儿童和青少年疫苗注射的心理干预措施：随机和半随机对照试验的系统评价
Psychological Interventions for Vaccine Injections in Children and Adolescents: Systematic Review of Randomized and Quasi-Randomized Controlled Trials.
作者信息
Birnie Kathryn A, Chambers Christine T, Taddio Anna, McMurtry C Meghan, Noel Melanie, Pillai Riddell Rebecca, Shah Vibhuti
机构信息
Departments of *Psychology and Neuroscience ‡Pediatrics, Dalhousie University †Centre for Pediatric Pain Research, IWK Health Centre, Halifax, NS §Leslie Dan Faculty of Pharmacy, University of Toronto ∥The Hospital for Sick Children ‡‡York University §§Mount Sinai Hospital ∥∥Faculty of Medicine, University of Toronto, Toronto ¶Department of Psychology, University of Guelph, Guelph #Children's Health Research Institute **Department of Paediatrics, Western University, London, ON ††Department of Psychology, University of Calgary, AB, Canada.
出版信息
Clin J Pain. 2015 Oct;31(10 Suppl):S72-89. doi: 10.1097/AJP.0000000000000265.
BACKGROUND
This systematic review evaluated the effectiveness of psychological interventions for reducing vaccination pain and related outcomes in children and adolescents.
DESIGN/METHODS: Database searches identified relevant randomized and quasi-randomized controlled trials. Data were extracted and pooled using established methods. Pain, fear, and distress were considered critically important outcomes.
RESULTS
Twenty-two studies were included; 2 included adolescents. Findings showed no benefit of false suggestion (n=240) for pain (standardized mean difference [SMD] -0.21 [-0.47, 0.05]) or distress (SMD -0.28 [-0.59, 0.11]), or for use of repeated reassurance (n=82) for pain (SMD -0.18 [-0.92, 0.56]), fear (SMD -0.18 [-0.71, 0.36]), or distress (SMD 0.10 [-0.33, 0.54]). Verbal distraction (n=46) showed reduced distress (SMD -1.22 [-1.87, -0.58]), but not reduced pain (SMD -0.27 [-1.02, 0.47]). Similarly, video distraction (n=328) showed reduced distress (SMD -0.58 [-0.82, -0.34]), but not reduced pain (SMD -0.88 [-1.78, 0.02]) or fear (SMD 0.08 [-0.25, 0.41]). Music distraction demonstrated reduced pain when used with children (n=417) (SMD -0.45 [-0.71, -0.18]), but not with adolescents (n=118) (SMD -0.04 [-0.42, 0.34]). Breathing with a toy (n=368) showed benefit for pain (SMD -0.49 [-0.85, -0.13]), but not fear (SMD -0.60 [-1.22, 0.02]); whereas breathing without a toy (n=136) showed no benefit for pain (SMD -0.27 [-0.61, 0.07]) or fear (SMD -0.36 [-0.86, 0.15]). There was no benefit for a breathing intervention (cough) in children and adolescents (n=136) for pain (SMD -0.17 [-0.41, 0.07]).
CONCLUSIONS
Psychological interventions with some evidence of benefit in children include: verbal distraction, video distraction, music distraction, and breathing with a toy.
背景
本系统评价评估了心理干预对减轻儿童和青少年疫苗接种疼痛及相关结果的有效性。
设计/方法：通过数据库检索确定相关的随机和半随机对照试验。使用既定方法提取和汇总数据。疼痛、恐惧和痛苦被视为至关重要的结果。
结果
纳入22项研究；2项纳入青少年。结果显示，虚假暗示（n = 240）对疼痛（标准化均数差[SMD] -0.21[-0.47, 0.05]）或痛苦（SMD -0.28[-0.59, 0.11]）无益处，反复安慰（n = 82）对疼痛（SMD -0.18[-0.92, 0.56]）、恐惧（SMD -0.18[-0.71, 0.36]）或痛苦（SMD 0.10[-0.33, 0.54]）也无益处。言语分心（n = 46）显示痛苦减轻（SMD -1.22[-1.87, -0.58]），但疼痛未减轻（SMD -0.27[-1.02, 0.47]）。同样，视频分心（n = 328）显示痛苦减轻（SMD -0.58[-0.82, -0.34]），但疼痛（SMD -0.88[-1.78, 0.02]）或恐惧（SMD 0.08[-0.25, 0.41]）未减轻。音乐分心与儿童（n = 417）一起使用时显示疼痛减轻（SMD -0.45[-0.71, -0.18]），但与青少年（n = 118）一起使用时未减轻（SMD -0.04[-0.42, 0.34]）。借助玩具呼吸（n = 368）对疼痛有益（SMD -0.49[-0.85, -0.13]），但对恐惧无益（SMD -0.60[-1.22, 0.02]）；而不借助玩具呼吸（n = 136）对疼痛（SMD -0.27[-0.61, 0.07]）或恐惧（SMD -0.36[-0.86, 0.15]）均无益处。儿童和青少年（n = 136）进行呼吸干预（咳嗽）对疼痛无益处（SMD -0.17[-0.41, 0.07]）。
结论
在儿童中显示有一定益处证据的心理干预措施包括：言语分心、视频分心、音乐分心和借助玩具呼吸。
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