Oulu, Finland, Oulu, Finland
- Oulu University Unit of Clinical Medicine, University of Oulu, Oulu, Finland
| | - Hong-Gu He
- Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
- National University Health System, Singapore, Singapore
| | - Tarja Pölkki
- Medical Research Center Oulu, Oulu University Hospital and University of Oulu, Oulu, Finland
- Research Unit of Health Sciences and Technology, University of Oulu, Oulu, Finland
- Oulu University Hospital, Oulu, Finland
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13
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Hudson S, Nishat F, Stinson J, Litwin S, Zeller F, Wiles B, Foster ME, Ali S. Perspectives of Healthcare Providers to Inform the Design of an AI-Enhanced Social Robot in the Pediatric Emergency Department. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1511. [PMID: 37761472 PMCID: PMC10529269 DOI: 10.3390/children10091511] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/14/2023] [Revised: 09/03/2023] [Accepted: 09/04/2023] [Indexed: 09/29/2023]
Abstract
Children commonly experience pain and distress in healthcare settings related to medical procedures such as blood tests and intravenous insertions (IVIs). Inadequately addressed pain and distress can result in both short- and long-term negative consequences. The use of socially assistive robotics (SARs) to reduce procedure-related distress and pain in children's healthcare settings has shown promise; however, the current options lack autonomous adaptability. This study presents a descriptive qualitative needs assessment of healthcare providers (HCPs) in two Canadian pediatric emergency departments (ED) to inform the design an artificial intelligence (AI)-enhanced social robot to be used as a distraction tool in the ED to facilitate IVIs. Semi-structured virtual individual and focus group interviews were conducted with eleven HCPs. Four main themes were identified: (1) common challenges during IVIs (i.e., child distress and resource limitations), (2) available tools for pain and distress management during IVIs (i.e., pharmacological and non-pharmacological), (3) response to SAR appearance and functionality (i.e., personalized emotional support, adaptive distraction based on child's preferences, and positive reinforcement), and (4) anticipated benefits and challenges of SAR in the ED (i.e., ensuring developmentally appropriate interactions and space limitations). HCPs perceive AI-enhanced social robots as a promising tool for distraction during IVIs in the ED.
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Affiliation(s)
- Summer Hudson
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.H.); (S.A.)
| | - Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (F.N.); (B.W.)
| | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (F.N.); (B.W.)
- Lawrence S. Bloomberg, Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
| | - Sasha Litwin
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, ON M5G 1E8, Canada;
| | - Frauke Zeller
- School of Computing, Engineering, and The Built Environment, Edinburgh Napier University, Edinburgh EH11 4BN, UK;
| | - Brittany Wiles
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON M5G 0A4, Canada; (F.N.); (B.W.)
| | - Mary Ellen Foster
- School of Computing Science, University of Glasgow, Glasgow G12 8RZ, UK;
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB T6G 1C9, Canada; (S.H.); (S.A.)
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14
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Nishat F, Hudson S, Panesar P, Ali S, Litwin S, Zeller F, Candelaria P, Foster ME, Stinson J. Exploring the needs of children and caregivers to inform design of an artificial intelligence-enhanced social robot in the pediatric emergency department. J Clin Transl Sci 2023; 7:e191. [PMID: 37745926 PMCID: PMC10514688 DOI: 10.1017/cts.2023.608] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 06/30/2023] [Accepted: 07/30/2023] [Indexed: 09/26/2023] Open
Abstract
Background & Objective Socially assistive robots (SARs) are a promising tool to manage children's pain and distress related to medical procedures, but current options lack autonomous adaptability. The aim of this study was to understand children's and caregivers' perceptions surrounding the use of an artificial intelligence (AI)-enhanced SAR to provide personalized procedural support to children during intravenous insertion (IVI) to inform the design of such a system following a user-centric approach. Methods This study presents a descriptive qualitative needs assessment of children and caregivers. Data were collected via semi-structured individual interviews and focus groups. Participants were recruited from two Canadian pediatric emergency departments (EDs) between April 2021 and January 2022. Results Eleven caregivers and 19 children completed 27 individual interviews and one focus group. Three main themes were identified: A. Experience in the clinical setting, B. Acceptance of and concerns surrounding SARs, and C. Features that support child engagement with SARs. Most participants expressed comfort with robot technology, however, concerns were raised about sharing personal information, photographing/videotaping, and the possibility of technical failure. Suggestions for feature enhancements included increasing movement to engage a child's attention and tailoring language to developmental age. To enhance the overall ED experience, participants also identified a role for the SAR in the waiting room. Conclusion Artificial intelligence-enhanced SARs were perceived by children and caregivers as a promising tool for distraction during IVIs and to enhance the overall ED experience. Insights collected will be used to inform the design of an AI-enhanced SAR.
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Affiliation(s)
- Fareha Nishat
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Summer Hudson
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Prabdeep Panesar
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
| | - Samina Ali
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Sasha Litwin
- Division of Emergency Medicine, The Hospital for Sick Children, Toronto, ON, Canada
| | - Frauke Zeller
- School of Computing, Engineering, and The Built Environment, Edinburgh Napier University, Edinburgh, SC, UK
| | - Patricia Candelaria
- Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Jennifer Stinson
- Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, ON, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON, Canada
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15
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Litwin S, Clarke L, Copeland J, Tyrrell J, Tait C, Mohabir V, Campbell F. Designing a Child-, Family-, and Healthcare Provider-Centered Procedure Room in a Tertiary Care Children's Hospital. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2023; 16:195-209. [PMID: 37021379 PMCID: PMC10328143 DOI: 10.1177/19375867231161097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/07/2023]
Abstract
AIM The study aim was to co-design new pediatric procedure room prototypes with children, caregivers, and healthcare providers (HCPs). BACKGROUND Medical procedures can cause pain and anxiety for children and their families. If spaces are not designed for patients' needs, procedures may take longer, require sedation, and result in an inferior care experience. Involving HCPs in co-designing optimal spaces can result in more efficient and safer environments. co-designing spaces with patients and their families can inform psychologically safer and less traumatic environments. METHODS We followed human-centered design methodology. Data were collected via semi-structured interviews, field observations, and two multidisciplinary design workshops with patients, caregivers, and HCPs. Themes from the data were extracted using a content analysis and used to make evidence-informed recommendations for design features. RESULTS The study took place from October 2021 to February 2022. Patients, families, and HCPs reported similar needs: (1) control over the environment, including the ability to adjust lighting, temperature, and sound; (2) space that supports patient privacy; (3) the use of evidence-based pain reduction and distraction methods; (4) attention to the sensory environment, including visual (light, color), tactile (textures of furniture and equipment), auditory, and olfactory stimuli; (5) human factors organization of the space and equipment; (6) accessible and equitable spatial design; and (7) the significance of the journey leading up to and after the procedure. CONCLUSIONS It is feasible to co-design procedure rooms that support evidence-based psychological, physical, and pharmacological interventions that are known to minimize pain for children.
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Affiliation(s)
- Sasha Litwin
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, Canada
| | - Lindsay Clarke
- Design and Improvement, Process Improvement and Innovation Team, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jocelyne Copeland
- Facilities Planning and Redevelopment Project Horizon, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Jennifer Tyrrell
- Transitional Pain Clinic, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Caleb Tait
- Department of Child Life, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Vina Mohabir
- Child Health Evaluative Sciences, SickKids Research Institute, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Fiona Campbell
- Department of Anesthesiology and Pain Medicine, Hospital for Sick Children, Faculty of Medicine, University of Toronto, Ontario, Canada
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16
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Topçu SY, Semerci R, Kostak MA, Güray Ö, Sert S, Yavuz G. The effect of an interactive robot on children's post-operative anxiety, mobilization, and parents' satisfaction; randomized controlled study. J Pediatr Nurs 2023; 68:e50-e57. [PMID: 36437131 DOI: 10.1016/j.pedn.2022.11.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 11/09/2022] [Accepted: 11/09/2022] [Indexed: 11/27/2022]
Abstract
PURPOSE To evaluate the effect of an interactive robot on Turkish children's post-operative anxiety, mobilization, and parents' satisfaction related to post-operative care. METHOD A randomized controlled study was conducted with 84 children who will undergo day surgery aged 5-10 years and their parents at a university hospital between June 2020-April 2022. The interactive robot was provided to accompany the children during the postoperative mobilization. Children in the control group received standard care during mobilization. Data were collected using the Personal Information Form, Children's State Anxiety (CSA), Parental Satisfaction Scale-Visual Analog Scale, and Mobilization Chart. RESULTS It was determined that the CSA score of the children in the control group were higher than the intervention group before their first mobilization after surgery (p = 0.005). During the first (p = 0.042) and second (p = 0.012) mobilization, it was determined that the mobilization duration of children in the intervention group was longer than the children in the control group. It was found that the parents of the children in the intervention group had a high level of satisfaction. CONCLUSION It has been determined that interactive robots positively affect postoperative mobilization in children undergoing day surgery, reduce the anxiety level of children before mobilization, and increase the duration of mobilization. In addition, the use of interactive robots increased parents' satisfaction with post-operative mobilization care. PRACTICE IMPLICATIONS Using interactive robots to reduce the stress and anxiety of children during the perioperative process can be a promising approach to improve their recovery by providing early mobilization.
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Affiliation(s)
- Sacide Yildizeli Topçu
- Trakya University, Faculty of Health Science, Department of Surgical Nursing, Edirne, Turkey.
| | | | - Melahat Akgün Kostak
- Trakya University, Faculty of Health Science, Department of Pediatric Nursing, Edirne, Turkey
| | - Özlem Güray
- Trakya University Hospital, Department of Pediatric Surgical, Edirne, Turkey
| | - Senem Sert
- Trakya University Hospital, Department of Pediatric Surgical, Edirne, Turkey
| | - Gözde Yavuz
- Trakya University Hospital, Department of Pediatric Surgical, Edirne, Turkey
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17
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Lee HN, Park JW, Hwang S, Jung JY, Kim DK, Kwak YH, Lee EJ. Effect of a Virtual Reality Environment Using a Domed Ceiling Screen on Procedural Pain During Intravenous Placement in Young Children: A Randomized Clinical Trial. JAMA Pediatr 2023; 177:25-31. [PMID: 36409508 PMCID: PMC9679961 DOI: 10.1001/jamapediatrics.2022.4426] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 08/24/2022] [Indexed: 11/23/2022]
Abstract
Importance Distraction using virtual reality (VR) has been found to provide a clinically significant reduction in the experience of pain during various painful procedures. Commercially available VR systems usually require the user to wear a head-mounted display helmet, which can be challenging for young children, and whether VR can reduce pain during intravenous (IV) placement in young children is currently unknown. Objective To determine whether a VR environment using a novel domed ceiling screen reduces distress among children over the course of IV placement compared with standard care in a pediatric emergency department. Design, Setting, and Participants This randomized clinical trial was conducted from June 3, 2020, to February 8, 2021, at an urban tertiary academic children's hospital. Included were children aged 6 months to 4 years undergoing IV placement in the pediatric emergency department. Intervention Children in the intervention group lay on a bed to experience a VR animation using a domed ceiling screen during the IV placement procedure, which was performed as usual. Children in the control group also lay on a bed during the procedure but did not view a VR animation. Main Outcomes and Measures The primary outcome was pain scores measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at 4 time points during IV placement: immediately after the child lay down on the bed (T1), the moment the tourniquet was applied (T2), the moment a sterile alcohol swab was applied (T3), and the moment the needle penetrated the skin (T4). Results Of the 88 children included in the final analysis, 44 received VR distraction (median [IQR] age, 24.0 [14.5-44.0] months; 27 boys [61.4%]), and 44 received standard care (median [IQR] age, 23.0 [15.0-40.0] months; 26 boys [59.1%]). The median [IQR] FLACC scores at T4 were 6.0 (1.8-7.5) in the intervention group and 7.0 (5.5-7.8) in the control group. The ordinal logistic regression model showed that children in the VR intervention group vs the control group had a lower probability of higher FLACC scores (odds ratio, 0.53; 95% CI, 0.28-0.99; P = .046). Conclusions and Relevance The findings of this trial indicate that displaying VR using a domed ceiling screen may be an effective distraction method that reduces distress in young children undergoing IV placement. Trial Registration isrctn.org Identifier: KCT0005122.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children’s Hospital, Seoul, Korea
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eui Jun Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Korea
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18
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Taddio A, Ilersich ANT, Bucci L, McMurtry CM, Gudzak V, Ipp M, Zita T, Tharmarajah S, MacDonald N. Letting kids play their CARDs (Comfort, Ask, Relax, Distract) to help cope with needle-related fear and pain: Results from user testing. Vaccine 2022; 40:7667-7675. [PMID: 36372667 DOI: 10.1016/j.vaccine.2022.09.035] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 09/05/2022] [Accepted: 09/08/2022] [Indexed: 11/11/2022]
Abstract
This study examined perceptions of children and parents about a new web-based CARD (Comfort, Ask, Relax, Distract) game that teaches children how to cope with needle-related pain and fear. A convenience sample of 15 child-parent dyads (children, 6-12 years) participated. Children played the game on a handheld device while being virtually monitored. Activity tracking revealed most children engaged with multiple components. Children reported they understood the game, it was easy to play, they learned coping strategies and believed they could implement them. Children reported lower fear of needles after playing. Parents liked the simplicity and variety of game activities. Most children and parents reported they would use the game or its coping strategies for future needles and would recommend the game. In summary, children and parents found the CARD web game acceptable and appropriate. Future studies can evaluate its effectiveness when integrated into upcoming needle procedures like COVID-19 vaccinations.
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Affiliation(s)
- Anna Taddio
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario, Canada; Child Health Evaluative Sciences, The Hospital for Sick Children, Toronto, Ontario, Canada.
| | | | - Lucie Bucci
- Immunize Canada, Canadian Public Health Association, Ottawa, Ontario, Canada.
| | - C Meghan McMurtry
- Department of Psychology, University of Guelph, Guelph; Pediatric Chronic Pain Program, McMaster Children's Hospital, Hamilton, Ontario, Canada.
| | - Victoria Gudzak
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Moshe Ipp
- Faculty of Medicine, University of Toronto, Toronto, Canada.
| | - Tina Zita
- Peel District School Board, Mississauga, Canada.
| | - Shenthuraan Tharmarajah
- Clinical Social and Administrative Pharmacy, Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Ontario, Canada.
| | - Noni MacDonald
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada.
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19
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Leung T, Hess CW, Choate ES, Van Orden AR, Tremblay-McGaw AG, Menendez M, Boothroyd DB, Parvathinathan G, Griffin A, Caruso TJ, Stinson J, Weisman A, Liu T, Koeppen K, Koeppen K. Virtual Reality-Augmented Physiotherapy for Chronic Pain in Youth: Protocol for a Randomized Controlled Trial Enhanced With a Single-Case Experimental Design. JMIR Res Protoc 2022; 11:e40705. [PMID: 36508251 PMCID: PMC9793297 DOI: 10.2196/40705] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2022] [Revised: 09/13/2022] [Accepted: 09/21/2022] [Indexed: 12/30/2022] Open
Abstract
BACKGROUND Chronic musculoskeletal (MSK) pain is a prominent health concern, resulting in pain-related disability, loss of functioning, and high health care costs. Physiotherapy rehabilitation is a gold-standard treatment for improving functioning in youth with chronic MSK pain. However, increasing physical activity can feel unattainable for many adolescents because of pain-related fear and movement avoidance. Virtual reality (VR) offers an immersive experience that can interrupt the fear-avoidance cycle and improve engagement in physiotherapy. Despite promising initial findings, data are limited and often lack the rigor required to establish VR as an evidence-based treatment for MSK pain. OBJECTIVE This trial evaluates physiorehabilitation with VR in adolescents with MSK pain. This protocol outlines the rationale, design, and implementation of a randomized controlled trial enhanced with a single-case experimental design. METHODS This study is a 2-group randomized controlled trial assessing the use of physiorehabilitation with VR in adolescents with MSK pain. The authors will collaborate with physical therapists to integrate VR into their standard clinical care. For participants enrolled in standard physiotherapy, there will be no VR integrated into their physical therapy program. Primary outcomes include physical function and engagement in VR. Secondary outcomes include pain-related fear and treatment adherence. Moreover, we will obtain clinician perspectives regarding the feasibility of integrating the intervention into the flow of clinical practice. RESULTS The pilot study implementing physiorehabilitation with VR demonstrated that high engagement and use of physiorehabilitation with VR were associated with improvements in pain, fear, avoidance, and function. Coupled with qualitative feedback from patients, families, and clinicians, the pilot study results provide support for this trial to evaluate physiorehabilitation with VR for youth with chronic MSK pain. Analysis of results from the main clinical trial will begin as recruitment progresses, and results are expected in early 2024. CONCLUSIONS Significant breakthroughs for treating MSK pain require mechanistically informed innovative approaches. Physiorehabilitation with VR provides exposure to progressive challenges, real-time feedback, and reinforcement for movement and can include activities that are difficult to achieve in the real world. It has the added benefit of sustaining patient motivation and adherence while enabling clinicians to use objective benchmarks to influence progression. These findings will inform the decision of whether to proceed with a hybrid effectiveness-dissemination trial of physiorehabilitation with VR, serving as the basis for potential large-scale implementation of physiorehabilitation with VR. TRIAL REGISTRATION ClinicalTrials.gov NCT04636177; https://clinicaltrials.gov/ct2/show/NCT04636177. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/40705.
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Affiliation(s)
| | - Courtney W Hess
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Ellison S Choate
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Amanda R Van Orden
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Alexandra G Tremblay-McGaw
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Maria Menendez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Derek B Boothroyd
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Gomathy Parvathinathan
- Quantitative Statistical Unit, Department of Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Stanford, CA, United States
| | - Jennifer Stinson
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.,The Research Institute, The Hospital for Sick Children, Toronto, ON, Canada
| | - Amy Weisman
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Timothy Liu
- Department of Rehabilitation, Lucile Packard Children's Hospital, Stanford, CA, United States
| | - Kurt Koeppen
- California Rehabilitation & Sports Therapy, Palo Alto, CA, United States
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20
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Suleiman‐Martos N, García‐Lara RA, Membrive‐Jiménez MJ, Pradas‐Hernández L, Romero‐Béjar JL, Dominguez‐Vías G, Gómez‐Urquiza JL. Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis. J Clin Nurs 2022; 31:3350-3367. [PMID: 35075716 PMCID: PMC9787560 DOI: 10.1111/jocn.16227] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2021] [Revised: 12/27/2021] [Accepted: 01/02/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological. AIMS To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients. METHODS A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication. RESULTS 26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded. CONCLUSIONS Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients. RELEVANCE TO CLINICAL PRACTICE In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients' emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.
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21
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Alrimy T, Alhalabi W, Malibari AA, Alzahrani FS, Alrajhi S, Alhalabi M, Hoffman HG. Virtual Reality Animal Rescue World: Pediatric virtual reality analgesia during just noticeable pressure pain in children aged 2-10 years old (crossover design). Front Psychol 2022; 13:963765. [PMID: 36389517 PMCID: PMC9651058 DOI: 10.3389/fpsyg.2022.963765] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 10/03/2022] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND AND AIMS Excessive pain during medical procedures is a worldwide medical problem. Most scald burns occur in children under 6, who are often undermedicated. Adjunctive Virtual Reality (VR) distraction has been shown to reduce pain in children aged 6-17, but little is known about VR analgesia in young children. This study tests whether desktop VR (VR Animal Rescue World) can reduce the just noticeable pressure pain of children aged 2-10. METHODS A within-subject repeated measures design was used. With treatment order randomized, each healthy volunteer pediatric participant underwent brief cutaneous pressure stimuli under three conditions: (1) no distraction, (2) a verbal color naming task (no VR), and (3) a large TV-based desktop VR distraction. A hand-held Wagner pressure pain stimulation device was used to generate just noticeable pain sensations. Participants indicated when a steadily increasing non-painful pressure stimulus first turned into a painful pressure sensation (just noticeable pain). RESULTS A total of 40 healthy children participated (43% aged 2-5 years; and 57% aged 6-10 years). Compared to the no distraction condition, the 40 children showed significant VR analgesia (i.e., a significant reduction in pain sensitivity during the VR Animal Rescue World condition), t(39) = 9.83, p < 0.001, SD = 6.24. VR was also significantly more effective at reducing pain sensitivity vs. an auditory color naming task, t(39) = 5.42, p < 0.001, SD = 5.94. The subset of children aged 2-5 showed significant reductions in pain during VR. Children under 6 showed greater sensitivity to pain during no distraction than children aged 6-10. CONCLUSION During no distraction, children under 6 years old were significantly more sensitive to pain than children aged 6-10. Virtual reality (VR) significantly reduced the "just noticeable" pressure pain sensitivity of children in both age groups.
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Affiliation(s)
- Taima Alrimy
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wadee Alhalabi
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Computer Science, School of Engineering, Computing and Informatics, Dar Al-Hekma University, Jeddah, Saudi Arabia
| | - Areej A. Malibari
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | | | - Sharifah Alrajhi
- Department of Statistics, Faculty of Science, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Mohammed Alhalabi
- Immersive Virtual Reality Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Hunter G. Hoffman
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Mechanical Engineering, University of Washington, Seattle, WA, United States
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22
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Biophilic virtual reality on children's anxiety and pain during circumcision: A randomized controlled study. J Pediatr Urol 2022; 19:201-210. [PMID: 36336624 DOI: 10.1016/j.jpurol.2022.10.023] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 09/08/2022] [Accepted: 10/16/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION The aim of this study was to evaluate the effects of the biophilic virtual reality (BVR) method on children's pain and anxiety undergoing circumcision. MATERIALS AND METHODS This randomized controlled study used a parallel trial design guided by the CONSORT checklist. A total of 106 children were included in the analysis. Intraoperative anxiety was assessed by using the simplified Chinese version of the modified Yale Preoperative Anxiety Scale (CmYPAS), Visual Analogue Scale (VAS), heart rate (HR), and Anxiety index (Ai). Intraoperative pain was assessed by using the Faces Pain Scale-Revised (FPS-R), and Pain index (Pi). The Pearson correlation analysis was used to analyze the relationship between Ai and the CmYPAS. The primary outcomes were CmYPAS, VAS, and FPS-R, which were analyzed using the Kruskal-Wallis test. RESULTS Baseline variables were not significantly different between the BVR group (34 patients), the indoor virtual reality (IVR) group (36 patients), and the blank control group (36 patients). The CmYPAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (25.0[22.9-29.2], 22.9[22.9-29.2], 33.3[33.3-38.5] respectively; P < 0.001). The VAS scores during surgery were significantly lower in the BVR group and the IVR group versus the blank control group (5.0[3.0-7.0], 3.0[2.0-5.0], 6.0[5.0-8.8] respectively; P < 0.001). The FPS-R scores during surgery were significantly lower in the BVR group and IVR group versus the blank control group (2.0[1.8-4.2], 3.0[2.0-4.8], 5.5[5.0-8.0], respectively; P < 0.001). At removal of the foreskin, Pi were significantly lower in the BVR group and IVR group versus the blank control group (6.9[4.1], 7.7[3.3], 9.8[6.2] respectively; P = 0.033). The Ai scores at each time point were significantly lower in the BVR group and IVR group versus the control (P = 0.015, P = 0.006 respectively). The correlation analysis of Ai (at removal of the foreskin) and CmYPAS scores in children showed that the Pearson correlation coefficient was 0.194 (P = 0.046). DISCUSSION This is the first RCT to investigate the effects of BVR in children undergoing circumcision. This study demonstrates a reduction in pediatric intraoperative pain and anxiety with the use of virtual reality (VR). CONCLUSION Intraoperative VR may be an effective noninvasive modality for reducing pain and anxiety during circumcision. Pi and Ai might be used to assess subjective pain and anxiety in patients.
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Russo L, Tozzi AE, Mastronuzzi A, Croci I, Gesualdo F, Campagna I, Miller KP, Ciaralli I, Amicucci M, Secco DE, Dell’Anna VA, Ripà A, Piccinelli E. Feasibility of a VR Intervention to Decrease Anxiety in Children with Tumors Undergoing CVC Dressing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11953. [PMID: 36231250 PMCID: PMC9565196 DOI: 10.3390/ijerph191911953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Virtual reality (VR) represents a promising digital intervention for managing distress and anxiety in children with tumors undergoing painful medical procedures. In an experimental cross-over study, we administered a VR intervention consisting of relaxing games during central venous catheter (CVC) dressing. The VR sessions were compared with no-VR during CVC medication. We used the distress thermometer and RCMAS-2 scale to assess distress and anxiety levels. We also explored the satisfaction level in patients and families. We enrolled 22 children. The distress levels after medication were lower in the VR group than in those without VR (VR: median 2; IQR 0-2; no-VR: median 4; IQR: 3-5). No variation in anxiety levels was detected by VR intervention. Satisfaction for using VR was very high in children and their families although a total of 12% of children were disappointed by the effect of VR. Most healthcare workers felt that VR would be useful in routine clinical practice. A VR intervention is highly acceptable, may be efficacious in decreasing distress in children with cancer undergoing painful procedures, but it is less likely that it has a measurable impact on anxiety. Evidence from larger studies is needed to assess VR translation into the clinical workflow.
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Affiliation(s)
- Luisa Russo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Angela Mastronuzzi
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Ileana Croci
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Francesco Gesualdo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Ilaria Campagna
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Kiersten P. Miller
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Italo Ciaralli
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Matteo Amicucci
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Domitilla Elena Secco
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Vito Andrea Dell’Anna
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Adele Ripà
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Elisa Piccinelli
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
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Lluesma-Vidal M, Carcelén González R, García-Garcés L, Sánchez-López MI, Peyro L, Ruiz-Zaldibar C. Effect of Virtual Reality on Pediatric Pain and Fear During Procedures Involving Needles: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e35008. [PMID: 35943776 PMCID: PMC9399850 DOI: 10.2196/35008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/19/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. Objective The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. Methods A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. Results From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] –2.37, 95% CI –3.20 to –1.54; Z=5.58; P<.001) and fear (IV –1.26, 95% CI –1.89 to –0.63; Z=3.92; P<.001) in children in the experimental groups. Conclusions The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.
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Affiliation(s)
- Marta Lluesma-Vidal
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Raquel Carcelén González
- Department of Medicine and Surgery, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Laura García-Garcés
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - María I Sánchez-López
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Loreto Peyro
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Cayetana Ruiz-Zaldibar
- Department of Nursing, Faculty of Health, University of Camilo José Cela, Villanueva de la Cañada, Madrid, Spain
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25
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Effectiveness of art-based distraction on reducing pediatric patients' pain and anxiety during venipuncture: A randomized controlled trial. Complement Ther Clin Pract 2022; 48:101597. [DOI: 10.1016/j.ctcp.2022.101597] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Revised: 04/10/2022] [Accepted: 04/25/2022] [Indexed: 11/23/2022]
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26
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Geva N, Hermoni N, Levy-Tzedek S. Interaction Matters: The Effect of Touching the Social Robot PARO on Pain and Stress is Stronger When Turned ON vs. OFF. Front Robot AI 2022; 9:926185. [PMID: 35875704 PMCID: PMC9305613 DOI: 10.3389/frobt.2022.926185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Accepted: 06/17/2022] [Indexed: 11/13/2022] Open
Abstract
Social touch between humans, as well as between humans and animals, was previously found to reduce pain and stress. We previously reported that touching a social robot can also induce a reduction in pain ratings. However, it is unclear if the effect that touching a robot has on pain perception is due to its appearance and its pleasant touch, or due to its ability to socially interact with humans. In the current experiment, we aimed to assess the contribution of the interactive quality to pain perception. We assessed the effect of touching the social robot PARO on mild and strong pain ratings and on stress perception, on a total of 60 healthy young participants. The robot either interacted with participants (ON group, n = 30) or was turned off (OFF group, n = 30). Touching the robot induced a decrease in mild pain ratings (compared to baseline) only in the ON group while strong pain ratings decreased similarly in both the ON and the OFF groups. The decrease in mild pain ratings in the ON group was significantly greater in participants with a higher positive perception of the interaction with PARO. We conclude that part of the effect that touching the robot has on pain stems from its interactive features.
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Affiliation(s)
- Nirit Geva
- Recanati School for Community Health Professions, Department of Physical Therapy, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Netta Hermoni
- Department of Biomedical Engineering, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Shelly Levy-Tzedek
- Recanati School for Community Health Professions, Department of Physical Therapy, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Zlotowski Center for Neuroscience, Ben-Gurion University of the Negev, Beer-Sheva, Israel
- Freiburg Institute for Advanced Studies (FRIAS), University of Freiburg, Freiburg, Germany
- *Correspondence: Shelly Levy-Tzedek,
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Du Q, Ma X, Wang S, Zhou S, Luo C, Tian K, Fei W, Liu X. A digital intervention using virtual reality helmets to reduce dental anxiety of children under local anesthesia and primary teeth extraction: A randomized clinical trial. Brain Behav 2022; 12:e2600. [PMID: 35485000 PMCID: PMC9226823 DOI: 10.1002/brb3.2600] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 05/24/2021] [Accepted: 03/26/2022] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION Behavior management of children during dental treatment is an important but challenging issue. As a new technique, VR has been applied in pediatric dental anxiety. But there is no final conclusion whether VR reduces children's dental anxiety. METHODS The aim of the study is to assess the effectiveness of a digital intervention using virtual reality (VR) helmets on dental anxiety, pain perception, and behavior triggered for children, as well as occurrence of simulator sickness in local anesthesia and primary teeth extraction. A total of 128 children, who needed primary teeth extraction under local anesthesia, were randomly allocated into two groups: use VR helmets and traditional behavior guidance procedures (control). Modified Child Fear Survey Schedule Dental Subscale (CFSS-DS), Wong-Baker FACES Pain Scale, Houpt Scale, and Simulator sickness questionnaire (SSQ) were used to assess children's dental anxiety, pain perception, and behavior triggered and occurrence of simulator sickness. RESULTS CFSS-DS score in the VR group was significantly decreased after dental treatment (34.58±6.90 before operation and 32.32±15.58 after operation, p = .02). The score of Wong Baker Scale in the VR group (3.47±0.76) was significantly lower than that in the control group (5.56±1.13, p = .015). There was no significant difference in the Houpt Behavior Scale score and the SSQ score between the VR group and the control group (p = .35, p = .305). CONCLUSION The use of VR helmets in primary teeth extraction can significantly reduce dental anxiety and pain perception in children without occurrence of simulator sickness.
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Affiliation(s)
- Qin Du
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Medicine, University of Electronic Science and Technology, Sichuan, China
| | - Xinru Ma
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Stomatology, Zunyi Medical University, Guizhou, China
| | - Shasha Wang
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,Department of Stomatology, North Sichuan Medical College, Sichuan, China
| | - Shiyu Zhou
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,Department of Stomatology, North Sichuan Medical College, Sichuan, China
| | - Chunmei Luo
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Stomatology, Zunyi Medical University, Guizhou, China
| | - Kun Tian
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Medicine, University of Electronic Science and Technology, Sichuan, China
| | - Wei Fei
- Department of Stomatology, Sichuan Academy of Medical Science & Sichuan People's Hospital, Sichuan, China.,School of Medicine, University of Electronic Science and Technology, Sichuan, China
| | - Xianghong Liu
- Department of Stomatology, Eastern Hospital, Sichuan Academy of Medical Sciences & Sichuan Provincial People's Hospital, Sichuan, China
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Triage through telemedicine in paediatric emergency care—Results of a concordance study. PLoS One 2022; 17:e0269058. [PMID: 35617339 PMCID: PMC9135216 DOI: 10.1371/journal.pone.0269058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/16/2022] [Indexed: 11/19/2022] Open
Abstract
Background In the German health care system, parents with an acutely ill child can visit an emergency room (ER) 24 hours a day, seven days a week. At the ER, the patient receives a medical consultation. Many parents use these facilities as they do not know how urgently their child requires medical attention. In recent years, paediatric departments in smaller hospitals have been closed, particularly in rural regions. As a result of this, the distances that patients must travel to paediatric care facilities in these regions are increasing, causing more children to visit an ER for adults. However, paediatric expertise is often required in order to assess how quickly the patient requires treatment and select an adequate treatment. This decision is made by a doctor in German ERs. We have examined whether remote paediatricians can perform a standardised urgency assessment (triage) using a video conferencing system. Methods Only acutely ill patients who were brought to a paediatric emergency room (paedER) by their parents or carers, without prior medical consultation, have been included in this study. First, an on-site paediatrician assessed the urgency of each case using a standardised triage. In order to do this, the Paediatric Canadian Triage and Acuity Scale (PaedCTAS) was translated into German and adapted for use in a standardised IT-based data collection tool. After the initial on-site triage, a telemedicine paediatrician, based in a different hospital, repeated the triage using a video conferencing system. Both paediatricians used the same triage procedure. The primary outcome was the degree of concordance and interobserver agreement, measured using Cohen’s kappa, between the two paediatricians. We have also included patient and assessor demographics. Results A total of 266 patients were included in the study. Of these, 227 cases were eligible for the concordance analysis. In n = 154 cases (68%), there was concordance between the on-site paediatrician’s and telemedicine paediatrician’s urgency assessments. In n = 50 cases (22%), the telemedicine paediatrician rated the urgency of the patient’s condition higher (overtriage); in 23 cases (10%), the assessment indicated a lower urgency (undertriage). Nineteen medical doctors were included in the study, mostly trained paediatric specialists. Some of them acted as an on-site doctor and telemedicine doctor. Cohen’s weighted kappa was 0.64 (95% CI: 0.49–0.79), indicating a substantial agreement between the specialists. Conclusions Telemedical triage can assist in providing acute paediatric care in regions with a low density of paediatric care facilities. The next steps are further developing the triage tool and implementing telemedicine urgency assessment in a larger network of hospitals in order to improve the integration of telemedicine into hospitals’ organisational processes. The processes should include intensive training for the doctors involved in telemedical triage. Trial registration DRKS00013207.
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29
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Philippe TJ, Sikder N, Jackson A, Koblanski ME, Liow E, Pilarinos A, Vasarhelyi K. Digital Health Interventions for Delivery of Mental Health Care: Systematic and Comprehensive Meta-Review. JMIR Ment Health 2022; 9:e35159. [PMID: 35551058 PMCID: PMC9109782 DOI: 10.2196/35159] [Citation(s) in RCA: 58] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2021] [Revised: 02/28/2022] [Accepted: 03/02/2022] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has shifted mental health care delivery to digital platforms, videoconferencing, and other mobile communications. However, existing reviews of digital health interventions are narrow in scope and focus on a limited number of mental health conditions. OBJECTIVE To address this gap, we conducted a comprehensive systematic meta-review of the literature to assess the state of digital health interventions for the treatment of mental health conditions. METHODS We searched MEDLINE for secondary literature published between 2010 and 2021 on the use, efficacy, and appropriateness of digital health interventions for the delivery of mental health care. RESULTS Of the 3022 records identified, 466 proceeded to full-text review and 304 met the criteria for inclusion in this study. A majority (52%) of research involved the treatment of substance use disorders, 29% focused on mood, anxiety, and traumatic stress disorders, and >5% for each remaining mental health conditions. Synchronous and asynchronous communication, computerized therapy, and cognitive training appear to be effective but require further examination in understudied mental health conditions. Similarly, virtual reality, mobile apps, social media platforms, and web-based forums are novel technologies that have the potential to improve mental health but require higher quality evidence. CONCLUSIONS Digital health interventions offer promise in the treatment of mental health conditions. In the context of the COVID-19 pandemic, digital health interventions provide a safer alternative to face-to-face treatment. However, further research on the applications of digital interventions in understudied mental health conditions is needed. Additionally, evidence is needed on the effectiveness and appropriateness of digital health tools for patients who are marginalized and may lack access to digital health interventions.
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Affiliation(s)
- Tristan J Philippe
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychiatry, The University of British Columbia, Vancouver, BC, Canada
| | | | - Anna Jackson
- School of Social Work, The University of British Columbia, Vancouver, BC, Canada
| | - Maya E Koblanski
- Department of Cellular & Physiological Sciences, The University of British Columbia, Vancouver, BC, Canada.,Department of Psychology, The University of British Columbia, Vancouver, BC, Canada
| | - Eric Liow
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada
| | - Andreas Pilarinos
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,School of Population and Public Health, The University of British Columbia, Vancouver, BC, Canada
| | - Krisztina Vasarhelyi
- Vancouver Coastal Health Research Institute, Vancouver, BC, Canada.,Faculty of Health Sciences, Simon Fraser University, Burnaby, BC, Canada
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Liu Q, Zang Y, Zang W, Cai W, Li W, Guo Y, Xin C, Tu X. Implementation of virtual reality technology to decrease patients' pain and nervousness during colonoscopies: a prospective randomised controlled single-blinded trial. Clin Med (Lond) 2022; 22:237-240. [PMID: 38589082 DOI: 10.7861/clinmed.2022-0001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND Improved patient satisfaction in endoscopy is worthy of study as it is an invasive and potentially uncomfortable procedure. There is growing literature on patient satisfaction assessment in endoscopy as part of improving quality assurance. This study aimed to determine whether virtual reality (VR) technology can decrease patients' pain and nervousness during colonoscopies. METHODS Patients enrolled without sedation were randomly categorised into groups that watched VR (VR group; n=58) and those that did not watch VR (control group; n=59). The primary outcomes were pain score and skin conductance. Secondary endpoints included heart rate, systolic and diastolic arterial pressures, overall patient satisfaction, willingness to repeat the procedure, the difficulty of the procedure, the procedure duration, and bowel preparation. RESULTS The median (interquartile range (IQR)) pain scores were 7 (6-8) and 5 (4-6) in the control and VR groups, respectively (p<0.001). The median (IQR) skin conductance values after colonoscope insertion were 0.660 (0.490-0.840) and 0.390 (0.280-0.600) in the control and VR groups, respectively (p<0.001). Overall, patient satisfaction was significantly improved with the use of VR, along with a significant reduction in the difficulty perceived by the endoscopist. CONCLUSION VR technology helped to reduce patients' pain and nervousness and to improve patients' satisfaction during colonoscopies.
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Affiliation(s)
- Qizhi Liu
- Shanghai Fourth People's Hospital, Shanghai, China
| | | | - Wei Zang
- Ministry of Education, Shanghai, China
| | | | - Weiwei Li
- Ministry of Education, Shanghai, China
| | | | - Cheng Xin
- Naval Medical University, Shanghai, China
| | - Xiaohuang Tu
- Shanghai Fourth People's Hospital, Shanghai, China.
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Ghasemi M, Hoseinialiabadi P, Yazdanpanah F, Mahani MA, Malekyan L, Najafi K, Arab M, Arab M, Ranjbar H. Comparison of music and vapocoolant spray in reducing the pain of venous cannulation in children age 6-12: a randomized clinical trial. BMC Pediatr 2022; 22:237. [PMID: 35488225 PMCID: PMC9052614 DOI: 10.1186/s12887-022-03271-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Venous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia. Methods The study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements. Results During and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control. Conclusions Vapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation. Trial registration The trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904.
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Affiliation(s)
| | - Poria Hoseinialiabadi
- Student Research Committee of School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | | | - Maryam Askaryzadeh Mahani
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Leila Malekyan
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Kazem Najafi
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran.,Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | | | - Mansour Arab
- Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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Wilkens R, Dolinger M, Burisch J, Maaser C. Point-of-Care Testing and Home Testing: Pragmatic Considerations for Widespread Incorporation of Stool Tests, Serum Tests, and Intestinal Ultrasound. Gastroenterology 2022; 162:1476-1492. [PMID: 34995530 DOI: 10.1053/j.gastro.2021.10.052] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2021] [Revised: 10/13/2021] [Accepted: 10/28/2021] [Indexed: 12/12/2022]
Abstract
Breaking through the biologic therapy efficacy plateau for inflammatory bowel disease requires the strategic development of personalized biomarkers in the tight control model. After risk stratification early in the disease course, targeted serial monitoring consistently to assess clinical outcomes in response to therapy allows for quick therapeutic adjustments before bowel damage can occur. Point-of-care intestinal ultrasound performed by the treating gastroenterologist is an accurate cross- sectional biomarker that monitors intestinal inflammation in real-time, enhances patient care, and increases shared understanding to help achieve common treatment goals. Combining intestinal ultrasound during a clinic visit with existing serum and stool biomarkers in a home testing setup with electronic health monitoring allows for an optimized, patient-centered personalized treatment algorithm that may improve treatment outcomes. Here, we review the current state, pragmatic considerations, and future implications of point-of-care testing and home testing for noninvasive inflammatory bowel disease monitoring in the tight control model.
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Affiliation(s)
- Rune Wilkens
- Gastrounit, Division of Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark; Digestive Disease Center, Copenhagen University Hospital - Bispebjerg & Frederiksberg, Copenhagen, Denmark.
| | - Michael Dolinger
- Susan and Leonard Feinstein Inflammatory Bowel Disease Center, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Johan Burisch
- Gastrounit, Division of Medicine, Copenhagen University Hospital Hvidovre, Hvidovre, Copenhagen, Denmark; Copenhagen Center for Inflammatory Bowel Disease in Children, Adolescents and Adults, University of Copenhagen, Hvidovre Hospital, Denmark
| | - Christian Maaser
- Inflammatory Bowel Disease Outpatient Unit, Department of Geriatric Medicine, University Teaching Hospital Lueneburg, Lueneburg, Germany
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Burger RK, Taylor TR, Chumpitazi CE, Robinson LC, Sims MJ, Tunc EM, Mulcrone AE, Caglar D, Sulton CD, Little-Wienert K, Klein EJ, Titus MO, Jackson BF. Pediatric Emergency Medicine Fellowship Procedural Sedation Training: Consensus Educational Guidelines. Pediatr Emerg Care 2022; 38:162-166. [PMID: 35358144 DOI: 10.1097/pec.0000000000002568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Pediatric procedural sedation (PPS) is a core clinical competency of pediatric emergency medicine (PEM) fellowship training mandated by both the Accreditation Council for Graduate Medical Education and the American Board of Pediatrics. Neither of these certifying bodies, however, offers specific guidance with regard to attaining and evaluating proficiency in trainees. Recent publications have revealed inconsistency in educational approaches, attending oversight, PPS service rotation experiences, and evaluation practices among PEM fellowship programs. METHODS A select group of PEM experts in PPS, PEM fellowship directors, PEM physicians with educational roles locally and nationally, PEM fellows, and recent PEM fellowship graduates collaborated to address this opportunity for improvement. RESULTS This consensus driven educational guideline was developed to outline PPS core topics, evaluation methodology, and resources to create or modify a PPS curriculum for PEM fellowship programs. This curriculum was developed to map to fellowship Accreditation Council for Graduate Medical Education core competencies and to use multiple modes of dissemination to meet the needs of diverse programs and learners. CONCLUSIONS Implementation and utilization of a standardized PPS curriculum as outlined in this educational guideline will equip PEM fellows with a comprehensive PPS knowledge base. Pediatric emergency medicine fellows should graduate with the competence and confidence to deliver safe and effective PPS care. Future study after implementation of the guideline is warranted to determine its efficacy.
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Affiliation(s)
- Rebecca K Burger
- From the Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Taryn R Taylor
- From the Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Corrie E Chumpitazi
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Lauren C Robinson
- Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Morgan J Sims
- Division of Emergency Medicine, Department of Pediatrics, University of North Carolina, Chapel Hill, NC
| | - Emine M Tunc
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Amanda E Mulcrone
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Derya Caglar
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - Carmen D Sulton
- From the Division of Emergency Medicine, Department of Pediatrics, Emory University School of Medicine and Children's Healthcare of Atlanta, Atlanta, GA
| | - Kim Little-Wienert
- Section of Emergency Medicine, Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Eileen J Klein
- Division of Emergency Medicine, Department of Pediatrics, University of Washington School of Medicine, Seattle, WA
| | - M Olivia Titus
- Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
| | - Benjamin F Jackson
- Division of Emergency Medicine, Department of Pediatrics, Medical University of South Carolina, Charleston, SC
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Ali S, Rajagopal M, Stinson J, Ma K, Vandermeer B, Felkar B, Schreiner K, Proctor A, Plume J, Hartling L. Virtual reality-based distraction for intravenous insertion-related distress in children: a study protocol for a randomised controlled trial. BMJ Open 2022; 12:e057892. [PMID: 35354617 PMCID: PMC8968513 DOI: 10.1136/bmjopen-2021-057892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Intravenous (IV) insertions are among the most performed procedures for children seeking medical care; they are often a painful and stressful experience for both children and their caregivers. Paediatric distress and pain that is inadequately treated may lead to a frightened and uncooperative child, repeated IV attempts and overall frustration with care for both the family and clinical team. We hypothesise that distraction via an immersive virtual reality (VR) experience may reduce the associated distress for children undergoing IV insertions. METHODS AND ANALYSIS This two-armed randomised controlled superiority trial will be conducted in a Canadian paediatric emergency department and will aim to enrol 80 children overall. Children will be randomised to receive either departmental standard of care alone or standard of care plus an immersive VR experience. Children 6-17 years of age who are undergoing IV insertion and have topical anaesthetic application will be considered for inclusion. Our primary objective is to compare the reduction of distress between the two study arms. The primary outcome will be the child's observed distress score as measured by the Observational Signs of Behavioral Distress-Revised tool. Secondary outcomes include the child's pain intensity and fear, parental anxiety, satisfaction with the IV procedure, as well as adverse events. Recruitment launched in September 2020 and is expected to end in March 2022. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent will be obtained from parents or guardians, and assent from children. Study data will be submitted for publication irrespective of results. This study is funded through a Women and Children's Health Research Institute Innovation grant. Purchase of the VR equipment was facilitated through a Stollery Children's Hospital Foundation small equipment grant. TRIAL REGISTRATION NUMBER NCT04291404Cite Now.
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Affiliation(s)
- Samina Ali
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Manasi Rajagopal
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Keon Ma
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Bailey Felkar
- London Health Sciences Centre Children's Hospital, London, Ontario, Canada
| | - Kurt Schreiner
- Pediatric Parents' Advisory Group, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Proctor
- Stollery Youth Advisory Council and Patient and Family Centred Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jennifer Plume
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Ogihara H. Development and validation of the Distracting Ingenuity Promotion Scale for paediatric nurses to support the psychological outcomes of paediatric patients and their families: A survey-based cross-sectional cohort study. Nurs Open 2022; 9:1653-1666. [PMID: 35274821 PMCID: PMC8994938 DOI: 10.1002/nop2.1190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Revised: 12/24/2021] [Accepted: 01/30/2022] [Indexed: 11/24/2022] Open
Abstract
Aim To develop and validate the Distracting Ingenuity Promotion Scale (DIPS) for paediatric nurses. Design Cross‐sectional study using anonymized self‐administered questionnaires. Methods From July–November 2013, paediatric nurses working in the wards or outpatient departments in 39 medical institutions in Japan were enrolled in the survey. Data were analysed using the Student's t‐test, Mann–Whitney U test and analysis of variance test. Exploratory and confirmatory factor analyses were performed to validate the factors in the DIPS. Cronbach's α was used to calculate the reliability of the DIPS. Results The DIPS included five subscales comprising 21 items. The goodness‐of‐fit indices for confirmatory factor analysis had a Comparative Fit Index of 0.923 and a Root Mean Square Error of Approximation of 0.059 and fulfilled the standard external validity criteria. Cronbach's α was 0.707–0.826 for each subscale and 0.895 for the overall scale.
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Affiliation(s)
- Hiroyuki Ogihara
- Pediatric Nursing, Faculty of Nursing, Ashikaga University, Ashikaga, Tochigi, Japan.,Graduate School of Science and Technology, Gunma University, Kiryu, Gunma, Japan
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Lee HN, Hwang S, Jung JY, Park JW, Kim DK, Kwak YH. Tablet personal computer distraction during intravenous placement for young children in the pediatric emergency department: A pilot study. Pediatr Int 2022; 64:e15150. [PMID: 35510723 DOI: 10.1111/ped.15150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 01/16/2022] [Accepted: 01/21/2022] [Indexed: 11/30/2022]
Abstract
BACKGROUND Intravenous (IV) placement is a common procedure experienced by children visiting the pediatric emergency department (PED). However, uncontrolled anxiety and pain cause children to interfere with the procedure. In this pilot study, we sought to evaluate the effectiveness of tablet personal computers as a distraction method during IV placement. METHODS This is a single-center pilot study conducted at a tertiary teaching hospital. Children visiting the PED were eligible if they were aged 3-5 years and required IV placement during the PED visit. After written consent was obtained from the guardian, the child was randomly assigned to a control group or an intervention group. For the intervention group, an animated video was played via tablet PC during IV placement. For both groups, children's anxiety, heart rate, and pain scale scores (the Face, Legs, Activity, Cry, Consolability and Evaluation Enfant Douleur) and guardian satisfaction were recorded. RESULTS 22 children were eligible for the final analysis. There was no significant difference in the pain scale scores between the two groups, with the exception of the degree of pain relief after the procedure measured using Evaluation Enfant Douleur (intervention group: 6.0, interquartile range (IQR): 4.2-6.8, and control group; 3.0, IQR: 2.0-3.8, P = 0.011) and Face, Legs, Activity, Cry, Consolability (intervention group: 4.0, IQR: 4.0-4.2 and control group; 3.0, IQR: 1.5-3.5, P = 0.043). CONCLUSION In this pilot study, distraction using tablet personal computers may have reduced children's distress during the recovery phase after venipuncture. Further study with a larger sample size and different methods of distraction is essential.
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Affiliation(s)
- Ha Ni Lee
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Soyun Hwang
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Jae Yun Jung
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Joong Wan Park
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Do Kyun Kim
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
| | - Young Ho Kwak
- Department of Pediatrics, Severance Children's Hospital, Yonsei University College of Medicine, Seodaemun-gu, Korea
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Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth 2021; 127:608-619. [PMID: 34340838 DOI: 10.1016/j.bja.2021.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. METHODS We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0-18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using 'R' of children's procedural pain and anxiety and caregivers' anxiety. RESULTS Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=-0.43; 95% confidence interval [CI]: -0.67 to -0.20), anxiety (SMD=0.61; 95% CI: -0.88 to -0.34), and caregivers' procedural anxiety (SMD=-0.31; 95% CI: -0.58 to -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. CONCLUSIONS Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.
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Gjærde LK, Hybschmann J, Dybdal D, Topperzer MK, Schrøder MA, Gibson JL, Ramchandani P, Ginsberg EI, Ottesen B, Frandsen TL, Sørensen JL. Play interventions for paediatric patients in hospital: a scoping review. BMJ Open 2021; 11:e051957. [PMID: 34312210 PMCID: PMC8314749 DOI: 10.1136/bmjopen-2021-051957] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Play is a non-invasive, safe and inexpensive intervention that can help paediatric patients and their families manage difficult aspects of being ill or hospitalised. Although play has existed in hospitals for decades, research on hospital play interventions is scarce. This review aimed to categorise and synthesise the last 20 years of research on hospital play interventions. DESIGN Scoping review. DATA SOURCES PubMed, CINAHL, CENTRAL, ERIC and PsycINFO (1 January 2000- 9 September 2020). STUDY SELECTION AND DATA EXTRACTION We systematically searched for original peer-reviewed articles, written in English, on hospital play interventions in paediatric patients (0-18 years) in non-psychiatric settings. Two reviewers independently screened titles and abstracts, reviewed full text of relevant articles and extracted data. We thematically synthesised the data from the included studies, and a descriptive analysis, based on a developed framework, is presented. RESULTS Of the 297 included articles, 78% came from high-income countries and 56% were published within the last 5 years. Play interventions were carried out across all ages by various healthcare professionals. Play interventions served different roles within four clinical contexts: A) procedures and diagnostic tests, B) patient education, C) treatment and recovery and D) adaptation. Across these contexts, play interventions were generally facilitated and purpose-oriented and had positive reported effects on pain, stress, and anxiety. CONCLUSIONS Play in hospitals is an emerging interdisciplinary research area with a significant potential benefit for child and family health. Future research should further describe principles for play in hospitals. High-quality studies investigating short-term and long-term effects are needed to guide when and how to best integrate play in hospitals.
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Affiliation(s)
- Line Klingen Gjærde
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jane Hybschmann
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Daniel Dybdal
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Martha Krogh Topperzer
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Morten Arnborg Schrøder
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jenny Louise Gibson
- Centre for Research on Play in Education, Development & Learning, Faculty of Education, Cambridge University, Cambridge, UK
| | - Paul Ramchandani
- Centre for Research on Play in Education, Development & Learning, Faculty of Education, Cambridge University, Cambridge, UK
| | - Elisabeth Ida Ginsberg
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Bent Ottesen
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Thomas Leth Frandsen
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
| | - Jette Led Sørensen
- Children's Hospital Copenhagen and Juliane Marie Centre, Rigshospitalet, Copenhagen, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
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Cadet LB, Reynaud E, Chainay H. Memory for a virtual reality experience in children and adults according to image quality, emotion, and sense of presence. VIRTUAL REALITY 2021; 26:55-75. [PMID: 34075297 PMCID: PMC8153522 DOI: 10.1007/s10055-021-00537-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 05/06/2021] [Indexed: 06/12/2023]
Abstract
UNLABELLED Numerous studies have explored the effects of virtual reality (VR) on adults' cognition. Little is known, however, of these effects in children. The aim of this study was to explore, in both children and adults, the respective roles of the specific factors of VR, such as immersion, sense of presence and emotion, on memory performance. To do so, we used a head-mounted display to present a VR experience in which we manipulated immersion by varying 3D asset quality (High and Low) and emotion by presenting negative, neutral and positive stimuli. 48 adults (M age = 20.65) and 40 children (M age = 11.63) were both divided into two experimental groups (High vs. Low 3D model quality). Valence, arousal, and sense of presence were self-assessed by means of questionnaires, while memory of the presented stimuli was assessed using a free recall task. We also performed physiological measurements to provide objective support for our data. Results showed that memory performance was better for emotional than for neutral stimuli regardless of age group, even though children seemed to avoid looking at negative stimuli compared to neutral ones. Memory was predicted by arousal and presence in adults and only by arousal in children. Memory was not impaired by using poor image quality when highly arousing content was displayed. This study revealed that, contrary to adults, the use of poor image quality did not protect children from strong emotional experiences in VR. The roles of familiarity and arousal are discussed to help explain these results. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s10055-021-00537-y.
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Affiliation(s)
- Lénaïc B. Cadet
- Laboratoire d’Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676 Bron, France
| | - Emanuelle Reynaud
- Laboratoire d’Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676 Bron, France
| | - Hanna Chainay
- Laboratoire d’Etude des Mécanismes Cognitifs, Université Lyon 2, 5 avenue Pierre Mendès France, 69676 Bron, France
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Logan DE, Simons LE, Caruso TJ, Gold JI, Greenleaf W, Griffin A, King CD, Menendez M, Olbrecht VA, Rodriguez S, Silvia M, Stinson JN, Wang E, Williams SE, Wilson L. Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management. J Med Internet Res 2021; 23:e25916. [PMID: 33667177 PMCID: PMC8111507 DOI: 10.2196/25916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. OBJECTIVE The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. METHODS An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. RESULTS Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR and AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions. CONCLUSIONS To realize the promise of this realm of innovation, key ingredients for success include productive partnerships among industry, academic, and clinical stakeholders; a uniform set of outcome domains and measures for standardized evaluation; and widespread access to the latest opportunities, tools, and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children.
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Affiliation(s)
- Deirdre E Logan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Jeffrey I Gold
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Maria Menendez
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Vanessa A Olbrecht
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Megan Silvia
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, United States
- Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, United States
| | | | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Luke Wilson
- Mighty Immersion, Inc., New York, NY, United States
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Nazarian A, Negus SS, Martin TJ. Factors mediating pain-related risk for opioid use disorder. Neuropharmacology 2021; 186:108476. [PMID: 33524407 PMCID: PMC7954943 DOI: 10.1016/j.neuropharm.2021.108476] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 12/03/2020] [Accepted: 01/23/2021] [Indexed: 12/23/2022]
Abstract
Pain is a complex experience with far-reaching organismal influences ranging from biological factors to those that are psychological and social. Such influences can serve as pain-related risk factors that represent susceptibilities to opioid use disorder. This review evaluates various pain-related risk factors to form a consensus on those that facilitate opioid abuse. Epidemiological findings represent a high degree of co-occurrence between chronic pain and opioid use disorder that is, in part, driven by an increase in the availability of opioid analgesics and the diversion of their use in a non-medical context. Brain imaging studies in individuals with chronic pain that use/abuse opioids suggest abuse-related mechanisms that are rooted within mesocorticolimbic processing. Preclinical studies suggest that pain states have a limited impact on increasing the rewarding effects of opioids. Indeed, many findings indicate a reduction in the rewarding and reinforcing effects of opioids during pain states. An increase in opioid use may be facilitated by an increase in the availability of opioids and a decrease in access to non-opioid reinforcers that require mobility or social interaction. Moreover, chronic pain and substance abuse conditions are known to impair cognitive function, resulting in deficits in attention and decision making that may promote opioid abuse. A better understanding of pain-related risk factors can improve our knowledge in the development of OUD in persons with pain conditions and can help identify appropriate treatment strategies. This article is part of the special issue on 'Vulnerabilities to Substance Abuse.'.
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Affiliation(s)
- Arbi Nazarian
- Department of Pharmaceutical Sciences, Western University of Health Sciences, Pomona, CA 91766, USA.
| | - S Stevens Negus
- Department of Pharmacology and Toxicology, Virginia Commonwealth University, Richmond, VA 23298, USA
| | - Thomas J Martin
- Department of Anesthesiology, Wake Forest School of Medicine, Winston-Salem, NC 27157, USA
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Ali S, Manaloor R, Ma K, Sivakumar M, Beran T, Scott SD, Vandermeer B, Beirnes N, Graham TAD, Curtis S, Jou H, Hartling L. A randomized trial of robot-based distraction to reduce children's distress and pain during intravenous insertion in the emergency department. CAN J EMERG MED 2021; 23:85-93. [PMID: 33683608 DOI: 10.1007/s43678-020-00023-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/08/2020] [Indexed: 12/27/2022]
Abstract
OBJECTIVES Our objectives were to evaluate the effectiveness of humanoid robot-based distraction on reducing distress and pain in children undergoing intravenous insertion. METHODS A two-arm, open-label randomized controlled trial was conducted April 2017-May 2018, in a pediatric emergency department (ED). A sample of 86 children aged 6-11 years who required intravenous insertion were recruited. Exclusion criteria included hearing/visual impairments, neurocognitive delay, sensory impairment to pain, previous enrollment, and ED clinical staff discretion. Outcome measures included the Observed Scale of Behavioral Distress-Revised (OSBD-R) (distress) and the Faces Pain Scale-Revised (FPS-R) (pain). RESULTS Of the 86 children recruited (median age 9 years, IQR 7,10); 55% (47/86) were male, 9% (7/82) were premature, 82% (67/82) had a previous ED visit, 31% (25/82) had a previous hospitalization and 78% (64/82) had previous intravenous insertion. Ninety-six percent (78/81) received topical anesthetic prior to intravenous insertion. Total OSBD-R distress score was 1.49 ± 2.36 (standard care) versus 0.78 ± 1.32 (robot) (p < 0.05). FPS-R pain score was 4 (IQR 2,6) (standard care) versus 2 (IQR 0,4) (robot) (p = 0.13). Parental anxiety immediately after the procedure was 36.7 (11.1) (standard care) versus 31.3 (8.5) (robot) (p = 0.04). Parents were more satisfied with pain management in the robotic distraction group (95% vs 72% very satisfied) (p = 0.002). CONCLUSIONS Humanoid robot-based distraction therapy is associated with a modest positive impact on child distress for pediatric intravenous insertion, but not pain. It can be considered a potential tool in the ED toolkit for procedural pain-associated distress reduction. CLINICAL TRIAL REGISTRATION Clinicaltrials.gov Identifier: NCT02997631.
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Affiliation(s)
- Samina Ali
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada. .,Women and Children's Health Research Institute (WCHRI), Edmonton, AB, Canada.
| | - Robin Manaloor
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Keon Ma
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Mithra Sivakumar
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Tanya Beran
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Shannon D Scott
- Faculty of Nursing, University of Alberta, Edmonton, AB, Canada
| | - Ben Vandermeer
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.,Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, AB, Canada
| | - Natasha Beirnes
- Child Life Department, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Timothy A D Graham
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Sarah Curtis
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.,Women and Children's Health Research Institute (WCHRI), Edmonton, AB, Canada
| | - Hsing Jou
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada
| | - Lisa Hartling
- Department of Pediatrics, Faculty of Medicine and Dentistry, University of Alberta, 3-583 Edmonton Clinic Health Academy, 11405-87 Avenue, Edmonton, AB, T6G 1C9, Canada.,Women and Children's Health Research Institute (WCHRI), Edmonton, AB, Canada.,Department of Pediatrics, Alberta Research Centre for Health Evidence, University of Alberta, Edmonton, AB, Canada
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43
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Affiliation(s)
- Cesare Hassan
- Endoscopy Unit, Nuovo Regina Margherita Hospital, Rome, Italy
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Lima TRD, Boniatti MM. Randomising children to electronic distraction and vibration was not associated with reduced pain during childhood vaccinations. Acta Paediatr 2020; 109:2162-2163. [PMID: 32145114 DOI: 10.1111/apa.15246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Thais Reis de Lima
- Postgraduate Program in Health and Human Development, La Salle University, Canoas, Brazil.,Vaccine Center, Hospital Moinhos de Vento, Porto Alegre, Brazil
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