La distraction par la réalité virtuelle pour le soulagement de la douleur de jeunes enfants ayant subi des brûlures

Les brûlures chez les enfants provoquent une douleur sévère surtout durant les procédures de soins. La gestion de la douleur est un rôle principal de l’infirmière œuvrant dans les soins aux brûlés. En plus d’administrer les médicaments et d’en assurer la surveillance, l’infirmière peut initier des interventions non pharmacologiques puisque les médicaments ne procurent souvent pas un soulagement total et ont de nombreux effets secondaires. La distraction par la réalité virtuelle (RV) est une intervention non pharmacologique qui permet de dévier l’attention de l’enfant des stimuli douloureux. Plusieurs études ont montré un effet prometteur de cette technologie pour le soulagement de la douleur procédurale. Cependant, aucune étude n’a exploré son effet auprès de jeunes enfants. Le but de cette thèse était d’abord, d’évaluer la faisabilité et l’acceptabilité, et ensuite l’effet préliminaire sur la douleur d’un nouveau prototype de RV (projecteur en dôme – RV hybride) développé spécifiquement pour distraire les enfants brûlés âgés entre 6 mois et 7 ans durant les séances d’hydrothérapie. À cet effet, deux études ont été menées. La première était une étude pilote à un groupe. Les participants étaient 15 enfants âgés en moyenne de 2.2 ± 2.1 ans avec une moyenne de surface corporelle brûlée de 5% ± 4. Ils ont tous reçu la distraction par le projecteur en dôme de RV combiné au traitement pharmacologique standard. Les résultats ont montré que le projecteur était une intervention faisable et adaptée à la salle d’hydrothérapie. Il n'a pas interféré avec la procédure et a été jugé utile pour la gestion de la douleur par la plupart des intervenants. Les mesures de douleur, de confort et de sédation étaient faisables, mais pas celle de l’anxiété compte tenu du jeune âge des participants. La seconde étude, basée sur la première, concernait un essai clinique d’efficacité intra-sujet auprès de 38 enfants âgés de 1.8 ± 1.3 ans. Chaque participant a reçu, durant la même séance d’hydrothérapie, le traitement pharmacologique seul (intervention contrôle) ainsi que le traitement pharmacologique combiné à la distraction par le projecteur en dôme de RV (intervention expérimentale) selon un ordre randomisé. L’intervention expérimentale a eu un effet bénéfique sur la douleur (mesurée par la FLACC (Face, Legs, Activity, Cry, Consolability scale) statistiquement significatif comparé à l’intervention contrôle pour tous les participants combinés (p= 0.026), ainsi qu’au niveau du confort mesuré par l’OCCEB-BECCO (Échelle d'Observation Comportementale du Confort d'Enfants Brûlés) (p=0.002). Cependant, selon l’analyse par séquences de randomisation, la différence était seulement significative pour le groupe qui a débuté par l’intervention expérimentale suggérant qu’il est plus difficile de distraire l’enfant une fois que les procédures douloureuses sont débutées. Aucun effet secondaire n’a été observé. Les résultats de cette thèse soulignent l’effet bénéfique de la distraction par la RV hybride chez les jeunes enfants brûlés. Cet outil peut être intégré à la pratique infirmière quotidienne pour offrir de meilleures interventions pour le soulagement de la douleur procédurale sans effets secondaires.Burns in children cause severe pain especially during wound care procedures. Pain management is a primary role of nurses involved in burn care. In addition to administration and monitoring of the medication, the nurse can initiate non-pharmacological interventions since the medication does not provide total relief with this population of patients and has many side effects. Virtual reality (VR) distraction is a non-pharmacological intervention that helps divert the child's attention away from painful stimuli. Several studies have shown a promising effect of this technology for the relief of procedural pain. However, no studies have explored its effect on pain in young children. The purpose of this thesis was two-fold: First to evaluate the feasibility and acceptability, and secondly the preliminary effect on pain of a new VR prototype (projector-based hybrid VR) developed specifically for burned children between 6 months and 7 years of age during hydrotherapy sessions. For this purpose, two studies were conducted. The first study was a single group pilot study. Participants were 15 children aged 2.2 +/- 2.1 years with a mean body surface area of 5% +/- 4%. They all received distraction by the projector-based hybrid VR combined with standard pharmacological treatment. Results showed that the VR projector was a feasible intervention adapted to the treatment room. It did not interfere with the procedure and was found useful for pain management by most care providers. Measurements of pain, comfort, and sedation were feasible, but not the measurement of anxiety given the participants’ age-group. The second study, based on the first one, was an efficacy crossover clinical trial of 38 children aged 1.8 ± 1.3 years. Each participant received, during the same hydrotherapy session, the pharmacological treatment alone (control intervention) as well as the pharmacological treatment combined with the distraction by the projector-based hybrid VR (experimental intervention) in a randomized order. The experimental intervention had a statistically significant beneficial effect compared to the control intervention for all participants combined for pain levels measured by the FLACC (Face, Legs, Activity, Cry, Consolability Scale) (p = 0.026) and comfort levels measured by OCCEB-BECCO (Behavioral Observational Scale of Comfort Level for Child Burn Victims) (p = 0.002). However, according to the analysis by randomization sequences, the difference was only significant for the group for which the sequence started with the experimental intervention suggesting that it is more difficult to distract a child once the painful procedures are started. No side effects were observed. Results of this thesis highlight the beneficial effect of a hybrid VR distraction device with young burned children. This tool could be implemented in daily nursing practice to provide better pain care to young children with no side effects

Développement d'une échelle de mesure de la souffrance chez les adolescents ayant le cancer

La complexité du traitement oncologique a amélioré les taux de survie des adolescents ayant le cancer mais a également augmenté leur souffrance. Le but de la présente étude était d'élaborer une échelle pour mesurer la souffrance chez cette population. À partir d’entrevues semi-structurées auprès de 19 adolescents et 16 experts, un pool d’items associés à la souffrance a été créé. Les items ont été présentés à un panel de neuf experts pour déterminer leur validité de contenu. Les analyses ont montré une validité de contenu élevée de l’échelle par l’indice de validité de contenu de 0,98 associé à un accord inter-juges de 0,88. La majorité des items étaient considérés faciles à comprendre et à y répondre. L’Échelle de Souffrance des Adolescents ayant le cancer (ESAC) est de type likert à quatre choix de réponses. Elle comprend 41 items portant sur la souffrance physique, psychologique, sociale, spirituelle, cognitive et globale.The complexity of cancer treatment has improved the survival rates among adolescents with cancer but has also increased their suffering. The purpose of this study was to develop a scale to measure suffering in this population. A pool of items associated with suffering was created after analysing the verbatim of semi-structured interviews conducted with 19 patients and 16 experts. The items were then presented to nine experts to determine their content validity. The analysis showed a high content validity of the scale with a content validity index (CVI) of 0.98 associated with an interrater agreement (IRA) of 0.88. The majority of the items were considered easy to understand and answer. The scale, called the “Suffering Scale of Adolescents with Cancer” (SSAC), is a likert type scale with four answer choices. It comprises 41 items about physical, psychological, social, spiritual, cognitive and global suffering

External cold and vibration for pain management of children undergoing needle-related procedures in the emergency department: a randomised controlled non-inferiority trial protocol.

INTRODUCTION: Needle-related procedures are considered as the most important source of pain and distress in children in hospital settings. Considering the physiological and psychological consequences that could result from these procedures, management of pain and distress through pharmacological and non-pharmacological methods is essential. Therefore, it is important to have interventions that are rapid, easy-to-use and likely to be translated into clinical practice for routine use. The aim of this study will be to determine whether a device combining cold and vibration (Buzzy) is non-inferior to a topical anaesthetic (liposomal lidocaine 4% cream) for pain management of children undergoing needle-related procedures in the emergency department. METHODS AND ANALYSIS: This study will be a randomised controlled non-inferiority trial comparing the Buzzy device to liposomal lidocaine 4% cream for needle-related pain management. A total of 346 participants will be randomly assigned in a 1:1 ratio to one of the two study groups. The primary outcome will be the mean difference in pain intensity between groups during needle-related procedures. A non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. A Non-inferiority margin of 0.70 on the Color Analogue Scale will be considered. The secondary outcomes will be the level of distress during the procedure, the success of the procedure at first attempt, the occurrence of adverse events, the satisfaction of both interventions and the memory of pain 24 hours after the procedure. The primary outcome will be assessed for non-inferiority and the secondary outcomes for superiority. ETHICS AND DISSEMINATION: This study protocol was reviewed and approved by the institutional review board of the study setting. Findings of this trial will be disseminated via peer-reviewed publications and conference presentations. TRIAL REGISTRATION NUMBER: NCT02616419

DREAM Project: Decreasing REcurrent pain and Anxiety in Medical procedures on a pediatric population

International audienceThe DREAM project is a joint venture between the medical world, university professors and developers with one goal in mind: create an efficient distraction tool to reduce pain and anxiety in children receiving medical treatments. Growing evidence in the medical literature suggests that virtual reality is a very potent and effective way of creating distraction. In turn, distraction has been shown to reduce pain and anxiety in children who are receiving painful medical procedures. The pediatric population offers quite a challenge when it comes to pain control, especially the pain caused by medical procedure. Anxiety and anticipation greatly modulates pain perception and can often jeopardize a treatment if a child’s collaboration cannot be obtained. With those premises in mind, our team is trying to create an efficient virtual reality game for distracting kids from their pain. The DREAM game has been tailored for the very specific needs and characteristics of our target population. The experience is optimized for the oculus rift and the controls have been simplified to work in various medical settings with minimal preparation time. Our main concern was to create a game that delivers a potent distractive effect while inciting almost no side effects or cyber sickness. The DREAM project is currently being tested on children with burn injuries. The objective of this paper is to present the methodology used to validate our hypotheses

Efficacy of the Buzzy® device for pain management of children during needle-related procedures: a systematic review protocol

Abstract Background Needle-related procedures are the most important source of pain in children in hospital setting. Unmanaged pain could result in short- and long-term physiological, psychological, and emotional consequences. Although the efficacy of numerous interventions has been evaluated, procedural pain management is often suboptimal in children undergoing needle-related procedures. The main objective of this systematic review is to examine the evidence for the efficacy of the Buzzy® device for needle-related procedural pain in children. Methods An electronic search will be conducted in the following databases: CENTRAL, PubMed, MEDLINE, EMBASE, PsycInfo, and CINAHL. There will be no restriction regarding the language, date of publication, and publication status. Eligible studies will be randomized controlled trials using the Buzzy® device for pain management in children undergoing needle-related procedures. Selection of studies, data extraction and management, assessment of risk of bias and quality of evidence will be performed by two independent reviewers. A third researcher will be consulted in case of discrepancies. Depending on the availability and quality of the data as well as clinical and statistical heterogeneity, a meta-analysis will be performed. Otherwise, findings will be qualitatively reported. Discussion This will be the first systematic review to examine the efficacy of the Buzzy® device on pain management of children during needle-related procedures. Results of this review will guide clinical practice and recommendations for further research to improve procedural pediatric pain management. Systematic review registration PROSPERO CRD4201707653

Développement et validation de l’Échelle d’Observation Comportementale du Confort d’Enfants Brûlés (OCCEB-BECCO)

Introduction. Les soins des brûlures chez les enfants occasionnent beaucoup de douleur et d’appréhension. Le confort, un concept référant autant à l’absence de douleur physique qu’au bien-être, est important pour évaluer la qualité des soins prodigués par les infirmières aux jeunes enfants brûlés. À notre connaissance, aucun instrument n’existe actuellement pour mesurer le confort lors de procédures douloureuses chez les enfants ayant subi des brûlures. Objectif. Développer et valider une échelle de mesure du confort, lors de procédures douloureuses, chez les jeunes enfants ayant subi des brûlures. Méthodes. Une revue de la littérature a permis de générer 38 énoncés dont le nombre a été réduit à 14 par un panel composé de 13 professionnels de la santé. Les énoncés ont été ensuite regroupés sous quatre sous-échelles comportementales principales : visage, pleurs, mouvements et attitude. L’instrument développé (OCCEB-BECCO) a été ensuite pré-testé auprès de 16 enfants âgés de moins de 5 ans ayant subi des brûlures. Résultats. L’instrument était clair, concis et simple à utiliser selon les experts. L’alpha de Cronbach était de 0,82. La corrélation était élevée entre l’OCCEB-BECCO et l’échelle Face Legs Activity Cry Consolability (FLACC) (r≥0,95) à tous les temps de mesure. Discussion et conclusion. L’OCCEB-BECCO, première échelle visant à évaluer le confort d’enfants brûlés lors de procédures douloureuses, est une mesure fiable et valide. Cependant, d’autres études devront être effectuées, auprès de plus grands échantillons, pour compléter la validation de l’échelle.Introduction. Burn care causes children a great deal of pain and apprehension. Comfort, a concept referring as much to the absence of physical pain as to well-being, is a key consideration in assessing the quality of nursing care provided to young burn victims. However, no instrument existed to measure level of comfort of child burn victims during the delivery of painful care procedures. Objective. To develop and validate a scale to measure the comfort level of young child burn victims subjected to painful care procedures. Methods. Following a review of the literature, 38 items were generated to measure comfort in this context. These were reduced to 14 by a panel of 13 healthcare professionals. The items were then grouped under four main headings: face, cry, movement, and attitude. Finally, the new instrument (OCCEB-BECCO) was pre-tested on 16 burn victims under the age of 5. Results. Experts found the instrument to be clear, concise and easy to use. Cronbach’s alpha was 0.82. The correlation between the OCCEB-BECCO and the Face Legs Activity Cry Consolability (FLACC) scale was high (r≥0.95) at all times of measurement. Discussion and conclusion. The first scale of its kind, the OCCEB-BECCO is a reliable and valid measure of the comfort level of young child burn victims during painful procedures. However, more research is needed with larger samples to complete the scale’s validation

Pain Management of Pediatric Musculoskeletal Injury in the Emergency Department: A Systematic Review

Background. Pain management for children with musculoskeletal injuries is suboptimal and, in the absence of clear evidence-based guidelines, varies significantly. Objective. To systematically review the most effective pain management for children presenting to the emergency department with musculoskeletal injuries. Methods. Electronic databases were searched systematically for randomized controlled trials of pharmacological and nonpharmacological interventions for children aged 0–18 years, with musculoskeletal injury, in the emergency department. The primary outcome was the risk ratio for successful reduction in pain scores. Results. Of 34 studies reviewed, 8 met inclusion criteria and provided data on 1169 children from 3 to 18 years old. Analgesics used greatly varied, making comparisons difficult. Only two studies compared the same analgesics with similar routes of administration. Two serious adverse events occurred without fatalities. All studies showed similar pain reduction between groups except one study that favoured ibuprofen when compared to acetaminophen. Conclusions. Due to heterogeneity of medications and routes of administration in the articles reviewed, an optimal analgesic cannot be recommended for all pain categories. Larger trials are required for further evaluation of analgesics, especially trials combining a nonopioid with an opioid agent or with a nonpharmacological intervention

Additional file 1: of Efficacy of the BuzzyÂŽ device for pain management of children during needle-related procedures: a systematic review protocol

Draft of the search strategy and terms used for one of the databases. (DOCX 133 kb

Development of the Adolescent Cancer Suffering Scale

BACKGROUND: While mortality due to pediatric cancer has decreased, suffering has increased due to complex and lengthy treatments. Cancer in adolescence has repercussions on personal and physical development. Although suffering can impede recovery, there is no validated scale in French or English to measure suffering in adolescents with cancer

Additional file 1: of Prevalence of low back pain in adolescents with idiopathic scoliosis: a systematic review

Appendix 1. Search strategy. (DOCX 96 kb