Aims To evaluate the effectiveness of web‐based mobile health interventions on paediatric patients and their parents in the day surgery context, where the primary outcome was children's pre‐operative anxiety and secondary outcomes were postoperative pain and parents’ anxiety and satisfaction with entire course of the day surgery. Design A systematic review and meta‐analysis of randomized controlled trials. Data Sources CENTRAL, CINAHL, Scopus, Ovid MEDLINE, and Web of Science were systematically searched without time limits (up to December 2018). Review Methods Studies were appraised using the Cochrane risk of bias tool. A random effect meta‐analysis of children's pre‐operative anxiety was performed. Results Eight studies with a total of 722 patients were included in the analysis. The effectiveness of web‐based mobile health interventions, including age‐appropriate videos, web‐based game apps, and educational preparation games made for the hospital environment, was examined in pre‐operative settings. A meta‐analysis (N = 560 children) based on six studies found a statistically significant reduction in pre‐operative anxiety measured by the Modified Yale Pre‐operative Anxiety Scale with a moderate effect size. Three studies reported parental satisfaction. Conclusion Web‐based mobile health interventions can reduce children's pre‐operative anxiety and increase parental satisfaction. Web‐based mobile health interventions could be considered as non‐pharmacological distraction tools for children in nursing. There is not enough evidence regarding the effectiveness of reducing children's postoperative pain and parental anxiety using similar interventions. Impact Web‐based mobile health interventions reduce children´s pre‐operative anxiety and could therefore be considered as non‐pharmacological distraction tools for children in nursing.

Introduction As the number of patients undergoing primary lower-limb joint replacement has risen continuously, hospital-based healthcare resources have become limited. Delivery of any ongoing rehabilitation needs to adapt to this trend. This systematic literature aimed to examine the effects and safety of telerehabilitation in patients with lower-limb joint replacement. Methods A systematic review of randomized controlled trials was conducted according to procedures by the Joanna Briggs Institute. Studies published prior to February 2020 were identified from Medline Ovid, Scopus, Ebsco Databases and Web of Science. Reference lists of relevant studies were also manually checked to find additional studies. Two researchers conducted study selection separately. The Joanna Briggs Institute Critical Appraisal Checklist for Randomized Controlled Trials was used to evaluate the quality of the relevant studies published. A narrative synthesis was used to report the results whereas effect sizes were estimated for different outcomes. Results Nine studies with 1266 patients were included. Study quality was predominantly affected by the lack of blinding. The patients who completed telerehabilitation showed an improvement in physical functioning that was similar to that of patients completing conventional in-person outpatient physical therapy without an increase in adverse events or resource utilization. The effect of telerehabilitation on physical functioning, however, was assessed as heterogeneous and moderate- to low-quality evidence. Discussion Telerehabilitation is a practical alternative to conventional in-person outpatient physical therapy in patients with lower-limb joint replacement. However, more robust studies are needed to build evidence about telerehabilitation.

Aims and objectives To describe the views on the needs of health specialists to consider when developing a digital gaming solution for children and families in a paediatric day surgery. Background Children's day surgery treatment is often cancelled at the last minute for various reasons, for example due to the lack of information. Digital gaming solutions could help families to be better oriented to the coming treatment. Despite the increasing demands for mHealth systems, there is not enough evidence‐based information from the health specialist perspective for developing a digital gaming solution. Design A qualitative descriptive study was conducted. Methods Health specialists (N = 15) including 11 nurses, one physiotherapist and four doctors from different areas from one university hospital in Finland were recruited using a snowball sampling method. Semi‐structured, face‐to‐face interviews were conducted in March and April 2019. The data were analysed using inductive conduct analyses. The COREQ checklist was used to report the data collection, analysis and the results. Results The data yielded 469 open codes, 21 sub‐categories, three upper categories and one main category. The main category the digital gaming solution to support knowledge, care and guidance in children’s day surgery included three upper categories: (a) support for preoperative information and guidance, (b) support for intra‐operative information and care, and (c) support for postoperative information, care and guidance. Conclusion Digital gaming solutions could be used to help children and families to be better prepared for upcoming treatments, to support communication in different languages and to improve children’s pain management after operations. Relevance to clinical practice Evidence‐based information is important to ensure that future digital solutions answer the real needs of the staff and patients. There is a need for families and children’s views to be taken into consideration when developing digital gaming solutions in the hospital context.

Background The parents of hospitalized children are often dissatisfied with waiting times, fasting, discharge criteria, postoperative pain relief, and postoperative guidance. Parents’ experiences help care providers to provide effective, family-centered care that responds to parents’ needs throughout the day surgery pathway. Objective The objective of our study was to describe parental experiences of the pediatric day surgery pathway and the needs for a digital gaming solution in order to facilitate the digitalization of these pathways. Methods This was a descriptive qualitative study. The participants (N=31) were parents whose children were admitted to the hospital for the day surgical treatments or magnetic resonance imaging. The data were collected through an unstructured, open-ended questionnaire; an inductive content analysis was conducted to analyze the qualitative data. Reporting of the study findings adheres to the Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist. Results Parental experiences of the children’s day surgery pathway included 3 main categories: (1) needs for parental guidance, (2) needs for support, and (3) child involved in his or her own pathway (eg, consideration of an individual child and preparation of child for treatment). The needs for a digital gaming solution were identified as 1 main category—the digital gaming solution for children and families to support care. This main category included 3 upper categories: (1) preparing children and families for the day surgery via the solution, (2) gamification in the solution, and (3) connecting people through the solution. Conclusions Parents need guidance and support for their children’s day surgery care pathways. A digital gaming solution may be a relevant tool to support communication and to provide information on day surgeries. Families are ready for and are open to digital gaming solutions that provide support and guidance and engage children in the day surgery pathways.

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