Background

Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes.

Methods

We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0–18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using ‘R’ of children's procedural pain and anxiety and caregivers' anxiety.

Results

Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=–0.43; 95% confidence interval [CI]: –0.67 to –0.20), anxiety (SMD=0.61; 95% CI: –0.88 to –0.34), and caregivers' procedural anxiety (SMD=–0.31; 95% CI: –0.58 to –0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction.

Conclusions

Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.

中文翻译：

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减少儿科手术疼痛和焦虑的互动视频游戏：系统评价和荟萃分析

背景

儿童手术过程中的疼痛和焦虑可能无法得到很好的控制，从而导致显着的短期和长期后遗症，例如手术时间延长或未来避免医疗保健。看护者的焦虑会加剧这些影响。我们旨在评估交互式视频游戏干预对儿童程序性疼痛和焦虑的影响，包括不同类型的视频游戏对这些结果的影响。

方法

我们对交互式视频游戏与接受痛苦手术的儿童（0-18 岁）的标准护理相比的有效性进行了系统评价和荟萃分析。我们搜索了数据库 MEDLINE、Embase 和 PsycINFO。我们使用“R”对儿童的程序性疼痛和焦虑以及看护人的焦虑进行了随机效应荟萃分析。

结果

在筛选的 2185 项研究中，36 项符合条件（n= 3406 名患者）。研究通常涉及静脉通路 (33%) 或日间手术 (31%)。34 项研究符合荟萃分析的条件。互动视频游戏似乎可以减少儿童的程序性疼痛（标准化平均差 [S​​MD]=–0.43；95% 置信区间 [CI]：–0.67 至 –0.20）、焦虑（SMD=0.61；95% CI：–0.88 至 –0.34 ) 和护理人员的程序性焦虑（SMD=–0.31；95% CI：–0.58 至 –0.04）。我们观察到准备游戏和分散注意力的游戏之间，或者虚拟现实和非虚拟现实游戏之间没有区别。我们还观察到交互式视频游戏与大多数医疗结果（例如手术时间）的标准护理相比没有差异，除了减少约束的需要。研究报告的副作用很小，并且通常具有较高的干预可接受性和满意度。

结论

我们的研究结果支持将容易获得的视频游戏（例如基于分散注意力的传统视频游戏）引入日常实践，以最大限度地减少儿科手术疼痛和儿童/看护人的焦虑。