title: Play and heal: randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns.
abstract: 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
  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.
authors.affiliation: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia. Electronic address: nadia.brown@uqconnect.edu.au.
authors.forename: Nadia J
authors.initials: NJ
authors.lastname: Brown
authors.affiliation: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia.
authors.forename: Roy M
authors.initials: RM
authors.lastname: Kimble
authors.affiliation: School of Health & Rehabilitation Sciences, Division of Occupational Therapy, The University of Queensland, Brisbane, Australia.
authors.forename: Sylvia
authors.initials: S
authors.lastname: Rodger
authors.affiliation: Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; School of Population Health, The University of Queensland, Brisbane, Australia.
authors.forename: Robert S
authors.initials: RS
authors.lastname: Ware
authors.affiliation: Centre for Children's Burns and Trauma Research, Queensland Children's Medical Research Institute, The University of Queensland, Royal Children's Hospital, Brisbane, Australia; Tissue Repair and Regeneration Program, Institute of Health and Biomedical Innovation, Queensland University of Technology, Australia.
authors.forename: Leila
authors.initials: L
authors.lastname: Cuttle
mesh_terms: D000700:Analgesics / Q000627:therapeutic use*; D001007:Anxiety / Q000378:metabolism / Q000523:psychology*; D002056:Burns / Q000378:metabolism / Q000523:psychology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D034201:Computers, Handheld; D005260:Female; D006801:Humans; D006854:Hydrocortisone / Q000378:metabolism; D008297:Male; D010146:Pain / Q000523:psychology*; D059408:Pain Management / Q000295:instrumentation / Q000379:methods*; D010147:Pain Measurement; D017060:Patient Satisfaction; D010988:Play and Playthings / Q000523:psychology*; D062326:Re-Epithelialization; D012463:Saliva / Q000737:chemistry; D012720:Severity of Illness Index; D013315:Stress, Psychological / Q000378:metabolism / Q000523:psychology*; D013997:Time Factors; D016896:Treatment Outcome; D014584:User-Computer Interface
chemical_list: D000700:Analgesics; D006854:Hydrocortisone
keywords: Anxiety; Burns; Child; Pain; Randomized clinical trial; Re-epithelialization; Salivary alpha-amylase; Salivary cortisol; Stress; Virtual reality