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A Web-based module and online video for pain management education for caregivers of children with fractures: A randomized controlled trial

  • Stevi Golden-Plotnik (a1) (a2), Samina Ali (a3), Amy L. Drendel (a4), Tammy Wong (a1), Frank Ferlisi (a1), Sydney Todorovich (a5), Kyle Canton (a1), Michael Miller (a1), Julia Younan (a5), Sharlene Elsie (a5) and Naveen Poonai (a1) (a5) (a6)...

Abstract

Introduction

Over 80% of children experience compromise in functioning following a fracture. Digital media may improve caregiver knowledge of managing fracture pain at home.

Objectives

To determine whether an educational video was superior to an interactive web-based module (WBM) and verbal instructions, the standard of care (SOC).

Methods

This randomized trial included caregivers of children 0-17 years presenting to the emergency department (ED) with non-operative fractures. Primary outcome was the gain score (pre-post intervention) on a 21-item questionnaire testing knowledge surrounding pain recognition and management for children with fractures. Secondary outcomes included survey of caregiver confidence in managing pain (five-item Likert scale), number of days with difficulty sleeping, before return to a normal diet, and work/school missed.

Results

We analyzed 311 participants (WBM 99; video 108; SOC 104) with a mean (SD) child age of 9.6 (4.2) years, of which 125/311 (40.2%) were female. The video (delta=2.3, 95% CI: 1.3, 3.3; p<0.001) and WBM (delta=1.6; 95% CI: 0.5, 2.6; p=0.002) groups had significantly greater gain scores than the SOC group. The mean video gain score was not significantly greater than WBM (delta=0.7; 95% CI: -0.3, 1.8; p=0.25). There were no significant differences in caregiver confidence (p=0.4), number of absent school days (p=0.43), nights with difficulty sleeping (p=0.94), days before return to a normal diet (p=0.07), or workdays missed (p=0.95).

Conclusions

A web-based module and online video are superior to verbal instructions for improving caregiver knowledge on management of children’s fracture pain without improvement in functional outcomes

Introduction

Plus de 80 % des enfants ayant subi une fracture éprouvent un certain degré de dysfonctionnement. Ainsi, la transmission d’information à l’aide de médias numériques pourrait améliorer les connaissances des aidants en ce qui concerne le soulagement de la douleur à domicile.

Objectif

L’étude visait à déterminer si une vidéo éducative donnerait de meilleurs résultats qu’un module interactif sur le Web ou des instructions verbales, norme actuelle en matière de soins.

Méthode

Il s’agit d’un essai avec répartition aléatoire auquel ont participé des aidants d’enfants âgés de 0 à 17 ans, qui ont été traités au service des urgences pour des fractures n’ayant pas nécessité d’opération. Le principal critère d’évaluation consistait en le nombre de points gagnés (avant et après intervention) à un questionnaire en 21 points sur les connaissances des aidants quant à la reconnaissance et à la prise en charge de la douleur chez des enfants ayant subi une fracture. Les critères d’évaluation secondaires comprenaient l’appréciation du degré de confiance des aidants en matière de soulagement de la douleur (échelle de Likert en 5 points) ainsi que le nombre de jours avec troubles du sommeil; avant le retour à une alimentation normale et d’absence au travail ou à l’école.

Résultats

Ont été analysés les résultats de 311 participants (module : 99; vidéo : 108; soins usuels : 104); l’âge moyen (écart-type) des enfants était de 9,6 ans (4,2) et 125 jeunes sur 311 (40,2 %) étaient des filles. Le nombre de points gagnés dans les groupes informés par vidéo (delta=2,3; IC à 95 % : 1,3 - 3,3; p<0,001) ou par le module (delta=1,6; IC à 95 % : 0,5 - 2,6; p=0,002) était nettement supérieur à celui enregistré dans le groupe des soins usuels. Par contre, le gain moyen de points dans le groupe informé par vidéo différait peu de celui obtenu dans le groupe informé par le module (delta=0,7; IC à 95 % : -0,3 - 1,8; p=0,25). Enfin, il n’y avait pas d’écart important quant au degré de confiance des aidants (p=0,4) ni au nombre de jours d’absence à l’école (p=0,43); avec troubles du sommeil (p=0,94); avant le retour à une alimentation normale (p=0,07) et d’absence au travail (p=0,95).

Conclusions

Le module sur le Web ou la vidéo en ligne se sont révélés plus efficaces que la simple transmission d’instructions verbales en ce qui concerne l’amélioration des connaissances des aidants sur la prise en charge de la douleur chez les enfants ayant subi une fracture, sans toutefois se traduire par une amélioration des résultats fonctionnels.

Copyright

Corresponding author

Correspondence to: Dr. Naveen Poonai, Paediatric Emergency Department, Children’s Hospital, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 2V5; Email: naveen.poonai@lhsc.on.ca

References

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1. Spady, DW, Saunders, DL, Schopflocher, DP, et al. Patterns of injury in children: a population-based approach. Pediatrics 2004;113(3):522-529.
2. Chamberlain, JM, Patel, KM, Pollack, MM, et al. Recalibration of the pediatric risk of admission score using a multi-institutional sample. Ann Emerg Med 2004;43(4):461-468.
3. Landin, LA. Epidemiology of children’s fractures. J Pediatr Orthop B 1997;6(2):79-83.
4. Drendel, AL, Lyon, R, Bergholte, J, et al. Outpatient pediatric pain management practices for fractures. Pediatr Emerg Care 2006;22(2):94-99.
5. Herndon, JB, Chaney, M, Carden, D. Health literacy and emergency department outcomes: a systematic review. Ann Emerg Med 2011;57:334-345.
6. Maimon, MS, Marques, L, Goldman, RD. Parental administration of analgesic medication in children after a limb injury. Pediatr Emerg Care 2007;23(4):223-226.
7. Gill, M, Drendel, AL, Weisman, SJ. Parent satisfaction with acute pediatric pain treatment at home. Clin J Pain 2013;29(1):64-69.
8. De Maio, VJ, Joseph, DO, Tibbo-Valeriote, H, Cabanas, JG, et al. Variability in discharge instructions and activity restrictions for patients in a children’s ED postconcussion. Pediatr Emerg Care 2014;30(1):20-25.
9. Sarsfield, MJ, Morley, EJ, Callahan, JM, Grant, WD, et al. Evaluation of emergency medicine discharge instructions in pediatric head injury. Pediatr Emerg Care 2013;29(8):884-887.
10. Engel, KG, Heisler, M, Smith, DM, Robinson, CH, et al. Patient comprehension of emergency department care and instructions: are patients aware of when they do not understand? Ann Emerg Med 2009;53(4):454-461.
11. Engel, KG, Buckley, BA, Forth, VE, McCarthy, DM, et al. Patient understanding of emergency department discharge instructions: where are knowledge deficits greatest? Acad Emerg Med 2012;19(9):E1035-E1044.
12. Kobak, KA, Stone, W, Wallace, E, Warren, Z, et al. A web-based tutorial for parents of young children with autism: results from a pilot study. Telemed J E-Health 2011;17(10):804-808.
13. Boren, SA, Gunlock, TL, Peeples, MM, Krishna, S. Computerized learning technologies for diabetes: a systematic review. J Diabet Sci Tech 2008;2(1):139-146.
14. Walker, ER, Wexler, B, Dilorio, C, Escoffery, C, et al. Content and characteristics of goals created during a self-management intervention for people with epilepsy. J Neurosci Nurs 2009;41(6):312-321.
15. Bussey-Smith, KL, Rossen, RD. A systematic review of randomized controlled trials evaluating the effectiveness of interactive computerized asthma patient education programs. Ann Allergy Asthma Immunol 2007;98(6):507-516.
16. Stinson, J, McGrath, P, Hodnett, E, et al. Usability testing of an online self-management program for adolescents with juvenile idiopathic arthritis. J Med Int Res 2010;12(3):e30.
17. File, T, Ryan, C. Computer and Internet use in the United States: 2013. Washington, DC: 2015 Available at: https://www.census.gov/history/pdf/acs-internet2013.pdf.
18. Park, G, Weiss, SJ, Repar, P. Randomized single-blinded clinical trial on effects of nursery songs for infants and young children’s anxiety before and during head computed tomography. Am J Emerg Med 2016;34(3):663.
19. Bianco, A, Zucco, R, Nobile, CG, Pileggi, C, et al. Parents seeking health-related information on the Internet: cross-sectional study. J Med Internet Res 2013;15(9):e204.
20. Drendel, AL, Gorelick, MH, Weisman, SJ, et al. A randomized clinical trial of ibuprofen versus acetaminophen with codeine for acute pediatric arm fracture pain. Ann Emerg Med 2009;54(4):553-560.
21. Stockvault, B G. 2004-2015. Available at: http://www.stockvault.net/.
22. Stockfreeimages; 2012-2015. Available at: http://www.stockfreeimages.com/.
23. Mueller, D, Summerill, S, Keyes, J, Drendel, AL. (eds). Parental knowledge and perceptions of the outpatient treatment of acute pain. Annual Meeting of the Pediatric Academic Society. Baltimore, MD: E-PAS; 2009.
24. Saidinejad, M, Zorc, J. Mobile and web-based education: delivering emergency department discharge and aftercare instructions. Pediatr Emerg Care 2014;30(3):211-216.
25. Schnellinger, M, Finkelstein, M, Thygeson, MV, Vander Velden, H, et al. Animated video vs pamphlet: comparing the success of educating parents about proper antibiotic use. Pediatrics 2010;125(5):990-996.
26. Hart, L, Nedadur, R, Reardon, J, Sirizzotti, N, et al. Web-based tools for educating caregivers about childhood fever: a randomized controlled trial. Pediatr Emerg Care 2016;epub, 10.1097/PEC.0000000000000936.
27. Lukoschek, P, Fazarri, M, Marantz, P. Patient and physician factors predict patients’ comprehension of health information. Patient Educ Couns 2003;50(2):201-210.
28. Atzema, CL, Austin, PC, Wu, L, Brzozowski, M, et al. Speak fast, use jargon, and don’t repeat yourself: a randomized trial assessing the effectiveness of online videos to supplement emergency department discharge instructions. PLoS One 2013;8(11):e77057.
29. Wood, EB, Harrison, G, Trickey, A, Friesen, MA, et al. Evidence-based practice: video-discharge instructions in the pediatric emergency department. J Emerg Nurs 2017;43(4):316-321.
30. Ismail, S, McIntosh, M, Kalynych, C, Joseph, M, et al. Impact of video discharge instructions for pediatric fever and closed head injury from the emergency department. J Emerg Med 2016;50(3):e177-e183.
31. Bloch, SA, Bloch, AJ. Using video discharge instructions as an adjunct to standard written instructions improved caregivers’ understanding of their child’s emergency department visit, plan, and follow-up: a randomized controlled trial. Pediatr Emerg Care 2013;29(6):699-704.
32. Abou-Karam, M, Dube, S, Kvann, HS, et al. Parental report of morphine use at home after pediatric surgery. J Pediatr 2015;167(3):599-604.
33. Makaryus, AN, Friedman, EA.. Patients’ understanding of their treatment plans and diagnosis at discharge. Mayo Clin Proc 2005;80(8):991-994.
34. Hwang, V, Trickey, AW, Lormel, C, Bradford, AN, et al. Are pediatric concussion patients compliant with discharge instructions? J Trauma Acute Care Surg 2014;77(1):117-122.
35. Drendel, AL, Brousseau, DC, Gorelick, MH. Pain assessment for pediatric patients in the emergency department. Pediatrics 2006;117(5):1511-1518.
36. Plint, AC, Gaboury, I, Owen, J, et al. Activities scale for kids: an analysis of normals. J Pediatr Orthop 2003;23(6):788-790.
37. Msall, ME, Diguardio, K, Duffy, LC, LaForest, S, et al. WeeFIM. Normative sample of an instrument for tracking functional independence in children. Clin Pediatr (Phila) 1994;33(7):431-438.
38. Ewing-Cobbs, L, Bloom, DR, Prasad, MR, Waugh, JK, et al. Assessing recovery and disability after physical trauma: the Pediatric Injury Functional Outcome Scale. J Pediatr Psychol 2014;39(6):653-665.

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