Hematology Oncology Unit, Second Pediatric Department, Aristotle University of Thessaloniki, University General Hospital AHEPA, Thessaloniki, Greece.
Department of Pediatrics, 404 General Military Hospital, Larissa, Greece.
J Paediatr Child Health. 2021 Apr;57(4):491-499. doi: 10.1111/jpc.15442. Epub 2021 Mar 12.
Most toddlers experience pain and distress during doctor or dental visits. Aim of this systematic review was to investigate the role of play-based interventions in pain and fear or distress management in pre-school children (aged from 2 to 6 years old) undergoing needle-related medical procedures adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines (registration number: CRD42020192161).
The key database that was searched was PubMed/MEDLINE along with references of relevant review studies. Only randomised controlled trials (RCTs) that fulfilled inclusion and eligibility criteria were selected for analysis. Methodological quality was evaluated using the Cochrane Collaboration's Risk of Bias Tool for RCTs and Review Manager version 5.4 was utilised in order to calculate standardised mean differences (SMDs) and create a forest plot for included studies that presented data on self-reported pain ratings. Primary outcomes refer to pain, anxiety and fear assessments, while secondary outcomes refer to physiological measures and cortisol levels.
All included RCTs suffered from high risk of bias that relied on selection and blinding methodology, while other sources of bias were also present in some cases. Despite low-quality of evidence, play-based interventions seem to favour less self-reported pain (SMD -0.39; 95% CI: -0.67 to -0.12; I = 84%).
Limitations of evidence, except from high risk of bias, include inconsistency in reporting primary outcome assessments and study designs that preclude reproducibility. Play-based techniques seem to contribute to pre-schoolers' coping towards needle-related medical procedures and further research is warranted in order to explore clinical benefits.
大多数幼儿在看医生或看牙医时会感到疼痛和不适。本系统评价的目的是研究基于游戏的干预措施在管理 2 至 6 岁幼儿（年龄在 2 至 6 岁之间）接受与针有关的医疗程序时的疼痛和恐惧或痛苦管理中的作用，该研究符合系统评价和荟萃分析报告的首选项目（注册号：CRD42020192161）。
主要搜索的数据库是 PubMed/MEDLINE 以及相关综述研究的参考文献。仅选择符合纳入和资格标准的随机对照试验（RCT）进行分析。使用 Cochrane 协作风险偏倚评估工具评估方法学质量，并使用 Review Manager 版本 5.4 计算标准化均数差值（SMD）并为呈现自我报告疼痛评分数据的纳入研究创建森林图。主要结局指标是疼痛、焦虑和恐惧评估，而次要结局指标是生理指标和皮质醇水平。
所有纳入的 RCT 都存在高度的偏倚风险，这些偏倚依赖于选择和盲法方法，而在某些情况下还存在其他来源的偏倚。尽管证据质量较低，但基于游戏的干预措施似乎可以减少自我报告的疼痛（SMD-0.39；95%CI：-0.67 至-0.12；I = 84%）。
除了高风险的偏倚外，证据的局限性还包括主要结局评估报告的不一致性和排除可重复性的研究设计。基于游戏的技术似乎有助于幼儿应对与针有关的医疗程序，需要进一步研究以探索临床获益。
