A RANDOMIZED PROSPECTIVE STUDY OF THE USE OF IPADS IN REDUCING ANXIETY DURING CAST ROOM PROCEDURES Justine S. Ko, BA, Zachariah Whiting, Cynthia Nguyen, MD, Raymond W. Liu, MD, Allison Gilmore, MD
ABSTRACT Background: Cast room procedures can be a source of anxiety for children. Various techniques, including music therapy, have been evaluated as a way to ease this anxiety. The use of iPads as a form of distraction during cast room procedures has not previously been evaluated and was the purpose of the current study. Methods: 146 children and adolescents who under went cast room procedures during JuneAugust 2015 were randomly assigned to one of three groups: no-iPad, iPad with video, or iPad with game. Patient heart rates were measured using a pulse oximeter in the waiting room, before the procedure, during the procedure, and after the procedure. Mean values for each group were calculated at each time inter val and compared both between groups and within groups over time. Results: There were no significant differences in baseline (waiting room) heart rate between the no-iPad and iPad groups. When compared with the no-iPad group, there was a trend toward decreased heart rate in the video group (p=0.13) and a significant increase in heart rate in the game group (p=0.026) before the procedure. There were no significant decreases in heart rate within any of the groups when comparing the waiting room heart rates with the during procedure heart rates. There was a significant difference between the no-iPad and video groups (p=0.047) when comparing the change in heart rate from baseline to before the
Division of Pediatric Orthopaedic Surgery Case Western Reserve University Rainbow Babies and Children’s Hospital Cleveland, OH Corresponding Author: Raymond W. Liu, MD Division of Pediatric Orthopaedic Surgery Case Western Reserve University Rainbow Babies and Children’s Hospital 11100 Euclid Avenue, RBC 6081 Cleveland, OH 44106 (216)844-7613, (216)844-1122 (f) [email protected] The authors declare no relevant conflict of interest This study received Institutional Review Board approval
128 The Iowa Orthopedic Journal
procedure, with a decreased heart rate obser ved in the video group. Conclusions: The results of this study show a significant decrease in heart rate when transitioning from the waiting room to the cast room while watching videos on the iPad. iPad-based video deliver y appears to decrease anxiety prior to cast room procedures. iPad-based game play is difficult to assess as elevations in heart rate prior to the procedure are presumed to be related to game play and confound the obser ved effect it may have on anxiety related to the procedure. INTRODUCTION Cast room procedures can be a source of anxiety for children during orthopedic visits. Anxiety can make procedures difficult for both the patient and the physician, and, in extreme cases, can even be harmful to the patient.1 Heart rate has been used in prior studies as a marker for anxiety, and increases in heart rate have been shown to correlate with anxiety, stress, and cardiac autonomic function.2 In studies evaluating preoperative patients, anxiety was associated with an increase in heart rate and had negative outcomes on postoperative recovery.3,4 Additional studies have utilized heart rate to assess physiological anxiety during colonoscopy and cardiac catheterization.5,6 Many methods of anxiety reduction have been evaluated previously. Ear protection has been shown to decrease heart rates in children
ABSTRACT Background: Cast room procedures can be a source of anxiety for children. Various techniques, including music therapy, have been evaluated as a way to ease this anxiety. The use of iPads as a form of distraction during cast room procedures has not previously been evaluated and was the purpose of the current study. Methods: 146 children and adolescents who under went cast room procedures during JuneAugust 2015 were randomly assigned to one of three groups: no-iPad, iPad with video, or iPad with game. Patient heart rates were measured using a pulse oximeter in the waiting room, before the procedure, during the procedure, and after the procedure. Mean values for each group were calculated at each time inter val and compared both between groups and within groups over time. Results: There were no significant differences in baseline (waiting room) heart rate between the no-iPad and iPad groups. When compared with the no-iPad group, there was a trend toward decreased heart rate in the video group (p=0.13) and a significant increase in heart rate in the game group (p=0.026) before the procedure. There were no significant decreases in heart rate within any of the groups when comparing the waiting room heart rates with the during procedure heart rates. There was a significant difference between the no-iPad and video groups (p=0.047) when comparing the change in heart rate from baseline to before the
Division of Pediatric Orthopaedic Surgery Case Western Reserve University Rainbow Babies and Children’s Hospital Cleveland, OH Corresponding Author: Raymond W. Liu, MD Division of Pediatric Orthopaedic Surgery Case Western Reserve University Rainbow Babies and Children’s Hospital 11100 Euclid Avenue, RBC 6081 Cleveland, OH 44106 (216)844-7613, (216)844-1122 (f) [email protected] The authors declare no relevant conflict of interest This study received Institutional Review Board approval
128 The Iowa Orthopedic Journal
procedure, with a decreased heart rate obser ved in the video group. Conclusions: The results of this study show a significant decrease in heart rate when transitioning from the waiting room to the cast room while watching videos on the iPad. iPad-based video deliver y appears to decrease anxiety prior to cast room procedures. iPad-based game play is difficult to assess as elevations in heart rate prior to the procedure are presumed to be related to game play and confound the obser ved effect it may have on anxiety related to the procedure. INTRODUCTION Cast room procedures can be a source of anxiety for children during orthopedic visits. Anxiety can make procedures difficult for both the patient and the physician, and, in extreme cases, can even be harmful to the patient.1 Heart rate has been used in prior studies as a marker for anxiety, and increases in heart rate have been shown to correlate with anxiety, stress, and cardiac autonomic function.2 In studies evaluating preoperative patients, anxiety was associated with an increase in heart rate and had negative outcomes on postoperative recovery.3,4 Additional studies have utilized heart rate to assess physiological anxiety during colonoscopy and cardiac catheterization.5,6 Many methods of anxiety reduction have been evaluated previously. Ear protection has been shown to decrease heart rates in children
