Background
Methods
Protocol and registration
Eligibility criteria
Inclusion | Exclusion |
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1. Studies focused on unintentional pediatric burn injuries. 2. Injured children < 18 years receiving treatment at time of study, and/or their caregivers. 3. Assessment of psychosocial interventionsa 4. Randomised control trials (RCT) or non-randomised control trials (NRCT) with clear comparison groups. 5. Assessing patient pain and theirs and/or caregiver’s anxiety, distress, and/or trauma symptoms. 6. Studies published in English with no date restrictions. | 1. Focus on non-burn injuries/illnesses or intentional burn injuries. 2. Injured adults > 18 years and/or injured children < 18 years post burns care. 3. Assessment of physical interventions i.e. dressings, physical therapy, massage etc. 4. Studies with no clear comparison group. 5. Assessment of any other outcome variable, or studies measuring only pain. |
Information sources
Study selection
Assessment of cultural components, study quality and risk of bias
Data synthesis
Results
Study selection
Main results
Reference | Group | N | Age M (SD) | Age Range | Male n (%) | TBSA% M (SD) | Ethnicity n (%) | ||
---|---|---|---|---|---|---|---|---|---|
Reported | Not reported | First Nation | |||||||
Blakeney 2005 [43]. | I | 32 | 14 (1.8) | 12–17 | 9 (28) | 36.8 (25.1) | 32 (100) | 0 (0) | 2 (6)* |
C | 32 | 14.2 (1.9) | 17 (53) | 44.2 (20.6) | 32 (100) | 0 (0) | 0 (0)* | ||
Brown 2014 [44]. | I | 47 | 8.3 (2.5) | 4–13 | 27 (57.5) | 1.9 (2.2) | 47 (100) | 0 (0) | 0 (0) |
C | 52 | 8.2 (2.7) | 33 (63.5) | 1.9 (2.1) | 52 (100) | 0 (0) | 0 (0) | ||
Burns-Nader 2017 [45]. | I | 15 | 7.8 (2.3) | 4–12 | 8 (53) | 9.2 (10.3) | 15 (100) | 0 (0) | 0 (0) |
C | 15 | 7.1 (2.8) | 11 (73) | 6.4 (7.5) | 15 (100) | 0 (0) | 0 (0) | ||
Chester 2018 [46]. | I | 29 | 8.6 (3.4) | 4–15 | 16 (59) | 1.2 (2.0)^ | 0 (0) | 29 (100) | 0 (0)** |
C | 35 | 7.1 (2.7) | 4–15 | 22 (63) | 1.0 (2.0)^ | 0 (0) | 35 (100) | 0 (0)** | |
Elliott 1983 [47] | I | 4 | 8.5 (3.5) | 5–12 | 4 (100) | 21.5 (15.0) | 3 (75) | 1 (25) | 0 (0) |
C | 4 | 6.7 (2.1) | 5–9 | 4 (100) | 32 (24.3) | 1 (25) | 3 (75) | 0 (0) | |
Foertsch 1998 [48] | I | 13 | 5.8 | 3–12 | 12 (52) | 11.4 | 0 (0) | 13 (100) | 0 (0) |
C | 10 | 0 (0) | 10 (100) | 0 (0) | |||||
Hyland 2015 [49] | I | 50 | 2.3 (1.5–4.5)^ | 0–16 | 25 (50) | 0.8 (0.5–2.0)^ | 0 (0) | 50 (100) | 0 (0) |
C | 50 | 2.2 (1.6–3.9)^ | 27 (54) | 0.5 (0.5–2.0)^ | 0 (0) | 50 (100) | 0 (0) | ||
Jeffs 2014 [50]. | IVR | 8 | 14.3 (2.0) | 10–17 | 3 (38) | 7.4 (8.5) | 6 (75) | 2 (25) | 0 (0) |
IPD | 10 | 12.6 (2.1) | 8 (80) | 3.4 (3.3) | 9 (90) | 1 (10) | 0 (0) | ||
C | 10 | 13.9 (2.8) | 8 (80) | 4.7 (6.9) | 10 (100) | 0 (0) | 0 (0) | ||
Kavanagh 1983 [51] | I | 4 | 6.3 (4.4) | 2–11 | 4 (100) | 22.7 (9.1) | 0 (0) | 4 (100) | 0 (0) |
C | 5 | 7.1 (3.8) | 2.5–11.5 | 3 (60) | 37.5 (27.1) | 0 (0) | 5 (100) | 0 (0) | |
Kipping 2012 [52] | I | 20 | 12.6 (1.3) | 11–17 | 13 (65) | 5.1 (6.3) | 0 (0) | 20 (100) | 0 (0) |
C | 21 | 13.5 (1.8) | 15 (71) | 4.7 (4.5) | 0 (0) | 21 (100) | 0 (0) | ||
Miller 2010 [53] | IVGD | 20 | 6.6 (2.5) | 3–10 | 12 (60) | 2.6 (1.4) | 0 (0) | 20 (100) | 0 (0) |
IMMD-D | 20 | 6.6 (2.6) | 13 (65) | 2.8 (1.9) | 0 (0) | 20 (100) | 0 (0) | ||
IMMD-PP | 20 | 5.5 (2.1) | 14 (70) | 4.3 (4.2) | 0 (0) | 20 (100) | 0 (0) | ||
C | 20 | 6.1 (2.1) | 8 (40) | 2.5 (1.4) | 0 (0) | 20 (100) | 0 (0) | ||
Miller 2011 [54] | I | 20 | 6.0 (2.0) | 3–10 | 12 (60) | 2.8 (1.0) | 20 (100) | 0 (0) | 0 (0) |
C | 20 | 5.9 (2.5) | 9 (45) | 2.2 (1.1) | 20 (100) | 0 (0) | 0 (0) | ||
Moore 2015 [55] | IPatient | 12 | 3.0^ | 3–6 | 6 (50) | – | 12 (100) | 0 (0) | 0 (0) |
CPatient | 9 | 3.0^ | 3–5 | 3 (33) | – | 9 (100) | 0 (0) | 0 (0) | |
ICaregiver | 12 | 34^ | 20–44 | 1 (8) | N/A | 0 (0) | 12 (100) | 0 (0) | |
CCaregiver | 9 | 28^ | 23–54 | 1 (11) | N/A | 0 (0) | 9 (100) | 0 (0) | |
Quay 1983 [56] | I | 26 | 5.3 | 0.7–15 | – | 23 (1–81) | 0 (0) | 26 (100) | 0 (0) |
C | 24 | 0 (0) | 24 (100) | 0 (0) | |||||
Sveen 2017 [57] | IPatient | 26 | 5.3 (3.5) | – | 13 (50) | 8.5 (7.0) | 0 (0) | 26 (100 | 0 (0) |
CPatient | 23 | 6.4 (3.8) | 14 (61) | 9.9 (7.0) | 0 (0) | 23 (100) | 0 (0) | ||
ICaregivers | 31 | 36.4 (6.6) | – | 9 (29) | N/A | 0 (0) | 31 (100) | 0 (0) | |
CCaregivers | 31 | 38.3 (5.5) | 11 (35) | N/A | 0 (0) | 31 (100) | 0 (0) | ||
Van der Heijden 2018 [58] | I | 71 | 2.0 (13.1–4.1)^ | 0–13 | 37 (52) | 7 (4–13)^ | 0 (0) | 71 (100) | 0 (0) |
C | 64 | 1.7 (1.3–2.9)^ | 32 (50) | 10 (5–15)^ | 0 (0) | 64 (100) | 0 (0) | ||
Whitehead-Pleaux 2006 [59] | I | 8 | – | 6–16 | 5 (36) | – | 0 (0) | 8 (100) | 0 (0) |
C | 6 | 0 (0) | 6 (100) | 0 (0) |
First author, year [reference] | Study design, location | Intervention | Control | Outcome: measures(assessor*) | Measurement time points |
---|---|---|---|---|---|
Blakeney 2005 [43]. | RCT, USA. | n = 32^3 (9) 4-day group social skills workshop based on Changing Faces REACH OUT, and ‘usual’ treatment. | n = 32^10 (31) ‘Usual’ treatment, and follow-up psychological appointments upon request only. | Anxiety/depression: CBCL(C). | Pre-intervention and 1 year post-intervention: CBCL. |
Brown 2014 [44]. | RCT, Australia. | n = 47^12 (23) Ditto™ PP pre-COD, and distraction interactive story/game during COD. | n = 52^12 (26) Standard distraction during COD: TV, videos, books, toys, and caregiver soothing. | Pain: FPS-R(Pt.), HR(N). Pain and distress: FLACC(N). Anxiety: VAS-A(Pt. > 8 yrs). Trauma: CTSQ(Pt. > 6 yrs). | Pre-randomisation: FPS-R, HR, FLACC, VAS-A. Pre-removal: FPS-R, FLACC, VAS-A. Post-removal: FPS-R, HR, FLACC, VAS-A, CTSQ(1st COD). Post- application: FPS-R, HR, FLACC, VAS-A. During removal and application: HR. 3mths post re-epithelisation: CTSQ. |
Burns-Nader 2017 [45]. | RCT, USA. | n = 15^0 (0) Tablet distraction game, and CLT support during 2nd and/or 3rd COD. | n = 15^0 (0) Standard distraction, and CLT support during 2nd and/or 3rd COD. | Pain: FACES(Pt.), nurse’s pain reports(N). Anxiety: CEMS(Pt.). | Prior and during hydrotherapy: CEMS. Post-hydrotherapy: FACEs, nurse’s pain reports, CEMS. |
Chester 2018 [46]. | RCT, Australia. | n = 29^0 (0) Hypnosis pre and during COD: guided imagery, breathing, muscle relaxation, and permissive and direct hypnotic suggestions. | n = 35^0 (0) Standard interventions pre and during COD: parent presence, books, TV, electronic games, DVDs, toys, bubbles, music, and Ditto™ PP and distraction. | Pain: FPS-R(Pt.), FLACC(N), NRS(C), HR(R). Anxiety: VAS-A(Pt. ≥8 yrs, C < 8 yrs). Trauma: CPSS(Pt. > 7 yrs), YCPC(C < 7 yrs). | Pre and post-procedure: FPS-R, FLACC, NRS, VAS-A. During procedure: FPS-R, FLACC, NRS. Pre-medication and post-application: HR. 3-months post-injury: CPSS, YCPC. |
Elliott 1983 [47]. | NRCT, USA. | n = 4^0 (0) Stress management during COD: distraction, breathing, emotive imagery, and pain reinterpretation. | n = 4^0 (0) SC during COD. | Pain and distress: BTDS(MS). | Removal, first 15mins of hydrotherapy, and during physical therapy and dressing re-application: BTDS. |
Foertsch 1998 [48]. | RCT, USA. | n = 13^Total 1 (43) Familiar imagery during COD: focus on childhood memory/experience. | n = 10^Total 1 (43) Social support during COD: researcher conversation and encouragement. | Pain and anxiety: FACES(Pt.’s 3–9 yrs), VAS(Pt.’s 9–12 yrs). Distress: OSBD(R). | Baseline and 15-s intervals during procedure: OSBD. Post-procedure: FACES, VAS. |
Hyland 2015 [49]. | RCT, Australia. | n = 50^0 (0) CLT PP, caregiver support and education, and distraction during COD. | n = 50^0 (0) SC, and minimal distraction during COD: caregiver, music, and toys/electronic devises. | Pain: CHEOPS(IA), FACES(Pt.’s 5–10 yrs), VAS(Pt.’s > 10 yrs). Pain and anxiety: Procedural pain and anxiety questionnaire(C), nursing staff questionnaire(N). Anxiety: CFS(IA, Pt.). | Pre-procedure: Procedural pain and anxiety questionnaire. 2-min intervals during procedure: CHEOPS, CFS. Post-procedure: FACES, VAS, Procedural pain and anxiety questionnaire, CFS. |
Jeffs 2014 [50]. | RCT, USA. | n = 8^0 (0) IVR: 3D interactive program pre and during COD. | n = 10^0 (0) ‘Typical’ care during COD: standard nurse communication. | Pain: APPT-WGRS(Pt.’s 8–17 yrs). Anxiety: STAI-CH(Pt.). | Pre-procedure: APPT-WGRS, STAI-CH. |
n = 10^0 (0) IPD: PD (i.e. movie) pre and during COD. | |||||
Kavanagh, 1983 [51]. | NRCT, USA. | n = 4^0 (0) Max. procedure ‘predictability’: specific nurse attire, and ‘patient control’ of ‘appropriate’ aspects of procedure. | n = 5^0 (0) Min. ‘predictability’, and medical staff control over procedure. | Pain: Nurse reports 0–6 scale(N). Anxiety: CBI(N, C of pt.’s 1–3 yrs). | 2–3 times daily: Nurse reports. Weekly: CBI. |
Kipping 2012 [52]. | RCT, Australia. | n = 20^0 (0) Off-the-shelf VR pre and during COD. | n = 21^0 (0) Standard distraction during COD: TV, stories, music, and caregiver. | Pain: VAS(Pt., C). Pain and distress: FLACC(N). | Baseline, and retrospective post-removal and application: VAS, FLACC. |
Miller 2010 [53]. | RCT, Australia. | n = 20^2 (10) IMMD-PP: MMD-PP pre-COD, and standard distraction during COD. | n = 20^3 (15) Standard distraction during COD: toys, TV, and nurse/caregiver interactions. | Pain: FACES(Pt.), VAS(C). Pain and distress: FLACC(N). | Pre and post-removal, pre and post-application: FACES, VAS, FLACC. |
n = 20^1 (5) IMMD-D: MMD-D interactive story/game during COD. | |||||
n = 20^4 (20) IVGD: VGD during COD. | |||||
Miller 2011 [54]. | RCT, Australia. | n = 20^0 (0) MMD-PP, MMD-D interactive story/game pre and during COD. | n = 20^0 (0) Standard PP and distraction pre and during COD. | Pain: FACES(Pt.), VAS(C), HR(N). Pain and distress: FLACC(N). | Pre and post-removal, pre and post-application: FACES, VAS, FLACC. During removal and application: HR. |
Moore 2015 [55]. | NRCT, USA. | n = 12^0 (0) CLT MP pre-COD: standard medical equipment, and puppets. | n = 9^0 (0) SC during COD: standard PP, and clinical staff verbal explanations. | Pain: FPS(Pt.). Pain and distress: FLACC(R). Anxiety: STAI-CH(C). | Pre and post-procedure: FPS, FLACC, STAI-CH. Post-removal: FPS. |
Quay 1983 [56]. | RCT, USA. | n = 26^0 (0) Discharge preparation weekly by nurse, written information, and procedural rehearsal 3 days pre-discharge. | n = 24^0 (0) Routine instructions 3 days pre-discharge. | Anxiety: STAI-CH(Pt., C). | 1-day pre-discharge, 1st follow-up visit: STAI-CH. |
Sveen 2017 [57]. | RCT, Sweden. | n = 31^16 (52) Internet based CBT and ACT support program. | n = 31^3 (10) SC during COD. | Post-traumatic stress: IES-R(C), PSI-SF(C), PSS(C). | Pre-procedure, post-procedure, 3mths post-injury, 12mths post-injury: IES-R, PSI-SF, PSS. |
Van der Heijden 2018 [58]. | RCT, South Africa. | n = 71^3 (4) 3–5 min MT, and parental soothing post-COD. | n = 64^3 (4) SC during COD, and parental soothing post-COD. | Pain: COMFORT-B(R), FACES(Pt.). Distress: OSBD-r(R), FPS-R(Pt.). | Pre-procedure, hallway, entering room: OSBD-r, COMFORT-B. Pre and post-procedure: FPS-R, FACES. |
Whitehead-Pleaux 2006 [59]. | RCT, USA. | n = 8^0 (0) MT during COD. | n = 6^0 (0) Verbal support and distraction by music therapists during COD. | Pain: FACES(Pt.), HR(R). Behavioral distress: NAPI(R). Anxiety: Fear Thermometer(Pt.). | Pre and post-procedure: FACES, HR, Fear Thermometer. During procedure: FACES, HR, NAPI, Fear Thermometer. |
Reference | Outcomes | Results |
---|---|---|
Procedural preparation and distraction | ||
Brown [44] | Pain | • FPS-R scores lower in Ditto™ than control at post-application of 2nd COD (MD = -1.51 [CI:-2.89, − 0.13] p = 0.032). • HR lowered across 3 CODs in Ditto™ group (MD = -4.89 [CI:-9.69, − 0.09], p = 0.046). |
Pain and distress | • FLACC scores not reported. | |
Anxiety | • VAS-A scores lower in Ditto™ than control at pre-removal (MD = -1.79 [CI:-3.59, −0.01] p = 0.510). | |
Trauma | • Intervention group did not affect CTSQ scores 1 week post-injury (MD not reported [CI:-1.49, 0.87] p = 0.602) or 3 months post re-epithelialisation (MD not reported [CI: −1.26, 2.00] p = 0.651). | |
Burns-Nader [45] | Pain | • Intervention group did not affect FACES scores (p = 0.290). • Nurse’s pain reports lower in tablet group (M = 3.73, SD = 0.88) than control (M = 2.93, SD = 1.03), (p = 0.030). |
Anxiety | • CEMS scores higher in control during (p = 0.001) and after (p = 0.002) hydrotherapy. • CEMS scores remained higher in control post-procedure (p < 0.050), tablet group returned to baseline levels (p = 0.570). | |
Millera [53] | Pain | • FACES scores sig. differed at pre and post-removal, and pre and post-application of all 3 CODs (p = ≤0.001 all time points). • FACES scores lowered across 3 COD’s in: ◦ MMD-D at pre-removal (p = ≤0.001), post-removal (p = 0.005), and pre-application (p = 0.004). ◦ MMD-PP at pre-removal (p = 0.044). ◦ VGD at post-application (p = 0.030). • FACES scores lowered in: ◦ MMD-PP more than VGD and control at pre-removal (both p = ≤0.010), post-removal (both p = < 0.001), pre-application (both p = < 0.001), and post-application (both p = < 0.001). ◦ MMD-D more than control at pre-application (p = ≤0.050), post-removal (p = < 0.001), and post-application (p = < 0.001); and VGD at post-removal (p = < 0.001) and post-application (p = < 0.001). • VAS scores sig. differed at pre-removal of 2nd and 3rd COD; and post-removal, pre and post-application of all 3 CODs (p = ≤0.001). • VAS scores increased across 3 CODs in VGD compared to MMD-PP at post-removal and application (both p = < 0.001), and MMD-D at post-removal (p = ≤0.050) and post-application (p = ≤0.001). • VAS scores lowered across 3 COD’s in: ◦ MMD-D at pre and post-removal, and pre-application (all p = ≤0.001), and post-application (p = 0.002). ◦ MMD-PP at pre-removal (p = 0.035), and post-application (p = 0.009). ◦ Control at pre-removal (p = 0.034). • VAS scores lowered in MMD-PP and MMD-D more than control at post-removal (both p = < 0.001) and post-application (both p = < 0.001). |
Pain and distress | • FLACC scores sig. differed at pre-removal of 2nd and 3rd COD (p = ≤0.001); post-removal at 1st (p = 0.003), 2nd, and 3rd CODs (p ≤ 0.001); pre-application of 1st (p = 0.010), 2nd, and 3rd CODs (p ≤ 0.001); and post-application of all 3 CODs (p ≤ 0.001). • FLACC scores lowered across 3 COD’s in: ◦ MMD-D at post-removal (p = 0.008), pre-application (p = 0.047), and post-application (p = 0.018). ◦ Control at pre-removal (p = ≤0.001). • FLACC scores lowered in: ◦ MMD-PP more than control at post-removal (p = ≤0.050) and post-application (p = < 0.001); and VGD at post-removal (p = ≤0.050) and post-application (p = ≤0.001). ◦ MMD-D more than control at post-removal (p = < 0.010), and post-application (p = < 0.001); and VGD at post-removal (p = ≤0.010) and post-application (p = < 0.001). | |
Millerb [54] | Pain | • FACES scores lower in MMD than control at pre-removal (p = 0.004); post-removal, and pre and post-application (all p = < 0.001), 30% reduction. • VAS scores lower in MMD than control at pre-removal (p = 0.018), post-removal (p = 0.010), pre-application (p = 0.001), and post-application (p = < 0.001), 30% reduction. • MMD combined sig. lowered pre-removal FACES (p = 0.009) and VAS scores (p = 0.035) compared to MMD-D. • HR lowered in MMD at removal and application (both p = 0.040). |
Pain and distress | • FLACC scores lower in MMD than control at post-removal (p = < 0.001), pre-application (p = 0.021), and post-application (p < 0.001), 50% reduction at removal. • MMD combined borderline less effective than MMD-D in reducing post-removal FLACC scores (p = 0.050). | |
Jeffs [50] | Pain | • APPT-WGRS pre-procedure scores highest in VR, then SC and PD (p = 0.041). • APPT-WGRS procedure scores lower in VR than PD (MD = 23.70 mm [CI:2.40, 45.00] p = 0.029), and SC (MD = 9.70 mm [CI:-9.50, 28.90] not sig. p = 0.320). • Male patients reported less procedural pain (MD = 32.60 mm [CI: 14.90, 50.20] p = <.001). |
Anxiety | • Intervention group did not affect state (p = 0.060) or trait anxiety (p = 0.710). | |
Kipping [52] | Pain | • Intervention group did not affect patient VAS scores at dressing removal (p = 0.160) or application (p = 0.400). • Intervention group did not affect caregiver VAS scores at dressing removal (p = 0.710) or application (p = 0.750). |
Pain and distress | • FLACC scores lower in VR (M = 2.90, SD = 2.40) than control (M = 4.70, SD = 2.50) at dressing removal (p = 0.020), but not application (p = 0.230). | |
Van der Heijden [58] | Pain | • Intervention group did not affect COMFORT-B scores before or after intervention (SMD = 0.04 [CI:-0.30, 0.38] p = 0.990). • FACES scores lower in MT than SC (p = 0.050); relevant sample MT (n = 13), SC (n = 5). |
Distress | • Intervention group did not affect OSBD-r scores before or after intervention (SMD = 0.11 [CI:-0.23, 0.45] p = 0.530). • Intervention group did not affect FPS-R scores (p = 0.200). | |
Whitehead-Pleaux [59] | Pain | • Intervention group did not affect FACES scores before (p = 0.181), or after procedure (p = 0.345). • MD in HR from before to after procedure greatest in control (p = 0.003). |
Distress | • NAPI scores higher in MT than control during procedure (p = 0.020). | |
Anxiety | • Fear Thermometer scores higher in MT than control before (p = 0.043), and during procedures (p = 0.002), but not after (p = 0.228). | |
Hypnosis and guided imagery | ||
Chester [46] | Pain | • Intervention group did not affect overall FPS-R scores before, during, or after any procedure (p= > 0.100). • FPS-R scores lower in patients < 8 years at 3rd COD (MD = 4.71 [CI: 0.33, 9.09] p = 0.040); relevant sample 3 per group. • NRS scores lower in hypnotherapy than control at pre-removal of 3rd COD (MD = -0.91 [CI:-1.62, − 0.20] p = 0.010). • Intervention group did not affect NRS scores at any other time point across 3 CODs (p= > 0.200). • HR lower in hypnotherapy than SC at pre-removal (MD = -15.20 [CI:-27.20, − 3.20] p = 0.010) and post-application of 3rd COD (MD = -15.49 [CI:-28.25, − 2.53] p = 0.020). |
Pain and distress | • FLACC scores not reported. | |
Anxiety | • Patients > 8 years VAS-A scores lower in hypnotherapy than SC at pre-removal of 2nd COD (MD = -0.80 [CI:-1.50, − 0.10] p = 0.030). • Caregiver VAS-A scores for patients < 8 years lower in hypnotherapy than SC at pre-removal of 2nd (MD = -1.37 [CI:-2.57, − 0.16] p = 0.030), and 3rd CODs (MD = -2.07 [CI:-3.64, − 0.49] p = 0.010). | |
Trauma | • Patient CPSS impairment severity scores lower in hypnotherapy than SC (MD = 0.46 [CI:-0.01, 0.92] p = 0.050). • Caregiver YCPC symptom severity scores for children < 7 years higher in hypnotherapy than SC (MD = 0.75 [CI:0.05, 1.45] p = 0.040). | |
Foertsch [48] | Pain and anxiety | • FACES and VAS scores not analysed due to patient difficulty in comprehending tools. |
Distress | • Intervention group did not affect OSBD scores between groups (F1,9 = 0.18, p= > 0.500), or across 4 CODs (exact F3,18 = 1.10, p = < 0.300). • Cry behaviors correlated with verbal resistance at 2nd (r [22]=0.77, p = < 0.010), 3rd (r [22]=0.56, p = < 0.050), and 4th CODs (r [22]=0.49, p = < 0.050); with emotional support at 1st (r [23]=0.58, p = < 0.050), and 2nd CODs (r [22]=0.88, p = < 0.010); and with verbal pain at 1st (r [23]=0.52, p = < 0.050), and 2nd CODs (r [22]=0.83, p = < 0.010). | |
Therapeutic approaches | ||
Blakeney [43] | Anxiety/ distress | • CBCL anxious and depressed scores sig. lowered from pre-intervention to 1 year post-intervention in intervention group (t = − 2.50, p = .017) and control (t = − 2.40, p = .026); however not between groups (p = > 0.300). |
Elliott [47] | Pain and distress | • Group comparisons not possible. • BTDS scores reduced in intervention group by 25–52% (mean = 36.7%) from baseline to post-intervention. • BTDS scores consistently increased for intervention group in therapist absence. • Patient’s preferred: relaxation, emotive imagery, distraction, imagery of pleasant scenery, and earning tangible reinforcement for coping techniques. |
Hyland [49] | Pain | • CLT group received fewer additional analgesic medication during procedure than SC (n = 6, 12% vs n = 9, 18%). • Average CHEOPS scores lower in CLT (Mdn = 5.30, IQR: 4.50–6.70) than SC (Mdn = 6.00, IQR: 5.40–7.60), (CI: 0.10, 1.20, p = 0.020). • Nursing staff observed higher pre-procedural pain in CLT than SC (Mdn = 1.00, IQR: 0.00–2.00 vs. Mdn = 0.50, IQR: 0.00–1.00). • Intervention group did not affect nursing staff observations of procedural pain (Mdn = 2.00 for both groups). • FACES scores not reported. |
Pain and anxiety | • CLT caregivers observed higher patient pre-procedural pain than SC caregivers (Mdn = 3.50, IQR: 0.00–4.00 vs. Mdn = 3.00, IQR: 0.00–5.00). • CLT caregivers observed lower patient procedural pain than SC caregivers (Mdn = 2.00, IQR: 0.00–4.00 vs. Mdn = 3.00, IQR: 1.00–7.00). • Intervention group had no affect on caregiver observations of patient pre-procedural anxiety (Mdn = 2.00, IQR: 1.00–5.00 vs. Mdn = 2.00, IQR: 0.00–5.00). • CLT caregivers observed less patient procedural anxiety than SC caregivers (Mdn = 3.00, IQR: 1.00–6.00 vs. Mdn = 4.30, IQR: 1.00–8.00). | |
Anxiety | • Intervention group did not affect average CFS scores (CI: 0.00–0.20, p = 0.300). • CLT caregivers had higher anxiety than SC caregivers at pre-procedure (Mdn = 7.00, IQR: 5.00–8.00 vs. Mdn = 6.00, IQR: 4.00–8.00), and during procedure (Mdn = 5.00, IQR: 1.00–7.00 vs. Mdn = 3.50, IQR: 2.00–7.50). • Nursing staff observed higher patient pre-procedural anxiety in CLT than SC (Mdn = 2.00, IQR: 0.00–4.00 vs. Mdn = 1.50, IQR: 0.00–3.00). • Intervention group did not affect nursing staff observations of patient procedural anxiety (Mdn = 2.00 for both groups). | |
Sveen [57] | Post-traumatic stress | • IES-R scores lower in intervention than control at 6 weeks post-randomization (β = − 11.50 [SE:3.88] p = 0.003) and 3mths post-intervention (β = − 7.89 [SE:3.38] p = 0.020). • Intervention group did not affect IES-R scores at baseline or 12mths post-intervention. • Intervention group did not affect caregivers PSI-SF or PSS scores at any time point during CODs. • Caregivers perceived the intervention as informative and meaningful, but time consuming. |
Preparation & ‘patient control’ | ||
Kavanagh [51] | Pain | • Intervention group required less analgesic pain medication in 1st 2 weeks of hospitalisation (p = < 0.010). • Intervention group received more analgesic medication between CODs (p = < 0.025). • Nurse reports not reported. |
Anxiety | • Maladaptive symptoms higher in SC than intervention in 1st 2 weeks of hospitalisation (p = 0.043). • Anxiety levels higher in SC than intervention in 1st 2 weeks, not sig. (p = 0.135). | |
Moore [55] | Pain | • Intervention group did not affect FPS scores from baseline, during, or post-procedure (p = 0.717). |
Pain and distress | • FLACC scores lower in MP than SC during CODs (0.50 vs 2.00 respectively), not sig. (p = 0.165). | |
Anxiety | • Intervention group did not affect caregivers state anxiety from baseline to post-procedure (p = 0.421). | |
Quay [56] | Anxiety | • Caregivers were able to rehearse treatments and share concerns about returning home. • STAI-CH scores decreased in intervention caregivers of patients with > 30% TBSA burns at discharge (p = < 0.050) and 1st follow-up (p = < 0.050). • Intervention group did not affect STAI-CH scores for any patient’s, or caregiver of patients with < 30% TBSA burns at discharge or 1st follow-up visit. |