Burns Research Group, Royal Children's Hospital, Brisbane, Australia.
Burns. 2010 Aug;36(5):647-58. doi: 10.1016/j.burns.2009.06.199. Epub 2009 Nov 3.
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 customized programs designed to inform the child about the procedure he/she is about to experience and to distract the child during dressing changes.
(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.
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.
MMD-D and MMD-PP were both shown to significantly relieve reported pain (p<or=0.05) and reduce the time taken for dressings (p<or=0.05) compared to SD and VG. The positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing changes.
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.
尽管人们一直认识到非药物性疼痛管理在急性儿科烧伤疼痛管理方案中的作用，但在急性儿科烧伤疼痛管理方案中，非药物性疼痛管理仍然是随意的。成人疼痛服务的进步，包括虚拟现实的整合，已经适应了满足疼痛儿童的需求，例如多模式分散注意力（MMD）的发展。这种易于使用的手持互动设备使用定制的程序，旨在向孩子介绍他/她即将经历的程序，并在换衣服时分散孩子的注意力。
（1）研究 MMD 程序准备（MMD-PP）或分散注意力（MMD-D）是否比标准分散注意力（SD）或手持视频游戏分散注意力（VG）更能减轻儿童疼痛，（2）通过比较组间治疗时间来了解 MMD-PP 和 MMD-D 对诊所效率的影响，最后，（3）评估分散注意力技术在三次换衣过程中的效果。
在一家儿科三级医院烧伤门诊进行了一项前瞻性随机对照试验。招募了 80 名参与者，并在他们的前三次换衣过程中对他们进行了研究。使用经过验证的儿童报告、护理人员报告、护理观察和生理测量来评估疼痛。
与 SD 和 VG 相比，MMD-D 和 MMD-PP 均显著减轻报告的疼痛（p<0.05）并缩短换衣时间（p<0.05）。在随后的换衣过程中，MMD-D 和 MMD-PP 的积极作用得以持续。
与标准做法或手持视频游戏相比，在门诊烧伤诊所中，将 MMD 用作准备工具或分散注意力工具可以在三次换衣过程中为儿童提供更好的疼痛缓解效果。该设备具有通过缩短治疗时间提高诊所效率的潜力。
