Journal club presentation

Presented By :
Priyanka gurav
1st year, 2nd sem,
M.sc.(N),
M.T.I.N., Changa.
Table of content
• Article • Assessment tool
• Authors information • Treatment protocol
• Topic • Findings
• Purpose of the study • Result
• Search strategy • Limitations
• Abstract • Critical appraisal
• Research
methodology
 Article
• International organization of scientific research
Volume 3, Issue 3 Ver. II (May-Jun. 2014), PP 08-15
• Author Information :
• Baljit kaur
• Co- author:
• Jyoti sarin
• Yogesh Kumar
Topic
• Effectiveness of cartoon distraction on pain
perception and distress in children during
intravenous injection
Purpose of the study
• Purpose of the study was to assess the Effectiveness of
cartoon distraction on pain perception and distress in
children during intravenous injection
Search strategy
• This article was taken from International
organization of scientific research Volume 3, Issue 3
Ver. II (May-Jun. 2014), PP 08-15
• I choose this topic because I am interested in future
study on effectiveness of Different play based
therapy on children.
• I searched about studies on play based therapy and I
end up with this study.
 Abstract
• Aim: Aim of the study was to assess the Effectiveness of cartoon distraction on pain
perception and distress in children during intravenous injection

• Objectives:
• To assess and compare pain perception in children with and without cartoon distraction during
intravenous injection.
• To assess and compare distress in children with and without cartoon distraction during
intravenous injection.
• To determine relationship between pain perception and distress in children with and without
cartoon distraction during intravenous injection.
CONT………..
• To determine association of level of pain perception in children with and
without cartoon distraction during intravenous injection with selected
variables.
• To determine association of level of distress in children with and without
cartoon distraction during intravenous injection with selected variables.
•  
 Abstract
• Materials and Methods:
• A quasi - experimental study was undertaken on children of 4 to 12
years age who were undergoing intravenous injections to
determine the effectiveness of “Cartoon Distraction” as a strategy
to reduce the pain perception and distress. The study comprised of
30 children selected through purposive sampling method.
Abstract
• In present study the assessment of pain and distress done in morning

without cartoon distraction and in evening with cartoon distraction at

initiation, at five minutes and at termination of administration of
intravenous injection on FACES pain scale and on distress assessment scale
respectively on day 1. While on day 2, to understand the diurnal effect of
pain and distress, there was assessment of pain and distress in morning with
cartoon distraction and in evening without cartoon distraction at initiation,
at five minutes and at termination of administration of intravenous injection.
Abstract
• Results:
• The results revealed that there is significantly (p <0.005) less pain and distress
in children with cartoon distraction at initiation, at five minutes and at
termination of administration of intravenous injection.
• The findings also revealed that there is no influence of gender on perception of
pain but there was an inverse relation of behavior pain response with age of
the child. Children who had history of previous hospitalization had an
increased perception of pain and distress during the current hospitalization.
Pain and distress is also directly proportional to time duration of
administration of intravenous injection and number of intravenous injection
per day and the presence of caregiver had no role on the same.
Abstract
• Conclusion:

• It was concluded that cartoon distraction is an effective distraction

strategy to reduce pain and distress among children during intravenous
injection
Research methodology
• Research design : A quasi experimental
Research design
• Sampling technique: Purposive sampling
method
• Population: All the children age between 4-12
years of age admitted in the selected hospitals
Research methodology
• Sample size :
• 30 children (17 male,13 females) who were Admitted in
hospital were included in the study.
• Setting:
• The present study was conducted in different pediatric units of
Doaba Hospital, Jalandhar, Punjab and M.M.I.M.S. & R Hospital,
Mullana, Ambala, Haryana.
Research methodology
• Inclusion Criteria:

• Children within the age group of 4-12 years.

• Present at the time of data collection

• Receiving one same selected intravenous injection (Amikacin, Ceftriaxone, Amoxiclav and
Meropenum) diluted in normal saline administered directly through fixed cannula twice a
day for two consecutive days are included in study.
• Exclusion Criteria:

• Children undergoing any painful procedure, administration of analgesics, sedatives within

hours of duration before Intravenous injection, receiving intravenous fluids, having
thrombophlebitis at site of cannula, unconscious children and having facial palsy,
peripheral nerve palsy, compartment syndrome, skin and soft tissue necrosis were
excluded from the study.
Research methodology
• Null hypothesis (H0):
• There is no statistically significant improvement in play
behavior of children with Down’s syndrome with play based
Occupational Therapy.
• Alternate hypothesis (H1):
• Improvement in play behavior of children with Down’s
syndrome is statistically significant with play based
Occupational Therapy.
Research methodology
• Data collection :
• 10 children with a diagnosis of Down’s syndrome coming to
Occupational Therapy; pediatric OPD of KEM Hospital, Mumbai were
selected as per inclusion and exclusion criteria.
• Parents of children selected were explained the purpose and nature of
the study. Written consent was taken from the parents in the language
best understood by them.
• Any queries regarding the study were explained to the parents.
• Four week protocol was administered. Evaluations were done on the
1st day and at 4th week of Protocol using RKPPS.
• Period Of Study :
• January 2013 - December 2013
Research methodology
• Data analysis :
• Statistical analysis was done using Student’s ‘t’ test. (Paired ‘t’ test) Test
was used to assess the statistical significance of Play based Occupational
Therapy intervention in the selected sample. Observations were noted pre
and post intervention and ‘t’ value was calculated using following formula.

• x=Mean, S= Standard Deviation, n= Sample size

Assessment tool
• Revised Knox Preschool Play scale: The RKPPS is an observational
measure that allows therapists to evaluate the play of children ages birth
to 72 months in their natural environments.
• The scale has 12 categories in 4 components namely :
• Material management,
• Space management,
• Pretense-Symbolic
• Participation.

• Observed play behavior that matches the age descriptors is recorded and
each factor is scored at the upper age of age grouping. (For eg. 6 to 12
months is scored at 12 months).
• Each dimension is scored with the mean of factor scores and overall play
age is scored with the mean of the dimension scores.
Treatment protocol
• Occupational Therapy and Play Based Therapy. Subjects were called twice a
week, each session lasting for one hour. 45 minutes of play based
Occupational Therapy was given followed by 15 minutes of Free play.
• Occupational Therapy intervention was inclusive of :
• Parental counseling
• Normalization of tone
• Facilitation of normal mature motor patterns and equilibrium reactions
• Therapy for arm-hand control
 Treatment protocol
Information regarding selected personal and clinical variables obtained
through interviewing the care giver and reviewing the hospital record of the
child and for assessing pain and distress on day 1 for the injection scheduled
at 10:00 am no treatment was instituted and simultaneously to collect
baseline pain and distress scores facial expression and behavioral responses of
child during intravenous injection was videotaped with the purpose to code
pain and distress at initiation, at five minutes and at termination of
administration of intravenous injection on FACES pain scale and on distress
assessment scale respectively by the researcher and for the injection
scheduled at 10:00 pm treatment was instituted and likewise facial expression
and behavioral responses of child were video recorded to code pain and
distress at initiation, at five minutes and at termination of administration of
intravenous injection.
• While on day two, to understand the diurnal effect of pain and distress, for the

injection scheduled at 10:00 am treatment was instituted and for the injection
scheduled at 10:00 pm no treatment was instituted and likewise facial expression
and behavioral responses of child were video recorded to code pain and distress at
initiation, at five minutes and at termination of administration of intravenous
injection
Result
• At initiation of administration of intravenous injection with cartoon

distraction 40% of children on day 1 and 43.33% on day 2 had level of

pain as hurts little more whereas without cartoon distraction 66.70% on
day 1 and 56.70% on day 2 as hurts worst. Similarly at five minutes of
administration of intravenous injection with cartoon distraction 46.70% of
children on day 1 had level of pain as hurts little more and 63.33% on day
2 as hurts little bit whereas without cartoon distraction 56.70% on day 1
as hurts worst and 60% on day 2 as hurts whole lot.
• Likewise at termination of administration of intravenous injection with cartoon

distraction 43.33% of children on day 1 had level of pain as hurts little bit and
63.33% on day 2 as no hurts whereas without cartoon distraction in 53.33% of
children on day 1and 56.70% on day 2 as hurts whole lot. Comparison of the
pain perception in children with and without cartoon distraction on Day 1 and 2
shown and revealed that the mean pain score of children without cartoon
distraction at initiation (9.20, 8.93), at five minute (9.07, 3.30) .
• The mean pain score of children without cartoon distraction at initiation
(9.20, 8.93), at five minute (6.00, 6.40) and at termination (7.76, 0.73) of
intravenous injection were higher than the mean pain score of children
with cartoon distraction at initiation (4.20, 3.60), at five minute (3.07,
1.03) and at termination (1.53, 0.17) of intravenous injection on day 1 and
day 2 respectively. It further showed that „t‟ value calculated between
mean pain score of children with and without cartoon distraction at
initiation („t‟(29)=11.45, 13.76), at five minute („t‟(29)=16.15, 20.69) as
well as at termination („t‟(29)=15.10, 18.95) of administration of i
ntravenous injection were found to be statistically significant at 0.05 level
of significance
Limitations
• Small sample size
• Short study duration
Critical appraisal
• Study can be done on large samples so that
can go for generalization of the findings .
• Study can be compared using more different
age groups
Critical appraisal
• Study can be done using various setting and
hospital and various geographic region
Critical appraisal
• Similar study can be carried out on a larger sample after sample
size calculation. This study can be used for sample size
calculation.
• Duration of study protocol can be increased so that the long
term effects of the therapy can be evaluated.
• Similar study on an older age group can be carried out with
some different assessment tool so as to detect areas of
development which are lacking.
• A randomized controlled trial can be conducted to study the
efficacy of play based therapy in comparison to other therapies.
Group discussion