Psychosocial Interventions Targeting Recovery in Child and Adolescent Burns: A Systematic Review

Abstract

Children post-burn injury experience a range of psychosocial sequelae that benefit from early provision of psychosocial support. However, no systematic review exists evaluating the full range of psychological interventions. Objective To critically evaluate psychosocial interventions for children (<18 years old) with burn injuries in improving psychosocial recovery. Study design All-language studies were identified from inception to March 2018 in six electronic databases and appraised according to PRISMA checklist and Cochrane Risk of Bias Tool for quality. Studies were stratified into three groups: distraction (virtual reality, child life therapy, imagery-based therapy, hypnosis), burn camps, and other (social skills, cognitive behavioral therapy, parent group counseling). Results Out of a total of 5,456 articles identified, 297 underwent full review resulting in 27 included articles published between 1986 and 2018. Sample sizes ranged from 9 to 266, comprising child and adult participants. A range of interventions and psychosocial outcome measures were found. Several studies (n = 21) reported statistically significant improvements in outcome; the majority were distraction interventions to reduce pain and anxiety. A limited number of studies showing effect was found for cognitive behavioral therapy and parent counseling. Risk of bias was high in studies of burn camps and mixed for all other interventions. Conclusions A range of psychosocial interventions and outcome tools exist in pediatric burns. Distraction interventions prior to and/or during dressing changes or physical therapy were shown to effectively reduce pain and anxiety for a wide range of pediatric ages.

Efficacy and cultural appropriateness of psychosocial interventions for paediatric burn patients and caregivers: a systematic review

“…This systematic review highlights a gap in understanding the effectiveness of psychosocial interventions for Aboriginal and Torres Strait Islander paediatric burn patients' and their caregivers. Previous systematic reviews have not accounted for this specific group [60][61][62][63][64], assessed the effects of all psychosocial interventions available [60,61], or considered psychological trauma as a primary outcome [60][61][62][63]. To the authors' knowledge, this systematic review is the first to assess the effectiveness of psychosocial interventions in reducing pain and/or anxiety, distress, and trauma symptoms among paediatric burn patients and their caregivers as well as their relevance to Aboriginal and Torres Strait Islander peoples.…”

Efficacy and cultural appropriateness of psychosocial interventions for paediatric burn patients and caregivers: A systematic review.

“…Previous systematic reviews have not accounted for this specific group [59][60][61][62][63], assessed the effects of all psychosocial interventions available [59,61], or considered psychological trauma as a primary outcome [59][60][61][62]. To the authors' knowledge, this systematic review is the first to assess the Similarly, only two studies provided interventions to caregivers and focused on their symptoms [57,58].…”

Hypnotherapy for procedural pain, itch, and state anxiety in children with acute burns: a feasibility and acceptability study protocol

“…Yet, evidence regarding distraction techniques is lacking for burn-related itch [5]. Plus, the high cost of virtual reality or multimodal devices, the need for training and technical support, and the lack of tailoring and consensus on the optimal method of delivery and technology may limit the use of distraction techniques [6,7].…”

“…Although research has indicated the benefits of hypnotherapy for children with a range of conditions, data is limited in paediatric burns. Only one recently conducted randomised controlled trial (RCT) on hypnotherapy for pain and anxiety in children with burns has been identified in a recent systematic review [6]. The RCT involving some of the current authors indicated that parents of children with acute burns expressed more satisfaction with hypnotherapy in comparison to standard care at the 3rd dressing change [18].…”