Elsevier

Burns

Volume 37, Issue 3, May 2011, Pages 395-405
Burns

A novel technology approach to pain management in children with burns: A prospective randomized controlled trial

https://doi.org/10.1016/j.burns.2010.12.008Get rights and content

Abstract

Background

Non-pharmacological approaches to supporting young children through painful medical procedures are an essential component of burn pain management protocols. New technology developed from collaborations between healthcare professionals and IT teams can enhance the preparation and distraction approaches used with children. This study follows on from previous studies using such technology, and aim to determine whether levels of pain and distress using a combined preparation and distraction content can be further reduced, and offer more efficient clinical outcomes.

Methods

Forty children (3–10 years) undergoing acute burn care procedures were randomized to two groups: (1) Standard Distraction (SD) Group and (2) Multi Modal Distraction (MMD) Group (combined protocol of procedural preparation and distraction). Pain intensity and child distress were measured prior to and during the procedure. Clinical utility end points were also included; length of treatment, days to healing and adverse pain events.

Results

A combined MMD protocol significantly reduced pain intensity (p < 0.001) and distress scores (p < 0.001) when compared to SD. Length of treatment (p < 0.05), days to healing and the number of pain adverse events were also reduced (p < 0.05) with the use of the MMD protocol.

Conclusions

A combined MMD protocol reduces the pain experiences for young children during burn care procedures. When compared with a previous MMD trial, outcomes reiterated the use of procedural preparation as an essential component of non-pharmacological approaches. In addition to minimizing pain and distress, this innovative technology reduced treatment length and pain adverse events, and may have an impact on reducing days to healing, providing evidence of clinical efficacy and utility.

Introduction

Technology based distractions are continuing to demonstrate the positive impact of developmentally appropriate, focused and intensive non-pharmacological support on pain and distress during burn care procedures [1], [2], [3], [4], [5]. Technology delivers multi-sensory, novel, cognitive and physically engaging activities continuously to the patient throughout treatment. In relation to children, it can also be modified to meet their developmental needs to ensure motivation and engagement. Previous studies have assessed the use of Multi-Modal Distraction (MMD) as a purely distraction based approach [1], [5] and the development of content to deliver procedural preparation prior to wound care procedures [5]. MMD is a hand held technology device, developed specifically to prepare and engage children between 3 and 10 years during medical procedures to reduce their pain experiences. Results of these trials suggest that individually both these techniques significantly reduce children's pain and distress [5]. Reports in the paediatric pain literature indicate that these two approaches utilize different cognitive mechanisms to impact upon the child's pain/distress. Procedural preparation aims to alleviate fears and misconceptions about the procedure by giving the child truthful information about what to expect and what is expected of them during the procedure [6], [7]. This gives them context for the event and a feeling of some control over what may happen to them. Distraction aims to divert the child's attention away from the sights and sounds of the procedures to reduce the impact these experiences have on the child's fear and affective response to the pain experience. Given the differences in these mechanisms and their individual impact on the pain experience, it may be hypothesized that when combined procedural preparation and distraction may even further reduce the child's pain and distress.

The aim of this study was to determine if a combined MMD protocol (preparation and distraction) will reduce the pain and distress of 3–10 year olds undergoing burn care procedures as outpatients when compared with children provided with Standard Distraction (SD) (current typical treatment). The study results will be compared with the previous MMD trial [5], to understand the benefits of a combined protocol over offering preparation and distraction separately.

Section snippets

Participants

Forty children attending the Stuart Pegg Paediatric Burns Outpatient Centre (SPPBC) at the Royal Children's Hospital, Brisbane, Australia, were recruited for this study. Recruitment occurred over an eight month period from November 2008 until June 2009. During the data collection period (November 2008 to June 2009), 816 potential participants were screened for eligibility. 346 children who attended were treated for a new burn or skin grafting during this time. Of these, there were 271 children

Sample

At baseline the MMD and Standard Distraction groups were comparable across all personal and clinical characteristics, Table 1, including age, gender, TBSA, depth of burn, site and mode of injury, pain medication provided and caregiver presence. Participants eligible for the study but whom did not provide consent (n = 8) or were missed by the research team (n = 26) did not differ from the sample in terms of age (p = 0.836), gender (p = 0.578), TBSA (p = 0.833), days to heal (p = 0.867), burn depth (p = 

Discussion

This clinical trial has progressed the clinical understanding of the benefits of the MMD device and its’ content in managing the pain experience of children with burns. The study has presented four new contributions to the literature and has supported previous outcomes of the use of the MMD device within the Stuart Pegg Paediatric Burns Centre (SPPBC) [1], [5]. Firstly, the results showed that a combined approach of preparation prior to the procedure and distraction during the procedure using

Conclusion

Consistent pain reductions have been shown with the use of MMD in three clinical trials compared to current standard distraction practices [1], [5]. This study indicated the significant impact that a combined protocol of MMD procedural preparation and distraction had on pain intensity, and clinical efficiency and utility. This study also investigated what MMD distraction content children chose to engage in during the burn care procedures, with the majority of children choosing a novel look and

Conflict of interest statement

The study was supported financially by a grant given to the Royal Children's Hospital, Brisbane, by DTT; however DTT had no role in the study design, data collection or analysis of results from the clinical trial. Roy Kimble is the supervisor of this trial, and also holds options with this company but at the time of the clinical trial and submission will not stand to lose or gain financially or personally from the results. The principal researcher remains an employee of the Royal Children's

Acknowledgements

We would like to thank the nursing staff, namely Annette Wright, Cath McMillian and Kristen Storey at the Stuart Pegg Paediatric Burns Centre for your assistance with the project. Thanks to Diversionary Therapy Technologies (DTT) for the use of their Ditto™ (MMD) device and the RCH Occupational Therapy Department for all your support.

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