Play and heal : randomized controlled trial of Ditto intervention efficacy on improving re-epithelialization in pediatric burns

Brown, Nadia J., Kimble, Roy M., Rodger, Sylvia, Ware, Robert S., & Cuttle, Leila (2014) Play and heal : randomized controlled trial of Ditto intervention efficacy on improving re-epithelialization in pediatric burns. Burns, 40(2), pp. 204-213.

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BACKGROUND: The relationships between pain, stress and anxiety, and their effect on burn wound re-epithelialization have not been well explored to-date. The aim of this study was to investigate the effect of the Ditto (a hand-held electronic medical device providing procedural preparation and distraction) intervention on re-epithelialization rates in acute pediatric burns.

METHODS/DESIGN: From August 2011 to August 2012, children (4-12 years) with an acute burn presenting to the Royal Children's Hospital, Brisbane, Australia fulfilled the study requirements and were randomized to [1] Ditto intervention or [2] standard practice. Burn re-epithelialization, pain intensity, anxiety and stress measures were obtained at every dressing change until complete wound re-epithelialization.

RESULTS: One hundred and seventeen children were randomized and 75 children were analyzed (n=40 standard group; n=35 Ditto group). Inability to predict wound management resulted in 42 participants no longer meeting the eligibility criteria. Wounds in the Ditto intervention group re-epithelialized faster than the standard practice group (-2.14 days (CI: -4.38 to 0.10), p-value=0.061), and significantly faster when analyses were adjusted for mean burn depth (-2.26 days (CI: -4.48 to -0.04), p-value=0.046). Following procedural preparation at the first change of dressing, the Ditto group reported lower pain intensity scores (-0.64 (CI: -1.28, 0.01) p=0.052) and lower anxiety ratings (-1.79 (CI: -3.59, 0.01) p=0.051). At the second and third dressing removals average pain (FPS-R and FLACC) and anxiety scores (VAS-A) were at least one point lower when Ditto intervention was received.

CONCLUSIONS: The Ditto procedural preparation and distraction device is a useful tool alongside pharmacological intervention to improve the rate of burn re-epithelialization and manage pain and anxiety during burn wound care procedures.

Impact and interest:

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13 citations in Web of Science®
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ID Code: 67190
Item Type: Journal Article
Refereed: Yes
Additional URLs:
Keywords: Burns, Child, Pain, Stress, Anxiety, Salivary cortisol, Salivary alpha-amylase, Re-epithelialization, Virtual reality, Randomized clinical trial
DOI: 10.1016/j.burns.2013.11.024
ISSN: 0305-4179
Divisions: Current > Schools > School of Biomedical Sciences
Current > QUT Faculties and Divisions > Faculty of Health
Current > Institutes > Institute of Health and Biomedical Innovation
Deposited On: 27 Feb 2014 03:56
Last Modified: 13 Mar 2014 05:08

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