Bocklage Clare, Selden Raven, Tumsuden Olivia, Nanney Eleanor, Sawicki Caroline, Rapolla Allen, Cass Katelyn, Lee Jessica, Ginnis Jeannie, Strauman Timothy, Graves Christina, Divaris Kimon, Hodges Eric, Jacox Laura Anne
Orthodontics Group, Division of Craniofacial and Surgical Care, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
Division of Biomedical Sciences, Adams School of Dentistry, University of North Carolina, Chapel Hill, North Carolina, USA.
Int J Paediatr Dent. 2025 Mar;35(2):241-258. doi: 10.1111/ipd.13227. Epub 2024 Jul 12.
Dental practitioners desire non-pharmacological methods to alleviate anxiety, fear, and pain in children receiving dental care; high-quality evidence, however, is required to evaluate methods' efficacy.
This study aimed to develop and validate an observation-based coding approach (paediatric dental pain, anxiety, and fear coding approach [PAFCA]) to evaluate non-pharmacological behavior management techniques for anxiety, fear, and pain.
Objective (video-based) and subjective (self-reported) anxiety, fear, and pain data were collected from a pilot clinical trial evaluating animal-assisted therapy (AAT) in paediatric dentistry, in which 37 children aged 7-14 were assigned to AAT or control before dental treatment (restorations or extractions). A coding approach utilizing a codebook, a gold standard calibration video, and a user training guide was developed. Trained examiners coded the gold standard video for inter-rater agreement, and masked, calibrated examiners analyzed videos using the Noldus Observer XT software.
A novel, software-based coding approach was developed, with moderately high inter-rater agreement. Using PAFCA, we found children reporting higher levels of pain, fear, and anxiety exhibited treatment-interfering behaviors, including crying/moaning, attempts to dislodge instruments, and more upper and lower body movements.
PAFCA shows promise as a reliable tool for assessing anxiety, pain, and fear in behavioral research for paediatric dentistry.
牙科从业者希望采用非药物方法来减轻接受牙科治疗儿童的焦虑、恐惧和疼痛；然而，需要高质量的证据来评估这些方法的疗效。
本研究旨在开发并验证一种基于观察的编码方法（儿科牙科疼痛、焦虑和恐惧编码方法[PAFCA]），以评估用于焦虑、恐惧和疼痛的非药物行为管理技术。
从一项评估儿科牙科动物辅助治疗（AAT）的试点临床试验中收集客观（基于视频）和主观（自我报告）的焦虑、恐惧和疼痛数据，在该试验中，37名7至14岁的儿童在牙科治疗（修复或拔牙）前被分配接受AAT或对照治疗。开发了一种利用编码手册、黄金标准校准视频和用户培训指南的编码方法。经过培训的检查人员对黄金标准视频进行编码以评估评分者间的一致性，并且经过掩蔽和校准的检查人员使用Noldus Observer XT软件分析视频。
开发了一种新颖的基于软件的编码方法，评分者间一致性中等偏高。使用PAFCA，我们发现报告疼痛、恐惧和焦虑水平较高的儿童表现出干扰治疗的行为，包括哭闹/呻吟、试图移除器械以及更多的上半身和下半身动作。
PAFCA有望成为儿科牙科行为研究中评估焦虑、疼痛和恐惧的可靠工具。
