Efficacia dei cartoni animati per il dolore procedurale dei bambini: una revisione sistematica con meta-analisi.
DOI:
https://doi.org/10.54103/dn/22649Parole chiave:
ansia anticipatoria, dolore procedurale, bambini, cartoni animati meta-analisiAbstract
BACKGROUND: I cartoni animati sono una delle tecniche di distrazione utilizzate per la gestione non farmacologica del dolore procedurale in ambito pediatrico. Esistono alcuni studi in letteratura che valutano l’effetto dell’intervento sul dolore procedurale, ma manca una revisione sistematica volta a fornire una sintesi dell’effetto complessivo.
OBIETTIVO: Riassumere le prove disponibili sull’efficacia dei cartoni animati per il dolore procedurale dei bambini.
METODI: La ricerca di studi controllati a gruppi paralleli è stata effettuata su tredici database biomedici, cinque registri di studi, risorse web e fonti di letteratura grigia, dalla data di impostazione di ciascun database o risorsa al 22 gennaio 2023. L'outcome primario era il dolore procedurale, l'esito secondario era l'ansia. RoB 2 e ROBINS-I sono stati utilizzati per valutare il rischio di bias degli studi inclusi.
RISULTATI: Per questa revisione sono stati selezionati 24 studi, che includevano un totale di 3046 soggetti pediatrici. I bambini che guardano i cartoni animati durante le procedure mediche sperimentano meno dolore (SMD= -1,29; IC 95%: -1,75, -0,83; N=2239) e ansia (UMD= -1,75; IC 95%: -2,94, -0,56; N=552) rispetto ai bambini a cui è stato fornito lo standard di cura; per entrambi gli outcome, i risultati sono statisticamente significativi. Il metodo GRADE mostra una moderata certezza/qualità dell’evidenza.
CONCLUSIONI: I cartoni animati sono più efficaci dello standard di cura nel ridurre il dolore procedurale e l'ansia nei bambini. In attesa che studi futuri confermino i risultati, raccomandiamo la loro implementazione nella pratica clinica quotidiana anche in contesti assistenziali con risorse limitate.
Riferimenti bibliografici
Kaur B, Sarin J, Kumar Y. Effectiveness of cartoon distraction on pain perception and distress in children during intravenous injection. J Nurs Health Sci 2014;3(3):8-15. https://doi.org/10.9790/1959-03320815
Taylor EM, Boyer K, Campbell FA. Pain in hospitalized children: a prospective cross-sectional survey of pain prevalence, intensity assessment and management in a Canadian pediatric teaching hospital. Pain Res Manage 2008;13(1):25-32. https://doi.org/10.1155/2008/478102
Stevens BJ, Abbott LA, Yamada J, Harrison D, Stinson J, Taddio A, et al. Epidemiology and management of painful procedures in children in canadian hospitals. CMAJ 2011;183(7):E403-E410. https://doi.org/10.1503/cmaj.101341
Birnie KA, Noel M, Parker JA, Chambers CT, Uman LS, Kisely SR et al. Systematic review and meta-analysis of distraction and hypnosis for needle-related pain and distress in children and adolescents. J Pediatr Psychol 2014;39(8):783-808. https://doi.org/10.1093/jpepsy/jsu029
Ali S, Chambers A, Johnson DW, Newton AS, Vandermeer B, Williamson J et al. Reported practice variation in pediatric pain management: a survey of Canadian pediatric emergency physicians. CJEM 2014;16(5):352-360. https://doi.org/10.2310/8000.2013.131261
Bagnasco A, Pezzi E, Rosa F, Fornoni L, Sasso L. Distraction techniques in children during venipuncture: an italian experience pain and collaboration assessment in children during venipuncture. J Prev Med Hyg 2012;53:44-8. https://doi.org/10.15167/2421-4248/jpmh2012.53.1.314
Freitas DMO, Spadoni VS. Is virtual reality useful for pain management in patients who undergo medical procedures? Einstein (São Paulo) 2019;17. https://doi.org/10.31744/einstein_journal/2019MD4837
Rogers TL, Ostrow CL. The use of EMLA cream to decrease venipuncture pain in children. J Pediatr Nurs 2004;19(1):33-39. https://doi.org/10.1016/j.pedn.2003.09.005.
Czarnecki ML, Turner HN, Collins PM, Doellman D, Wrona S, Reynolds J. Procedural pain management: A position statement with clinical practice recommendations. Pain Manag Nurs 2011; 12(2):95-111. https://doi.org/10.1016/j.pmn.2011.02.003.
Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle‐related procedural pain and distress in children and adolescents. Cochrane Database Syst Rev 2018;(10). https://doi.org/10.1002/14651858.CD005179.pub4.
Curtis SJ, Jou H, Ali S, Vandermeer B, Klassen T. A randomized controlled trial of sucrose and/or pacifier as analgesia for infants receiving venepuncture in a paediatric emergency department. BMC Pediatr 2007;7(1):1-9. https:// doi.org/10.1186/1471-2431-7-27.
Chambers CT, Taddio A, Uman LS, McMurtry CM; HELPinKIDS Team. Team psychological interventions for reducing pain and distress during routine childhood immunizations: a systematic review. Clin Ther 2009;31:S77-S103. https://doi.org/10.1016/j.clinthera.2009.07.023.
Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ et al. Inadequate pain management during routine childhood immunizations: the nerve of it. Clin Ther 2009;31:S152-S167. https://doi.org/10.1016/j.clinthera.2009.07.022.
James J, Ghai S, Rao KLN, Sharma N. Effectiveness of “Animated Cartoons” as a distraction strategy on behavioural response to pain perception among children undergoing venipuncture. Nurs Midwifery Res J 2012;8(3):198-209. https://doi.org/10.33698/NRF0142
Wente S. Nonpharmacologic pediatric pain management in emergency departments: A systematic review of the literature. J Emerg Nurs 2013;39(2):140-150. https://doi.org/10.1016/j.jen.2012.09.011
Fein JA, Zempsky WT, Cravero JP, Committee on Pediatric Emergency Medicine and Section on Anesthesiology and Pain Medicine, American Academy of Pediatrics. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 2012;114(5):1348-1356. https://doi.org/10.1542/peds.2012-2536
Thrane SE, Wanless S, Cohen SM, Danford CA. The assessment and non-pharmacologic treatment of procedural pain from infancy to school age through a developmental lens: a synthesis of evidence with recommendations. J Pediat Nurs 2016;31(1):e23-e32. https://doi.org/ 10.1016/j.pedn.2015.09.002
Viggiano MP, Giganti F, Rossi A, Di Feo D, Vagnoli L, Calcagno G et al. Impact of psychological interventions on reducing anxiety, fear and the need for sedation in children undergoing magnetic resonance imaging. Pediatr Rep 2015;7(1):5682. https://doi.org/10.4081/pr.2015.5682
Jacobson AF. Intradermal normal saline solution, self-selected music, and insertion difficulty effects on intravenous insertion pain. Heart 1999;28(2):114-122. https://doi.org/ 10.1053/hl.1999.v28.a95256
Ali S, McGrath T, Drendel AL. An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond. Pediatr Emerg Care 2016;32(1):36-42. https://doi.org/10.1097/PEC.0000000000000669
Schechter NL, Zempsky WT, Cohen LL, McGrath PJ, McMurtry CM, Bright NS. Pain reduction during paediatric immunizations: evidence-based review and recommendations. Pediatrics 2007;119(5):e1184-e1198. https://doi.org/10.1542/peds.2006-1107
Shih S, Rosen P. Pain management for nasogastric intubation in pediatrics. Cureus 2018;10(10). https://doi.org/10.7759/cureus.3429.
Kleiber C, Harper DC. Effects of distraction on children’s pain and distress during medical procedures: A meta-analysis. Nurs Res 1999;48(1):44-49. https://doi.org/10.1097/00006199-199901000-00007.
Puspita RR, Pratiwi RD, Selvia A, Yuniar AM, Poddar S. The Effect of Distraction Techniques (Watching Cartoons) on Pain in Children Aged 9-12 Months During Measles Immunization. Int J Manag Human Sci 2021;5(3):53-59. https://ejournal.lucp.net/index.php/ijmhs/article/view/1522
Cassidy K-L, Reid GJ, McGrath PJ, Finley GA, Smith DJ, Morley C et al. Watch needle, watch TV: Audiovisual distraction in preschool immunization. Pain Med 2002;3(2):108-118. https://doi.org/10.1046/j.1526-4637.2002.02027.x.
Cheraghi F, Kalili A, Soltanian A, Eskandarlou M, Sharifian P. A Comparison of the effect of visual and auditory distractions on physiological indicators and pain of burn dressing change among 6–12-year-old children: a clinical trial study. J Pediatr Nurs 2021;58:e81-e86. https://doi.org/10.1016/j.pedn.2021.01.011.
La Vonne D, Zun LS. The impact of watching cartoons for distraction during painful procedures in the emergency department. Pediatr Emerg Care 2012;28(10):1033-1035. https://doi.org/10.1097/PEC.0b013e31826cac1a
Gedam DS, Verma M, Patel U, Gedam S. Effect of distraction technique during immunization to reduce behaviour response score (FLACC) to pain in toddlers. J Nepal Paediatr Soc 2013;33(1). https://www.nepjol.info/index.php/JNPS/article/view/7017
Ha YO, Kim HS. The effects of audiovisual distraction on children's pain during laceration repair. Int J Nurs Pract 2013;19:20-27. https://doi.org/10.1111/ijn.12165
Inan G, Inal S. The impact of 3 different distraction techniques on the pain and anxiety levels of children during venipuncture. Clin J Pain 2019;35(2):140-147. https://doi.org/ 10.1097/AJP.0000000000000666
Wang Z-X, Sun L-H, Chen A-P. The efficacy of non-pharmacological methods of pain management in school-age children receiving venepuncture in a paediatric department: a randomized controlled trial of audiovisual distraction and routine psychological intervention. Swiss Med Wkly 2008;138(3940):579-584. https://doi.org/10.4414/smw.2008.12224
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hofmann TC, Mulrow CD et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;88:105906. https://doi.org/10.1136/bmj.n71
Sterne JA, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I et al. RoB 2: a revised tool for assessing risk of bias in randomised trials. BMJ 2019;366. https://doi.org/ 10.1136/bmj.l4898
Jüni P, Loke Y, Pigott T, Ramsay C, Regidor D, Rothstein H et al. Risk of bias in non-randomized studies of interventions (ROBINS-I): detailed guidance. BMJ 2016;355:i4919. https://www.msg.ugent.be/wp-content/uploads/2019/10/ROBINS-I_detailed_guidance.pdf
Hozo SP, Djulbegovic B, Hozo I. Estimating the mean and variance from the median, range, and the size of a sample. BMC Med Res Methodol 2005;5(1):1-10. https://doi.org/10.1186/1471-2288-5-13.
Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stat Methods Med Res 2018;27(6):1785-1805. https://doi.org/10.1177/0962280216669183
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014; 14:1-13. https://doi.org/ 10.1186/1471-2288-14-135
Cohen J. Statistical power analysis for the behavioral sciences. Academic press 2013.
Cochran WG. The comparison of percentages in matched samples. Biometrika 1950;37(3/4):256-266. PMID: 14801052
Higgins JP, Thompson SG, Deeks JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-560. https://doi.org/10.1136/bmj.327.7414.557
Calderón MA, Boyle RJ, Penagos M, Sheikh A. Immunotherapy: the meta-analyses. What have we learned? Immunol Allergy Clin North Am 2011;31(2):159-173. https://doi.org/10.1016/j.iac.2011.02.002
Sterne JA, Egger M. Funnel plots for detecting bias in metaanalysis: guidelines on choice of axis. J Clin Epidemiol 2001;54(10):1046-1055. https://doi.org/10.1016/s0895-4356(01)00377-8
Duval S, Tweedie R. Trim and fill: a simple funnel-plot-based method of testing and adjusting for publication bias in meta-analysis. Biometrics 2000;56(2):455-463. https://doi.org/10.1111/j.0006-341x.2000.00455.x
Egger M, Smith GD, Schneider M, Minder C. Bias in metaanalysis detected by a simple, graphical test. Bmj 1997;315(7109):629-634. https://doi.org/10.1136/bmj.315.7109.629
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;1088-1101. https://doi.org/10.2307/2533446
Orwin RG. A fail-safe N for effect size in meta-analysis. J Educ Stat 1983;8(2):157-159. https://doi.org/10.3102/10769986008002157
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, et al. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64(4):401-406. https://doi.org/10.1016/j.jclinepi.2010.07.015
Choi HJ, Kim HJ. Efficacy of Cartoons as a Distraction Technique for Children Undergoing Suture of Facial Lacerations in the Emergency Department. Pediatr Emerg Care 2021;37(9):471-473. https://doi.org/10.1097/PEC.0000000000001951
Cohen LL, Blount RL, Panopoulos G. Nurse coaching and cartoon distraction: An effective and practical intervention to reduce child, parent, and nurse distress during immunizations. J Pediatr Psychol 1997;22(3):355-370. https://doi.org/10.1093/jpepsy/22.3.355
Crevatin F, Cozzi G, Braido E, Bertossa G, Rizzitelli P, Lionetti D, et al. Hand‐held computers can help to distract children undergoing painful venipuncture procedures. Acta Paediatr 2016;105(8):930-934. https://doi.org/10.1111/apa.13454
Feng Z, Tang Q, Lin J, He Q, Peng C. Application of animated cartoons in reducing the pain of dressing changes in children with burn injuries. Int J Burns Trauma 2018;8(5):106. PMID: 30515348
Ganesan R. A study to compare the effectiveness of cartoon video distraction technique versus music therapy in altering behavior response to pain among toddler receiving immunization at pediatric outpatient department, Institute of child health and hospital, for children, Egmore, Chennai (Doctoral dissertation, College of Nursing, Madras Medical College, Chennai) 2005. http://repository-tnmgrmu.ac.in/10566/1/300216315ganesan.pdf
Accessed May 14, 2023
Hasanpour M, Tootoonchi M, Aein F, Yadegarfar G. The effects of two non-pharmacologic pain management methods for intramuscular injection pain in children. Acute Pain 2006;8(1):7-12. https://doi.org/10.1016/j.acpain.2005.11.001
Kuo HC, Pan HH, Creedy DK, Tsao Y. Distraction-based interventions for children undergoing venipuncture procedures: a randomized controlled study. Clin Nurs Res 2018;27(4):467-482. https://doi.org/10.1177/1054773816686262.
MacLaren JE, Cohen LL. A comparison of distraction strategies for venipuncture distress in children. J Pediatr Psychol 2005;30(5):387-396. https://doi.org/10.1093/jpepsy/jsi062
Sinha M, Christopher NC, Fenn R, Reeves L. Evaluation of nonpharmacologic methods of pain and anxiety management for laceration repair in the pediatric emergency department. Pediatrics 2006;117(4):1162-1168. https://doi.org/10.1542/peds.2005-1100
Ugucu G, Uysal DA, Polat OG, Artuvan Z, Kulcu DP, Aksu D, et al. Effects of cartoon watching and bubble-blowing during venipuncture on pain, fear, and anxiety in children aged 6–8 years: A randomized experimental study. J Pediatr Nurs 2022;65:e107-e114. https://doi.org/10.1016/j.pedn.2022.03.016.
Akgül EA, Karahan Y, Başoğlu F, Oğul A, Öztornaci BÖ, Yetim P, et al. Effects of watching cartoons on pain scores in children undergoing venepuncture. Nurs Child Young People 2022;35(5). https://doi.org/10.7748/ncyp.2018.e913
Bellieni CV, Cordelli DM, Raffaelli M, Ricci B, Morgese G, Buonocore G. Analgesic effect of watching TV during venipuncture. Arch Dis Child 2006; 91(12):1015-1017. https://doi.org/10.1136/adc.2006.097246
Bergomi P, Scudeller L, Pintaldi S, Dal Molin A. Efficacy of non-pharmacological methods of pain management in children undergoing venipuncture in a pediatric outpatient clinic: a randomized controlled trial of audiovisual distraction and external cold and vibration. J Pediatr Nurs 2018;42:e66-e72. https://doi.org/10.1016/j.pedn.2018.04.011
Bijimol NJ, Mathew S (2020) Effectiveness of an Animation Video on BehavioralResponse to Pain among Toddlers During Immunization in a Selected PHC at Mangalore India. Indian J Public Health Res Development 2020;20(4):41619. https://ijop.net/index.php/mlu/article/view/2064
Cerne D, Sannino L, Petean M. A randomised controlled trial examining the effectiveness of cartoons as a distraction technique. Nurs Child Young People 2015;27(3):28-33. https://doi.org/10.7748/ncyp.27.3.28.e534
Chavan S, Naregal P. Effectiveness of cartoon animation video on pain during venepuncture among 3-6 year old children. Sri Lanka J Child Health 2021;50(2):299-305. https://sljch.sljol.info/articles/10.4038/sljch.v50i2.9577
Daniel B, Mendonca TL. Effectiveness of Cartoon Movie as a Distraction Strategy on Behavioural Response to Pain among Toddlers (1–3 years) receiving Immunization in Selected Immunization Clinics, Mangalore. Int J Nurs Educ Res 2017;5(2):179-181. https://doi.org/10.5958/2454-2660.2017.00037.0
Düzkaya DS, Bozkurt G, Ulupınar S, Uysal G, Uçar S, Uysalol M. The effect of a cartoon and an information video about intravenous insertion on pain and fear in children aged 6 to 12 years in the pediatric emergency unit: a randomized controlled trial. J Emerg Nurs 2021;47(1):76-87. https://doi.org/ 10.1016/j.jen.2020.04.011
Gupta HV, Gupta VV, Kaur A, Singla R, Chitkara N, Bajaj KV, et al. Comparison between the analgesic effect of two techniques on the level of pain perception during venipuncture in children up to 7 years of age: A quasi-experimental study. J Clin Diagn Res 2014;8(8):PC01. https://doi.org/10.7860/JCDR/2014/9731.4675
İnangil D, Şendir M, Büyükyılmaz F. Efficacy of cartoon viewing devices during phlebotomy in children: a randomized controlled trial. Journal of PeriAnesth Nurs 2020;35(4):407-412. https://doi.org/10.1016/j.jopan.2020.01.008
Lobo MM, Umarani J. Cartoon distraction reduces venipuncture pain among preschoolers–a quasi experimental study. Med Sci 2013;2(6). https://www.worldwidejournals.com/international-journal-of-scientific-research-(IJSR)/article/cartoon-distraction-reduces-venipuncture-pain-among-preschoolers-a-quasi-experimental-study/MTIxOA==/?is=1
Accessed March 28, 2023
Maharjan S, Maheswari BU, Maharjan M. Effectiveness of animated cartoon as a distraction strategy on level of pain among children undergoing venipuncture at selected hospital. Int J Health Sci Res 2017;7(8):248-252. https://www.researchgate.net/profile/Nitasha-Sharma-3/publication/336736943_Effectiveness_ofAnimated_Cartoons_as_a_distraction_strategy_on_behavioural_response_to_pain_perception_among_children_undergoing_venipuncture/links/5dafd40f92851c577eb9b97a/Effectiveness-ofAnimated-Cartoons-as-a-distraction-strategy-on-behavioural-response-to-pain-perception-among-children-undergoing-venipuncture.pdf
Accessed January 24, 2023
Miguez‐Navarro C, Guerrero-Marquez C. Video‐distraction system to reduce anxiety and pain in children subjected to venipuncture in pediatric emergencies. Pediatr Emerg Care Med 2016;1(1):1. https://pediatric-emergency-care.imedpub.com/videodistraction-system-to-reduceanxiety-and-pain-in-children-subjected-tovenipuncture-in-pediatric-emergencies.pdf
Accessed February 12, 2023
Özsoy F, Ulus B. Comparison of Two Different Methods in Reducing Pain and Fear due to Dressing Change in 7-10 Years Old Children. J Pediatr Res 2022;9(1). https://doi.org/10.4274/jpr.galenos.2021.68335
Thomas MNS, Redyy MD, Lakhani R, Reddy MD. Effectiveness of cartoon video distraction in altering the behavioral response to vaccination pain among toddlers in selected hospitals in Navi Mumbai. Eur J Molecular Clin Med 2022;9(08). https://ejmcm.com/article_21044_ad1279118f39c74db8f6100cffd07715.pdf
Accessed April 8, 2023
van der Heijden MJ, Mevius H, van der Heijde N, van Rosmalen J, van As S, van Dijk M. Children listening to music or watching cartoons during ER procedures: A RCT. J Pediatr Psychol 2019;44(10):1151-1162. https://doi.org/10.1093/jpepsy/jsz066
Yoo H, Kim S, Hur HK, Kim HS. The effects of an animation distraction intervention on pain response of preschool children during venipuncture. Appl Nurs Res 2011;24(2):94-100. https://doi.org/10.1016/j.apnr.2009.03.005
Wong DL, Baker CM. Wong-Baker faces pain rating scale. Pain Manag Nurs 2012. https://doi.org/10.1037/t05330-000
XZ Malviya S, Voepel-Lewis T, Burke C, Merkel S, Tait AR. The revised FLACC observational pain tool: improved reliability and validity for pain assessment in children with cognitive impairment. Paediatr Anaesth 2006;16(3):258-265. https://doi.org/10.1111/j.1460-9592.2005.01773.x
McMurtry CM, Noel M, Chambers CT, McGrath PJ. Children's fear during procedural pain: preliminary investigation of the Children's Fear Scale. Health Psychol 2011;30(6):780. https://doi.org/10.1037/a0024817
Rezai MS, Goudarzian AH, Jafari-Koulaee A, Bagheri-Nesami M. The effect of distraction techniques on the pain of venipuncture in children: A systematic review. J Pediatr Rev 2017;5(1):26-37. https://doi.org/10.17795/jpr-9459
Cohen LL, Blount RL, Cohen RJ, Schaen ER, Zaff JF. Comparative study of distraction versus topical anesthesia for pediatric pain management during immunizations. Health Psychol 1999;18(6):591. https://doi.org/10.1037//0278-6133.18.6.591
Oliveira C, Santos J, Linhares M. Audiovisual distraction for pain relief in paediatric inpatients: a crossover study. Eur J Pain 2017; 21(1):178-187. https://doi.org/10.1002/ejp.915
Dowloads
Pubblicato
Come citare
Fascicolo
Sezione
Licenza
Copyright (c) 2024 Luca Giuseppe Re, Massimiliano D'Elia, Vincenza Aloia, Stefania Celeste Rippa, Valentina Tommasi
Questo lavoro è fornito con la licenza Creative Commons Attribuzione - Non commerciale - Non opere derivate 4.0 Internazionale.
Accettato 2024-04-15
Pubblicato 2024-07-31