Play and heal: Randomized controlled trial of Ditto鈩?intervention efficacy on improving re-epithelialization in pediatric burns

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• 作者：Nadia J. Brown ; Roy M. Kimble ; Sylvia Rodger ; Robert S. Ware ; Leila Cuttle
• 关键词：Burns ; Child ; Pain ; Stress ; Anxiety ; Salivary cortisol ; Salivary alpha-amylase ; Re-epithelialization ; Virtual reality ; Randomized clinical trial
• 刊名：Burns
• 出版年：March, 2014
• 年：2014
• 卷：40
• 期：2
• 页码：204-213
• 全文大小：506 K

文摘

Background

The relationships between pain, stress and anxiety, and their effect on burn wound re-epithelialization have not been well explored to-date. The aim of this study was to investigate the effect of the Ditto鈩?(a hand-held electronic medical device providing procedural preparation and distraction) intervention on re-epithelialization rates in acute pediatric burns.

Methods/Design

From August 2011 to August 2012, children (4-12 years) with an acute burn presenting to the Royal Children's Hospital, Brisbane, Australia fulfilled the study requirements and were randomized to Ditto鈩?intervention or standard practice. Burn re-epithelialization, pain intensity, anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization.

Results

One hundred and seventeen children were randomized and 75 children were analyzed (n = 40 standard group; n = 35 Ditto鈩?group). Inability to predict wound management resulted in 42 participants no longer meeting the eligibility criteria. Wounds in the Ditto鈩?intervention group re-epithelialized faster than the standard practice group (鈭?.14 days (CI: 鈭?.38 to 0.10), p-value = 0.061), and significantly faster when analyses were adjusted for mean burn depth (鈭?.26 days (CI: 鈭?.48 to 鈭?.04), p-value = 0.046). Following procedural preparation at the first change of dressing, the Ditto鈩?group reported lower pain intensity scores (鈭?.64 (CI: 鈭?.28, 0.01) p = 0.052) and lower anxiety ratings (鈭?.79 (CI: 鈭?.59, 0.01) p = 0.051). At the second and third dressing removals average pain (FPS-R and FLACC) and anxiety scores (VAS-A) were at least one point lower when Ditto鈩?intervention was received.

Conclusions

The Ditto鈩?procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures.