Audiovisual Distraction Research Articles

THE EFFECT OF ANIMATION MOVIE AGAINST ANXIETY LEVEL IN DENTAL TREATMENT OF ELEMENTARY SCHOOL 15 PADANG STUDENT

Anxiety, a normal condition which part of human development that happen from childhood. Dental anxiety has been studied for 10 years ago and still be the basic problem for dental treatment. Distraction is a technique to manage dental anxiety. Distraction is a method to distract patient to something that patient like. Audiovisual distraction is one of many techniques that effective to use for children. One of the idea to distract children to watch animation movie. This study use post test only control group design. This study use 50 samples. The anxiety level is measured by blood pressure, breathing, heartbeat, psychological sign, and physiological sign when student being treated for dental plaque record. Based on Kolmogorov-smirnov test, the result showed that there was an effect of animation movie for dental treatment with value of p<0.05 compare to control group. The conclusion of this study is animation movie have an effect against anxiety level in dental treatment.

Effectiveness of Non-Pharmacological Interventions in Reducing Dental Anxiety Among Children with Special Needs: A Scoping Review with Conceptual Map

Background: Children with special needs often need tailored approaches to oral healthcare to address their unique needs effectively. It is essential to analyze the effectiveness of non-pharmacological management in reducing dental anxiety among special needs children during dental treatment. Methods: Five electronic databases, PubMed, Scopus, Web of Science, Embase, and Google Scholar, were searched from 2007 to August 2024 for randomized control trials and observational studies comparing the effectiveness of non-pharmacological techniques in reducing dental anxiety during invasive and noninvasive dental treatment. The primary outcomes of the studied intervention were reduced dental anxiety and improved behavior during dental treatment. The conceptual map was created to understand the need for assessment and behavior management for special needs children (SN). Results: Nineteen articles qualified for the final analysis from 250 screened articles. Included studies evaluated the effect of strategies applied clinically, such as audio–visual distraction, sensory-adapted environment, and virtual reality. The included studies measured the trivial to large effect of measured interventions and supported non-pharmacological interventions in clinical settings. Conclusion: Most basic non-pharmacological interventions showed a trivial to large reduction in dental anxiety among SN patients. The conceptual map developed in this study supports the need for non-pharmacological interventions as they are cost-effective and create a positive environment in dental clinics. However, more studies need to focus on non-pharmacological behavior interventions in SN children to support the findings of this scoping review.

Audio-Visual Distraction- A Non-Pharmacological Approach to Alleviate Pain in Pediatric Vaccine Administration: An Observational Study

Introduction: The routine vaccine injections are one of the most common and painful procedures during childhood specifically in infancy. In order to improve the effectivity of pain reduction during routine vaccination OPD this study was done to analyse the effectiveness of audio-visual gadgets as a distraction tool for pain reduction in infants during the vaccination procedure. Methods: A comparative observational study conducted at a tertiary healthcare center vaccination out patient department. Children aged 1 month to 2 years receiving the vaccine were included in the study. The study group was exposed to audio-visual clip while the control group received the vaccine as per routine vaccination protocol. The Face, Legs, Activity, Cry, Controllability Scale score was used to assess the behavioural reactions to pain which assesses five behavioural areas. The study protocol was approved by the Institute Ethics Committee (Reference number: BJGMC/IEC/1122238-238).Results: The Face, Legs, Activity, Cry, Controllability Scale score were studied among two groups, it was observed that the pain score and every component of the score had a statistically significant lower mean score in audio-visual group as compared to the control group. Mean pain score in the audio-visual group was 6.31±0.79 as compared to 9.57±0.65 in the control group with the p value of 0.001.Conclusions: A lower pain score in response to vaccination with an audio-visual distraction indicates that it can be regularly used to reduce pain during the vaccination procedure and can be used during different painful procedures.

Attentional focus modulates physiological response to arousal in a competitive putting task.

Attentional focus during the execution of perceptual motor tasks has been shown to affect performance outcomes. The purpose of this study is to assess the physiological changes prompted by attentional focus in various levels of stress. Thirty-six healthy young males and females were randomized into groups and directed on attentional focus in a staged putting competition scenario intended to elicit competitive anxiety. External focus groups experienced less internal workload at all arousal levels and preserved heart rate variability measures when audiovisual distraction was introduced.

Prévention de l’anxiété péri-opératoire : Apport de la distraction audiovisuelle

Audiovisual distraction (AVD) is one of the non-pharmacological means of anxiety prevention. However, few studies have evaluated its perioperative effect in adults. To evaluate the contribution of audio-visual distraction in the prevention of perioperative anxiety in adult patients proposed for surgery under spinal anesthesia. This was a prospective randomized controlled study lasting three months from July 1, 2021. We included ASA I to III over 18 years patients, proposed for visceral or orthopedic surgery under spinal anesthesia. We didn't include patients operated in lateral or prone positions or with a history of anxiety disorders or communication difficulties. 90 patients were randomized into two groups: a control group T and a group A who had an AVD throughout the operation. The primary outcome was anxiety as assessed by the visual analogue scale (VAS). Demographic characteristics, Amsterdam preoperative anxiety and information scale (APAIS) and pain levels were comparable between the two groups. During the surgery, 22 (48.9 %) patients in group T versus 3 (6.7 %) in group A required Midazolam (p < 0.001). Anxiety assessed by VAS at the end of the act was lower in group A (p < 0.001). The pain levels also were lower in patients who received AVD (p = 0.004). A patient satisfaction score (Iowa Satisfaction with Anesthesia Scale French version) ≥ 5.4 was more frequently observed in group A (p < 0.001). AVD reduced perioperative anxiety and decreased the use of midazolam during surgery performed under spinal anesthesia.

Recent Developments in the Non-Pharmacological Management of Children's Behavior Based on Distraction Techniques: A Concise Review.

Oral diseases and conditions affect children's oral health and negatively influence their overall health. Early detection and intervention are important in mitigating these negative consequences. However, dental fear and anxiety (DFA) regarding dental procedures often hinder children from seeking necessary dental care. Non-pharmacological behavior management strategies, such as distraction techniques, are commonly adopted to manage children's behaviors. Distraction techniques have been developed rapidly in recent years and are widely accepted by both health professionals and parents due to their noninvasive and low-cost nature. This concise review aims to summarize current distraction techniques applied during dental treatments, especially for children. The most commonly reported techniques for children are audio distraction, audio-visual distraction, tactile distraction, olfactory distraction, and gustatory distraction. Audio distraction techniques involving music and storytelling help children relax. Audio-visual distraction techniques help to divert children's attention from the dental treatment. Tactile stimuli can reduce the transmission of pain signals. Olfactory stimuli can help children feel comfortable and relaxed. Gustatory distraction involving sweet substances can create a positive environment. These distraction techniques effectively reduce DFA in children and improve their satisfaction with dental procedures. As technology continues to develop, further research is needed to provide more robust, evidence-based guidance for dentists using distraction techniques.

The impact of animated video cartoons as a distraction technique on anticipatory anxiety levels among children during class I GIC restoration procedures.

Investigating the effect of visual distraction using animated video cartoons (AVCs) on anxiety of children during class I class I glass-ionomer cement (GIC) restoration procedures. This randomized clinical trial, 42 children between the ages of 5-6years were enrolled. These participants were divided into two groups: Group 1, consisting of 21 individuals (AVCs), who were exposed to a cartoon as a visual distraction tool, and Group 2, a control group with 21 participants who did not receive any form of distraction during their first visit. Both groups underwent class I GIC restoration procedures that were conducted in a consistent manner. To evaluate the anxiety levels of the children, measurements of their pulse rate (PR) were taken at the beginning and end of the treatment. Additionally, patient behavior was assessed using the Frankl behavior rating scale (FBRS) as well as validated self-reported dental anxiety scale, the Visual Analog Scale - Anxiety (VAS-A) score. In the control group, postoperative PR increased significantly, while the AVC group experienced a decrease compared to their preoperative PR levels. Additionally, audio-visual distraction had a notable impact on FBRS scores compared to the standard approach. Similarly, the VAS-A score displayed a significant reduction when patients received audio-visual distraction compared to the control condition. Subgroup analysis by gender showed that girls tended to be more responsive to AVCs than boys when evaluated by PR and FBRS, but such findings were not observed using VAS-A. Patients with deeper caries had higher VAS-A scores than those with shallower ones. Despite the caries depth, those who received AVC seemed to be calmer, especially to those with deeper lesions, as indicated lower postoperative VAS-A scores compared to their preoperative levels, unlike the control group. Our study suggests that the use of AVCs can be an effective method for reducing anxiety in children undergoing class I GIC restoration procedures.

The Use of Audiovisual Distraction Tools in the Dental Setting for Pediatric Subjects with Special Healthcare Needs: A Review and Proposal of a Multi-Session Model for Behavioral Management.

A Special Health Care Need (SHCN) is characterized by any type of physical, mental, sensorial, cognitive, emotional, or developmental condition that requires medical treatment, specialized services, or healthcare interventions. These conditions can negatively impact oral health as SHCN children can hardly cooperate or communicate and experience higher levels of dental fear/anxiety, which interfere with regular appointments. The present narrative review aims to analyze the use of audiovisual (AV) tools in dental setting for the management of SHCN children during dental treatment and to evaluate their effectiveness in anxiety/behavior control from the child, dentist, and care-giver perspectives. This analysis leads to the proposal of a new multi-session model for the behavioral management of SHCN pediatric subjects. An electronic search on the MEDLINE/Pubmed, Scopus, and Web of Science databases was carried out and through this analysis, a new model was proposed, the "UNISA-Virtual Stepwise Distraction model", a multi-session workflow combining traditional behavior management and the progressive introduction of AV media to familiarize the SHCN child with dental setting and manage behavior. AV tools helped in most cases to manage SHCN behavior and decreased stress in both the dentist and child during dental treatments. Care-givers also welcomed AV distractors, reporting positive feedback in using them during future treatments. The present narrative review found increasing evidence of the use of AV media for SHCN pediatric subjects as distraction tools during dental treatment. In the majority of the studies, AV tools proved to be effective for the management of anxiety, dental fear, and behavior in dental setting.

A Scoping Review of Audiovisual Distraction Techniques Among Children in Reducing Invasive Procedure Pain.

Invasive procedures in children can lead to painful and uncooperative procedures. It is essential to determine the appropriate method to create a comfortable environment for children during invasive procedures. However, audiovisuals are one of the distraction techniques used in pain management. This study aims to identify and categorize related audiovisual distraction techniques in reducing pain due to invasive procedures among children. This study uses a systematic scoping review. A literature review was conducted using PubMed, EBSCO, Science Direct, Scopus and grey literature through Google Scholar. The study was eligible for inclusion if it included articles published from 2012 to 2022, full-text and open accessed articles, and in Indonesian and English language. Studies were excluded if they were review studies and the adult population. The keywords in English were "Children" OR 'Child' OR"Kids" OR 'Youth' OR 'Adolescents' OR 'Teenager' OR 'Teens' OR 'Young People' OR 'Pediatric' OR 'Paediatric' OR 'Childhood' AND"Audiovisual" OR 'Movie' OR 'Video' OR 'Animation' AND"Pain" AND"Invasive procedures" and keyword in Indonesia were"Anak" OR 'Remaja' OR 'Bayi' OR 'Balita' AND"Audiovisual" OR 'Film' OR"Video" OR 'Animasi' OR "Nyeri" AND 'Prosedur invasif'. We found 15 articles showing audiovisual distraction techniques in managing pain among children undergoing invasive procedures. Three types of audiovisual interventions were used, including virtual reality (VR), video music, and animated cartoons. In addition, types of invasive procedures that benefited from the analyzed interventions were infusion, surgery, injection, blood draw, dressing change, circumcision, endoscopy, and phlebotomy. Our findings highlight that virtual reality, video music, and animated cartoons have clinical implications in helping to distract from pain in children undergoing invasive procedures. Our study indicates that the potential of audiovisual intervention can be used as an intervention strategy in the pediatric nursing area.

Efficacy of topical local anesthetic, topical cooling spray, and audiovisual distraction on relief of needle-related pain during blood collection: A randomized controlled trial.

Venipuncture is one of the most common invasive procedures in healthcare, often resulting in the experience of pain. While audiovisual distraction, topical anesthesia and cold spray application have been reported as methods to reduce pain, there is a lack of studies that focus on comparing their efficacy and safety. We aimed to compare the efficacy and safety of pain reduction during venipuncture using audiovisual distraction, topical anesthesia and cold spray application. A randomized controlled study was conducted at Walailak University (Nakhon Si Thammarat, Thailand) from April 2023 to July 2023. Eligible adult participants voluntarily enrolled in the study and were randomly assigned to 1 of 4 groups: group 1 (control), group 2 (topical anesthetic), group 3 (cooling spray), and group 4 (audiovisual distraction). Pain scores and satisfaction levels were assessed following the venipuncture procedure on the upper extremities. Forty-seven participants were included in the final analysis. The participants had a mean age of 42.3 years (standard deviation (±SD): 13.1), with the majority being female (66.0%). The participants in the intervention groups reported lower pain scores than those in group 1. The mean differences were 2.67 points in group 2 (95% confidence interval (95% CI): 1.49-3.84; p < 0.001), 1.56 points in group 3 (95% CI: 0.15-2.98; p = 0.077), and 1.67 points in group 4 (95% CI: 0.37-2.96; p = 0.042). However, the pain reduction did not reach statistical significance when comparing these 3 interventions. All groups reported a median satisfaction level of 3, with no significant difference among them (H(3) = 6.050, p = 0.109). Pain reduction interventions, including topical anesthetic, cooling spray and audiovisual distraction, are effective methods for alleviating pain during venipuncture. Participants who received a topical anesthetic reported the lowest pain scores and highest levels of satisfaction.

3-Dimensional Virtual Reality Versus 2-Dimensional Video for Distraction During the Induction of Anesthesia in Children to Reduce Anxiety: A Randomized Controlled Trial.

Preoperative anxiety is common in children. It can contribute to negative experiences with anesthetic induction and may cause adverse physiological and psychological effects. Virtual reality (VR) and electronic tablet devices are 2 audiovisual distraction tools that may help to reduce anxiety and enhance the preoperative experience. This study aimed to compare the use of an immersive 3-dimensional (3D) VR to 2-dimensional (2D) video on anxiety in children during induction of general anesthesia. Two hundred children (4-13 years) undergoing elective or emergency surgery under general anesthesia were enrolled in this randomized, controlled trial. Participants were randomized to use either the 3D VR goggles (intervention) or 2D video tablet (control) during anesthetic induction. Anxiety, the primary outcome, was measured using the modified Yale Preoperative Anxiety Scale Short Form (mYPAS-SF) at 2 time points: in the preoperative holding area before randomization (T1) and during induction of general anesthesia (T2). The primary outcome was analyzed using a linear regression model, including demographic and other covariates, to investigate any differences in anxiety scores. Secondary outcomes included evaluating compliance during the anesthetic induction (Induction Compliance Checklist), emergence of delirium (Cornell Assessment of Pediatric Delirium), perceived usefulness of the device, and child satisfaction. Participant characteristics were similar between the 3D VR (n = 98) and 2D video (n = 90) groups, with a mean (±standard deviation) age 8. 8 ± 2.8 years. The median (lower quartile, upper quartile) mYPAS-SF scores for the 3D VR group at the preoperative holding area were 22.9 (22.9, 35.4), then 29.2 (24.0, 41.7) during induction. For the 2D Video group, the scores were 27.1 (22.9, 35.4) and then 30.2 (22.9, 41.1). No significant difference was observed in the increase in mYPAS-SF scores between groups (P = .672). Children in the 3D VR group were less likely to be rated as having a perfect induction (P = .039). There was no evidence of a difference between the groups in emergence delirium. Both devices were rated highly for usefulness and patient satisfaction. Children preferred VR, while anesthesiologists and parents felt the 2D was more useful. This randomized controlled trial demonstrated that preoperative anxiety was equally low and induction compliance high with both 3D VR and 2D video distraction in children with parental presence during anesthetic induction.

Effect of Audio and Audiovisual Distraction Technique on Anxiety of Pediatric Patients During Pit and Fissure Sealant Application: A Clinical Trial

This clinical trial evaluates the impact of audio and audiovisual distraction techniques on reducing anxiety in pediatric patients undergoing pit and fissure sealant application. A total of 60 children aged 6-12 requiring sealant application were randomly assigned into three groups: Control (no distraction), Audio distraction (listening to music), and Audiovisual distraction (watching cartoons). Anxiety levels were measured using the Venhem Anxiety Rating Scale (VARS) before and after the procedure. The study found a significant reduction in anxiety levels in the audio and audiovisual distraction groups compared to the control group. Specifically, the audiovisual group showed the greatest reduction in VARS scores, followed by the audio group.

Comparative Study of Different Behavioral Management Techniques in Treating Anxious Pediatric Dental Patients

ABSTRACT Background: Pediatric dental anxiety poses a significant challenge in the delivery of dental care, often resulting in compromised treatment outcomes and negative experiences for both patients and dental professionals. Materials and Methods: A randomized controlled trial (RCT) was conducted involving 120 pediatric dental patients aged 4 to 10 years old, presenting with varying degrees of dental anxiety. Patients were randomly assigned to three groups: Group A received tell-show-do (TSD) technique, Group B received audiovisual distraction (AVD), and Group C received non-pharmacological behavior guidance (NPBG). Anxiety levels were assessed using a standardized anxiety scale before and after the dental procedure. Patient cooperation during treatment, as well as dentist and parent satisfaction, was also evaluated. Results: The study revealed significant reductions in anxiety levels across all groups post-treatment. However, Group B (AVD) demonstrated the most substantial reduction in anxiety scores, with a mean decrease of 60% from baseline. Group A (TSD) and Group C (NPBG) showed comparable reductions in anxiety levels, with mean decreases of 45% and 50%, respectively. Patient cooperation during treatment was highest in Group B, followed by Groups C and A. Dentist and parent satisfaction scores were significantly higher in Group B compared to the other groups. Conclusion: AVD emerged as the most effective behavioral management technique for treating anxious pediatric dental patients, resulting in significant reductions in anxiety levels and higher levels of patient cooperation during treatment compared to TSD and NPBG techniques.

Effectiveness of Audiovisual Distraction in Reducing Children's Anxiety for Pain During Medical and Dental Treatments: A Systematic Review and Meta-analysis.

Audiovisual distraction is a potentially good technique to reduce medical treatment procedure-related fear and anxiety among children. However, few studies have assessed its effectiveness. To conduct a systematic review and meta-analysis for evaluating the effectiveness of audiovisual distraction in reducing pain anxiety in pediatrics. Randomized control trials and experimental studies that reported the use of audiovisual distraction during medical/dental treatments among children aged 3-8 years, used the Face, Legs, Activity, Cry, Consolability (FLACC) scale to assess pain, and were published between 2005-2021 and in English were retrieved from PubMed, Scopus, and Web of Science. A random-effects model was used for evidence analysis. A total of four studies were included in the systematic review and meta-analysis: two were from South Asia and one each were from Africa and North America. Three of these studies were randomized control trials. The variability among the studies was high. Three of the four studies found that AV techniques were significantly effective in reducing pain during procedures compared with the control group (P < 0.00001), while one study found no difference; the cumulative evidence in the forest plot was similar. Cumulative evidence suggests that the use of audiovisual distraction is an effective strategy in reducing medical/dental procedures-related pain anxiety among children aged 3-8 years. However, evidence on this is currently limited, and thus further studies are required using various AD techniques and on different populations to substantiate these findings. None. PROSPERO (Ref no.: CRD42021245874).

Influence of audiovisual distraction on the feeling of stress, analgesic sedation and patient satisfaction during electrophysiological ablation procedures on the heart

Abstract Background Distraction using audiovisual stimuli has mostly been researched in a paediatric population with the results showing an inhibiting effect on stress and anxiety as well as the subjective perception of pain. Purpose We designed a study to test if audiovisual distraction may reduce the level of sedatives and analgesics by reducing anxiety and stress during electrophysiological intervention (EP). Methods We conducted a clinical intervention pilot study that was carried out in a randomized controlled manner. Consecutive 70 patients undergoing EP with subsequent ablation were randomized 1:1 to control (CTL) or intervention group (AVD). In addition to standardized sedation, all patients in AVD group received audiovisual glasses. Feeling of fear and stress was assessed through blood pressure changes. The patient satisfaction was assessed with Client Satisfaction Questionnaire, ZUF-8. Numeric scale (NRS) was used to quantify the perceived pain during the procedure. The difference between the subjective estimated duration of the procedure and the actual duration of the procedure was compared. Results The study included predominantly male patients (58.6%) with a mean age of 56 years. Technical aptitude was well balanced between both groups with the majority of patients in both groups owning a smartphone or a tablet (86.1% vs 85.7% for CTL and AVD respectively, p=0.92), and majority of patients in both groups using a computer, laptop or tablet on a weekly basis (58% vs 57.1% for CTL and AVD group respectively, p=0.97). The baseline feelings of anxiety were well balanced within both groups (Figure 1). Our analysis revealed no significant difference between the mean blood pressure values of the CTL and AVD groups (systolic: 135 vs. 141 mmHg; p = 0.32; diastolic: 74 vs. 72 mmHg; p = 0.45). Patient satisfaction score was comparable in both groups (26.5 vs. 26.8 points, p = 0.36). Average response for perceived pain using NRS scale as well as perceived procedure duration was similar between the groups (Figure 2). AVD group required a lower dose of Midazolam than CTL group (0.005 mg/kg/h vs 0.007 mg/kg/h, p = 0.07). Majority of patients (31.4%) in AVD group stated: "The audiovisual glasses made me feel distracted at times." 10% of the AVD patients stated: "The audiovisual glasses made me feel completely distracted and more relaxed." Conclusion The use of audiovisual glasses has no influence on the patients’ feelings of anxiety and stress during EP. The use of audiovisual glasses can temporarily induce distraction during EP, while they do not seem to be sufficient in reducing pain intensity during ablation therapy. Patients undergoing EP do not seem to be the target patient group for AVD use.

An In Vivo Study to Evaluate and Compare Anxiety and Behavior Management of Pediatric Patients Using Distraction Techniques.

To compare the efficacy of virtual reality (VR) glasses and on-screen distraction techniques in managing anxiety and behavior in children receiving dental treatments. Forty patients aged 4-8 years requiring restoration were divided into two groups: group I with 20 members using audio-visual distraction aid in the form of VR glasses and group II with 20 participants utilizing on-screen distraction techniques. Each child underwent two appointments one week apart; their anxiety and behavior levels were assessed at each visit using the Facial Image Scale and Frankel's Behavior rating scale. The Wilcoxon signed-rank and Chi-squared test were utilized to assess the correlation between two categorical variables, with VR demonstrating a notable divergence from on-screen distraction. Both on-screen distraction and VR applications decreased anxiety levels and improved behavior. However, VR was substantially more effective in managing these areas.

Comparison Between Jacobson’s Progressive Muscle Relaxation Technique and Audio-Visual Distraction Technique in Comparison to Tell-Show-Do Technique in Reducing Dental Anxiety in Children During Dental Visit: A Randomized Clinical Trial

Comparison Between Jacobson’s Progressive Muscle Relaxation Technique and Audio-Visual Distraction Technique in Comparison to Tell-Show-Do Technique in Reducing Dental Anxiety in Children During Dental Visit: A Randomized Clinical Trial

Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children.

Many behavior management techniques are employed to reduce the anxiety associated with dental procedures in children. One of the most commonly used methods comprises audiovisual distraction using virtual reality (VR) eyeglasses. In this study, an innovative device, a periorbital eye massager (PEM), is compared with VR to evaluate dental anxiety in children. in this study, 22 children were divided into two groups, that is, group I consisting of PEM and group II consisting of VR. The participants were instructed to wear the device and then subjected to dental restorative procedures. After completion of the procedure, anxiety was measured using a validated questionnaire by the children and by using the modified behavior pain scale by the second investigator. Also, physiological parameters like heart rate and oxygen saturation were evaluated before and after a dental procedure. The results were statistically insignificant for group I and group II when a validated questionnaire and modified behavior pain scale were used to measure the dental anxiety of children. Also, the data also shows no significant difference in heart rate and oxygen saturation between the two groups. The innovative PEM can also be used as an effective behavior management tool in managing dental anxiety in children, as there was no statistically significant difference between PEM and VR. As a pediatric dentist, the methods for administering a patient present a novel challenge because behavior management varies from patient to patient. As a result, the prospects for augmenting various techniques of behavior therapy for pediatric patients are limitless. Gala UP, Kalaskar R. Comparative Evaluation of the Effectiveness of Innovative Periorbital Eye Massager and Virtual Reality Eyeglasses for Reducing Dental Anxiety during Dental Restorative Procedures in Children. Int J Clin Pediatr Dent 2024;17(1):48-53.

Paediatric radiation therapy without anaesthesia – Are the children moving?

PurposeChildren who require radiation therapy (RT) should ideally be treated awake, without anaesthesia, if possible. Audiovisual distraction is a known method to facilitate awake treatment, but its effectiveness at keeping children from moving during treatment is not known. The aim of this study was to evaluate intrafraction movement of children receiving RT while awake. MethodsIn this prospective study, we measured the intrafraction movement of children undergoing treatment with fractionated RT, using pre- and post-RT cone beam CT (CBCT) with image matching on bony anatomy. Study CBCTs were acquired at first fraction, weekly during RT, and at last fraction. The primary endpoint was the magnitude of vector change between the pre- and post-RT scans. Our hypothesis was that 90 % of CBCT acquisitions would have minimal movement, defined as <3 mm for head-and-neck (HN) treatments and <5 mm for non-HN treatments. ResultsA total of 65 children were enrolled and had evaluable data across 302 treatments with CBCT acquisitions. Median age was 11 years (range, 2–18; 1st and 3rd quartiles 7 and 14 years, respectively). Minimal movement was observed in 99.4 % of HN treatments and 97.2 % of non-HN treatments. The study hypothesis of >90 % of evaluations having minimal movement was met. Children who were age >11 years moved less at initial evaluation but tended to move more as a course of radiation progressed, as compared to children who were younger. ConclusionChildren receiving RT with audiovisual distraction while awake had small magnitudes of observed intrafraction movement, with minimal movement in >97 % of observed RT fractions. This study validates methods of anaesthesia avoidance using audiovisual distraction for selected children.

Benefits to Clinicians of Nonpharmacological Distraction During Pediatric Medical Procedure.

Nonpharmacologic distraction (NPD) during medical procedures in children is known to be beneficial to patients; however, no reviews have assessed their benefits to medical providers. We aimed to assess the benefits of NPD to medical providers. We searched 5 databases for relevant articles. Peer-reviewed published randomized controlled trials comparing NPD with standard care that included children who had undergone medical procedures were included. Primary outcomes were procedure time, number of medical staff involved, and initial success rate of venipuncture. Two reviewers assessed the risk of bias by using the Cochrane Collaboration (Oxford, United Kingdom)'s Randomized Controlled Trials Risk of Bias Tool, and we performed a meta-analysis to assess efficacy. We included 22 trials with 1968 participants. The main NPD was audiovisual distraction, such as tablets. No significant difference was found in venipuncture procedure time (mean difference: -9.79; 95% confidence interval: -22.38 to 2.81; low certainty). We found no studies on the number of medical staff. Our review did not find any clear NPD-associated benefit for the medical provider. The review included a small amount of literature, analyzed a small number of cases, and had a low certainty of evidence regarding procedure duration; therefore, further studies are needed to conclude the benefits to clinicians of NPD.