THE EFFECTIVENESS OF DISTRACTION TECHNIQUES FOR CHILDREN UNDERGOING SURGERY ON REDUCING THEIR PERIOPERATIVE ANXIETY AND POSTOPERATIVE PAIN AND THEIR PARENTS’ PREOPERATIVE ANXIETY: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background. Children undergoing surgery often experience anxiety and pain. Distraction techniques have been used as a simple and effective method to reduce anxiety by diverting children’s attention away from the noxious stimuli. However, no systematic review has synthesised the evidence of using distraction techniques for children undergoing surgery on improving health outcomes of children and their parents. Aim. To synthesise the best available evidence on the effectiveness of distraction techniques for children receiving surgery in reducing preoperative anxiety and postoperative pain (primary outcomes) in addition to their postoperative anxiety and their parents’ preoperative anxiety (secondary outcomes) compared to routine care. Design: A systematic review and meta-analysis was performed. Methods. Systematic search within seven databases (CINAHL, Cochrane, EMBASE, PsycINFO, Scopus, PubMed, and Web of Science) was carried out from the date of inception until 13th January 2021. Randomised controlled trials looking into the effectiveness of distraction techniques on children to reduce postoperative pain and preoperative anxiety among 2-18-year-old children and their parents’ preoperative anxiety, published in English, were included. Databases search, data extraction and methodological quality assessment using Risk of Bias tool were performed by two reviewers. Meta-analysis was performed using RevMan5.4 software. Overall quality of evidence was assessed by the GRADE approach. Results: Twenty-five studies involving 2,227 participants were included. Meta-analysis demonstrated large effect size favouring distraction techniques on preoperative anxiety (SMD= -0.89, 95% CI [-1.21, -0.58], Z = 5.50, p < 0.00001). Distraction techniques was not significant (p > 0.05) in reducing children’s postoperative pain and postoperative anxiety, and parental preoperative anxiety. Conclusion and implication: The effectiveness of distraction techniques on reducing paediatrics’ anxiety preoperatively indicates its use in paediatric surgical settings as routine preoperative intervention. Future studies should examine the long-term effects of distraction techniques.