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Augmented reality and pain during botulinum neurotoxin A injections in children with cerebral palsy: A randomized
Emmanuelle Chaléat-Valayer1, Aurélie Lucet2, Angélique Denis3
1Massues Rehabilitation Center - French Red Cross, Lyon, France.
Insights
Augmented reality (AR) via Minidocs did not significantly reduce pain during botulinum neurotoxin A injections in children with cerebral palsy. Further research is needed to explore AR
Area of Science:
- Pediatric Pain Management
- Rehabilitation Technology
- Augmented Reality Applications
Background:
- Botulinum neurotoxin A (BoNT-A) injections are common for children with cerebral palsy (CP).
- Pain and anxiety during these procedures can be significant challenges.
- Novel non-pharmacological interventions are needed to improve patient experience.
Purpose of the Study:
- To evaluate the efficacy of the Minidocs augmented reality (AR) application in reducing pain during BoNT-A injections in children with CP.
- To assess the impact of AR on children's and parents' anxiety levels.
- To determine user satisfaction with the Minidocs application.
Main Methods:
- A randomized controlled trial was conducted with children aged 3-8 years with CP undergoing BoNT-A injections.
- Participants were assigned to either usual pain management or usual care plus the Minidocs AR application.
- Pain was assessed using the Faces Pain Scale (FPS) and the Face, Legs, Activity, Cry, Consolability (FLACC) scale. Anxiety and satisfaction were also measured.
Main Results:
- A lower percentage of children in the Minidocs group experienced significant pain (17.9%) compared to the control group (34.1%), but this difference was not statistically significant (p=0.087).
- No significant differences in anxiety scores were observed between the AR and control groups.
- High satisfaction rates were reported for the use of the Minidocs application.
Conclusions:
- The study did not provide statistically significant evidence for the benefit of augmented reality (Minidocs) in reducing pain during BoNT-A injections in children with CP.
- The counter-aggression feature within the Minidocs application presents a novel aspect for future investigation.
- Further research is recommended to identify specific patient profiles that may benefit from non-drug therapies like AR.
Aim:
To assess the effect of the augmented reality application called Minidocs on pain reduction during botulinum neurotoxin A (BoNT-A) injections in children with cerebral palsy (CP).
Method:
Children with CP aged 3 to 8 years undergoing BoNT-A injection were randomized to usual pain management alone (n = 41) or combined with Minidocs (n = 39). Minidocs is an augmented reality application on a digital device offering several games including active distraction, hypnotic suggestion, and counter-aggression features. The primary outcome was the child's pain during BoNT-A injection, combining patient-reported (Faces Pain Scale [FPS]) and observer-reported (Face, Legs, Activity, Cry, Consolability scale [FLACC]) outcomes. Secondary outcomes included anxiety of children (Modified Yale Preoperative Anxiety Scale) and parents (State-Trait Anxiety Inventory Form Y-1), and satisfaction with Minidocs.
Results:
In total, 14 out of 41 (34.1%) children in the control group and 7 out of 39 (17.9%) children in the experimental group experienced pain (i.e. FPS or FLACC scores ≥4). The difference between groups was not statistically significant (odds ratio 0.36; 95% confidence interval 0.11-1.16; p = 0.087). Changes in anxiety scores from before to after injection did not differ between groups. Satisfaction with the use of Minidocs was high.
Interpretation:
This study did not demonstrate the benefit of augmented reality on pain reduction. The counter-aggression feature is an innovation of Minidocs worth exploring. Further studies are needed to identify profiles of children who respond to non-drug therapies.
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