Table 4 Key results of included studies
Reference | Outcomes | Results |
|---|---|---|
Procedural preparation and distraction | ||
Brown [44] | Pain | • FPS-R scores lower in Ditto™ than control at post-application of 2nd COD (MD = -1.51 [CI:-2.89, − 0.13] p = 0.032). • HR lowered across 3 CODs in Ditto™ group (MD = -4.89 [CI:-9.69, − 0.09], p = 0.046). |
Pain and distress | • FLACC scores not reported. | |
Anxiety | • VAS-A scores lower in Ditto™ than control at pre-removal (MD = -1.79 [CI:-3.59, −0.01] p = 0.510). | |
Trauma | • Intervention group did not affect CTSQ scores 1 week post-injury (MD not reported [CI:-1.49, 0.87] p = 0.602) or 3 months post re-epithelialisation (MD not reported [CI: −1.26, 2.00] p = 0.651). | |
Burns-Nader [45] | Pain | • Intervention group did not affect FACES scores (p = 0.290). • Nurse’s pain reports lower in tablet group (M = 3.73, SD = 0.88) than control (M = 2.93, SD = 1.03), (p = 0.030). |
Anxiety | • CEMS scores higher in control during (p = 0.001) and after (p = 0.002) hydrotherapy. • CEMS scores remained higher in control post-procedure (p < 0.050), tablet group returned to baseline levels (p = 0.570). | |
Millera [53] | Pain | • FACES scores sig. differed at pre and post-removal, and pre and post-application of all 3 CODs (p = ≤0.001 all time points). • FACES scores lowered across 3 COD’s in:  ◦ MMD-D at pre-removal (p = ≤0.001), post-removal (p = 0.005), and pre-application (p = 0.004).  ◦ MMD-PP at pre-removal (p = 0.044).  ◦ VGD at post-application (p = 0.030). • FACES scores lowered in:  ◦ MMD-PP more than VGD and control at pre-removal (both p = ≤0.010), post-removal (both p = < 0.001), pre-application (both p = < 0.001), and post-application (both p = < 0.001).  ◦ MMD-D more than control at pre-application (p = ≤0.050), post-removal (p = < 0.001), and post-application (p = < 0.001); and VGD at post-removal (p = < 0.001) and post-application (p = < 0.001). • VAS scores sig. differed at pre-removal of 2nd and 3rd COD; and post-removal, pre and post-application of all 3 CODs (p = ≤0.001). • VAS scores increased across 3 CODs in VGD compared to MMD-PP at post-removal and application (both p = < 0.001), and MMD-D at post-removal (p = ≤0.050) and post-application (p = ≤0.001). • VAS scores lowered across 3 COD’s in:  ◦ MMD-D at pre and post-removal, and pre-application (all p = ≤0.001), and post-application (p = 0.002).  ◦ MMD-PP at pre-removal (p = 0.035), and post-application (p = 0.009).  ◦ Control at pre-removal (p = 0.034). • VAS scores lowered in MMD-PP and MMD-D more than control at post-removal (both p = < 0.001) and post-application (both p = < 0.001). |
Pain and distress | • FLACC scores sig. differed at pre-removal of 2nd and 3rd COD (p = ≤0.001); post-removal at 1st (p = 0.003), 2nd, and 3rd CODs (p ≤ 0.001); pre-application of 1st (p = 0.010), 2nd, and 3rd CODs (p ≤ 0.001); and post-application of all 3 CODs (p ≤ 0.001). • FLACC scores lowered across 3 COD’s in:  ◦ MMD-D at post-removal (p = 0.008), pre-application (p = 0.047), and post-application (p = 0.018).  ◦ Control at pre-removal (p = ≤0.001). • FLACC scores lowered in:  ◦ MMD-PP more than control at post-removal (p = ≤0.050) and post-application (p = < 0.001); and VGD at post-removal (p = ≤0.050) and post-application (p = ≤0.001).  ◦ MMD-D more than control at post-removal (p = < 0.010), and post-application (p = < 0.001); and VGD at post-removal (p = ≤0.010) and post-application (p = < 0.001). | |
Millerb [54] | Pain | • FACES scores lower in MMD than control at pre-removal (p = 0.004); post-removal, and pre and post-application (all p = < 0.001), 30% reduction. • VAS scores lower in MMD than control at pre-removal (p = 0.018), post-removal (p = 0.010), pre-application (p = 0.001), and post-application (p = < 0.001), 30% reduction. • MMD combined sig. lowered pre-removal FACES (p = 0.009) and VAS scores (p = 0.035) compared to MMD-D. • HR lowered in MMD at removal and application (both p = 0.040). |
Pain and distress | • FLACC scores lower in MMD than control at post-removal (p = < 0.001), pre-application (p = 0.021), and post-application (p < 0.001), 50% reduction at removal. • MMD combined borderline less effective than MMD-D in reducing post-removal FLACC scores (p = 0.050). | |
Jeffs [50] | Pain | • APPT-WGRS pre-procedure scores highest in VR, then SC and PD (p = 0.041). • APPT-WGRS procedure scores lower in VR than PD (MD = 23.70 mm [CI:2.40, 45.00] p = 0.029), and SC (MD = 9.70 mm [CI:-9.50, 28.90] not sig. p = 0.320). • Male patients reported less procedural pain (MD = 32.60 mm [CI: 14.90, 50.20] p = <.001). |
Anxiety | • Intervention group did not affect state (p = 0.060) or trait anxiety (p = 0.710). | |
Kipping [52] | Pain | • Intervention group did not affect patient VAS scores at dressing removal (p = 0.160) or application (p = 0.400). • Intervention group did not affect caregiver VAS scores at dressing removal (p = 0.710) or application (p = 0.750). |
Pain and distress | • FLACC scores lower in VR (M = 2.90, SD = 2.40) than control (M = 4.70, SD = 2.50) at dressing removal (p = 0.020), but not application (p = 0.230). | |
Van der Heijden [58] | Pain | • Intervention group did not affect COMFORT-B scores before or after intervention (SMD = 0.04 [CI:-0.30, 0.38] p = 0.990). • FACES scores lower in MT than SC (p = 0.050); relevant sample MT (n = 13), SC (n = 5). |
Distress | • Intervention group did not affect OSBD-r scores before or after intervention (SMD = 0.11 [CI:-0.23, 0.45] p = 0.530). • Intervention group did not affect FPS-R scores (p = 0.200). | |
Whitehead-Pleaux [59] | Pain | • Intervention group did not affect FACES scores before (p = 0.181), or after procedure (p = 0.345). • MD in HR from before to after procedure greatest in control (p = 0.003). |
Distress | • NAPI scores higher in MT than control during procedure (p = 0.020). | |
Anxiety | • Fear Thermometer scores higher in MT than control before (p = 0.043), and during procedures (p = 0.002), but not after (p = 0.228). | |
Hypnosis and guided imagery | ||
Chester [46] | Pain | • Intervention group did not affect overall FPS-R scores before, during, or after any procedure (p= > 0.100). • FPS-R scores lower in patients < 8 years at 3rd COD (MD = 4.71 [CI: 0.33, 9.09] p = 0.040); relevant sample 3 per group. • NRS scores lower in hypnotherapy than control at pre-removal of 3rd COD (MD = -0.91 [CI:-1.62, − 0.20] p = 0.010). • Intervention group did not affect NRS scores at any other time point across 3 CODs (p= > 0.200). • HR lower in hypnotherapy than SC at pre-removal (MD = -15.20 [CI:-27.20, − 3.20] p = 0.010) and post-application of 3rd COD (MD = -15.49 [CI:-28.25, − 2.53] p = 0.020). |
Pain and distress | • FLACC scores not reported. | |
Anxiety | • Patients > 8 years VAS-A scores lower in hypnotherapy than SC at pre-removal of 2nd COD (MD = -0.80 [CI:-1.50, − 0.10] p = 0.030). • Caregiver VAS-A scores for patients < 8 years lower in hypnotherapy than SC at pre-removal of 2nd (MD = -1.37 [CI:-2.57, − 0.16] p = 0.030), and 3rd CODs (MD = -2.07 [CI:-3.64, − 0.49] p = 0.010). | |
Trauma | • Patient CPSS impairment severity scores lower in hypnotherapy than SC (MD = 0.46 [CI:-0.01, 0.92] p = 0.050). • Caregiver YCPC symptom severity scores for children < 7 years higher in hypnotherapy than SC (MD = 0.75 [CI:0.05, 1.45] p = 0.040). | |
Foertsch [48] | Pain and anxiety | • FACES and VAS scores not analysed due to patient difficulty in comprehending tools. |
Distress | • Intervention group did not affect OSBD scores between groups (F1,9 = 0.18, p= > 0.500), or across 4 CODs (exact F3,18 = 1.10, p = < 0.300). • Cry behaviors correlated with verbal resistance at 2nd (r [22]=0.77, p = < 0.010), 3rd (r [22]=0.56, p = < 0.050), and 4th CODs (r [22]=0.49, p = < 0.050); with emotional support at 1st (r [23]=0.58, p = < 0.050), and 2nd CODs (r [22]=0.88, p = < 0.010); and with verbal pain at 1st (r [23]=0.52, p = < 0.050), and 2nd CODs (r [22]=0.83, p = < 0.010). • Female patients displayed higher verbal resistance at baseline (t [21]= − 2.40, p = 0.020); and cry behaviors at 2nd-4th COD (t [20]= − 2.26, p = 0.030). | |
Therapeutic approaches | ||
Blakeney [43] | Anxiety/ distress | • CBCL anxious and depressed scores sig. lowered from pre-intervention to 1 year post-intervention in intervention group (t = − 2.50, p = .017) and control (t = − 2.40, p = .026); however not between groups (p = > 0.300). |
Elliott [47] | Pain and distress | • Group comparisons not possible. • BTDS scores reduced in intervention group by 25–52% (mean = 36.7%) from baseline to post-intervention. • BTDS scores consistently increased for intervention group in therapist absence. • Patient’s preferred: relaxation, emotive imagery, distraction, imagery of pleasant scenery, and earning tangible reinforcement for coping techniques. |
Hyland [49] | Pain | • CLT group received fewer additional analgesic medication during procedure than SC (n = 6, 12% vs n = 9, 18%). • Average CHEOPS scores lower in CLT (Mdn = 5.30, IQR: 4.50–6.70) than SC (Mdn = 6.00, IQR: 5.40–7.60), (CI: 0.10, 1.20, p = 0.020). • Nursing staff observed higher pre-procedural pain in CLT than SC (Mdn = 1.00, IQR: 0.00–2.00 vs. Mdn = 0.50, IQR: 0.00–1.00). • Intervention group did not affect nursing staff observations of procedural pain (Mdn = 2.00 for both groups). • FACES scores not reported. |
Pain and anxiety | • CLT caregivers observed higher patient pre-procedural pain than SC caregivers (Mdn = 3.50, IQR: 0.00–4.00 vs. Mdn = 3.00, IQR: 0.00–5.00). • CLT caregivers observed lower patient procedural pain than SC caregivers (Mdn = 2.00, IQR: 0.00–4.00 vs. Mdn = 3.00, IQR: 1.00–7.00). • Intervention group had no affect on caregiver observations of patient pre-procedural anxiety (Mdn = 2.00, IQR: 1.00–5.00 vs. Mdn = 2.00, IQR: 0.00–5.00). • CLT caregivers observed less patient procedural anxiety than SC caregivers (Mdn = 3.00, IQR: 1.00–6.00 vs. Mdn = 4.30, IQR: 1.00–8.00). | |
Anxiety | • Intervention group did not affect average CFS scores (CI: 0.00–0.20, p = 0.300). • CLT caregivers had higher anxiety than SC caregivers at pre-procedure (Mdn = 7.00, IQR: 5.00–8.00 vs. Mdn = 6.00, IQR: 4.00–8.00), and during procedure (Mdn = 5.00, IQR: 1.00–7.00 vs. Mdn = 3.50, IQR: 2.00–7.50). • Nursing staff observed higher patient pre-procedural anxiety in CLT than SC (Mdn = 2.00, IQR: 0.00–4.00 vs. Mdn = 1.50, IQR: 0.00–3.00). • Intervention group did not affect nursing staff observations of patient procedural anxiety (Mdn = 2.00 for both groups). | |
Sveen [57] | Post-traumatic stress | • IES-R scores lower in intervention than control at 6 weeks post-randomization (β = − 11.50 [SE:3.88] p = 0.003) and 3mths post-intervention (β = − 7.89 [SE:3.38] p = 0.020). • Intervention group did not affect IES-R scores at baseline or 12mths post-intervention. • Intervention group did not affect caregivers PSI-SF or PSS scores at any time point during CODs. • Caregivers perceived the intervention as informative and meaningful, but time consuming. |
Preparation & ‘patient control’ | ||
Kavanagh [51] | Pain | • Intervention group required less analgesic pain medication in 1st 2 weeks of hospitalisation (p = < 0.010). • Intervention group received more analgesic medication between CODs (p = < 0.025). • Nurse reports not reported. |
Anxiety | • Maladaptive symptoms higher in SC than intervention in 1st 2 weeks of hospitalisation (p = 0.043). • Anxiety levels higher in SC than intervention in 1st 2 weeks, not sig. (p = 0.135). | |
Moore [55] | Pain | • Intervention group did not affect FPS scores from baseline, during, or post-procedure (p = 0.717). |
Pain and distress | • FLACC scores lower in MP than SC during CODs (0.50 vs 2.00 respectively), not sig. (p = 0.165). | |
Anxiety | • Intervention group did not affect caregivers state anxiety from baseline to post-procedure (p = 0.421). | |
Quay [56] | Anxiety | • Caregivers were able to rehearse treatments and share concerns about returning home. • STAI-CH scores decreased in intervention caregivers of patients with > 30% TBSA burns at discharge (p = < 0.050) and 1st follow-up (p = < 0.050). • Intervention group did not affect STAI-CH scores for any patient’s, or caregiver of patients with < 30% TBSA burns at discharge or 1st follow-up visit. |