Multi-modal distraction. Using technology to combat pain in young children with burn injuries

Miller, Kate, Rodger, Sylvia, Bucolo, Sam, Greer, Ristan and Kimble, Roy M. (2010) Multi-modal distraction. Using technology to combat pain in young children with burn injuries. Burns, 36 5: 647-658. doi:10.1016/j.burns.2009.06.199


Author Miller, Kate
Rodger, Sylvia
Bucolo, Sam
Greer, Ristan
Kimble, Roy M.
Title Multi-modal distraction. Using technology to combat pain in young children with burn injuries
Journal name Burns   Check publisher's open access policy
ISSN 0305-4179
1879-1409
Publication date 2010-08-01
Year available 2009
Sub-type Article (original research)
DOI 10.1016/j.burns.2009.06.199
Open Access Status Not yet assessed
Volume 36
Issue 5
Start page 647
End page 658
Total pages 12
Editor S. Wolf
Place of publication Oxford, U.K.
Publisher Elsevier Science.
Language eng
Subject C1
111403 Paediatrics
119999 Medical and Health Sciences not elsewhere classified
920501 Child Health
109999 Technology not elsewhere classified
Abstract Background: The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocols despite ongoing acknowledgement of its role. Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain, as exemplified by the development of multi-modal distraction (MMD). This easy to use, hand held interactive device uses customised programs designed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes.
Formatted abstract
Background The use of non-pharmacological pain management remains adhoc within acute paediatric burns pain management protocols despite ongoing acknowledgement of its role. Advancements in adult based pain services including the integration of virtual reality has been adapted to meet the needs of children in pain, as exemplified by the development of multi-modal distraction (MMD). This easy to use, hand held interactive device uses customised programs designed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes.

Aim

(1) To investigate if either MMD procedural preparation (MMD-PP) or distraction (MMD-D) has a greater impact on child pain reduction compared to standard distraction (SD) or hand held video game distraction (VG),
(2) to understand the impact of MMD-PP and MMD-D on clinic efficiency by measuring length of treatment across groups, and lastly,
(3) to assess the efficacy of distraction techniques over three dressing change procedures.

Methods
A prospective randomised control trial was completed in a paediatric tertiary hospital Burns Outpatient Clinic. Eighty participants were recruited and studied over their first three dressing changes. Pain was assessed using validated child report, caregiver report, nursing observation and physiological measures.

Results
MMD-D and MMD-PP were both shown to significantly relieve reported pain (p ≤ 0.05) and reduce the time taken for dressings (p ≤ 0.05) compared to SD and VG. The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes.

Conclusions
The use of MMD as a preparatory or a distraction tool in an outpatient burns clinic offered superior pain reduction across three dressing changes to children when compared to standard practices or hand held video games. This device has the potential to improve clinic efficiency with reductions in treatment lengths.
© 2009 Elsevier Ltd and ISBI. All rights reserved
Keyword Pain
Virtual reality
Multi-modal distraction
Paediatric
Burns
Randomized controlled-trial
Virtual-reality
Dressing changes
Self-report
Postoperative pain
Medical procedures
Procedural pain
Clinical-trials
Pediatric pain
Brain activity
Q-Index Code C1
Q-Index Status Confirmed Code
Institutional Status UQ
Additional Notes Available online 3 November 2009.

 
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Created: Wed, 03 Mar 2010, 01:30:17 EST by Meredith Downes on behalf of Paediatrics & Child Health - RBWH