Effects of therapeutic play on children undergoing cast-removal procedures: a randomised controlled trial

Abstract

Objectives: To examine (1) the effectiveness of therapeutic play in reducing anxiety and negative emotional manifestations among children undergoing cast-removal procedures and (2) the satisfaction of parents and cast technicians with cast-removal procedures.

Design: A randomised controlled trial.

Setting: An orthopaedic outpatient department of a regional teaching hospital in Hong Kong.

Participants: Children (n=208) aged 3-12 undergoing cast-removal procedure were invited to participate.

Interventions: Eligible children were randomly allocated to either the intervention (n=103) or control group (n=105) and stratified by the two age groups (3-7 and 8-12 years). The intervention group received therapeutic play intervention, whereas the control group received standard care only. Participants were assessed on three occasions: before, during and after completion of the cast-removal procedure.

Outcome measures: Children's anxiety level, emotional manifestation and heart rate. The satisfaction ratings of parents and cast technicians with respect to therapeutic play intervention were also examined.

Results: Findings suggested that therapeutic play assists children aged 3-7 to reduce anxiety levels with mean differences between the intervention and control group was -20.1 (95% CI -35.3 to -4.9; p=0.01). Overall, children (aged 3-7 and 8-12) in the intervention groups exhibited fewer negative emotional manifestations than the control group with a mean score difference -2.2 (95% CI -3.1 to -1.4; p<0.001). Parents and technicians in the intervention group also reported a higher level of satisfaction with the procedures than the control group with a mean score difference of 4.0 (95% CI -5.6 to 2.3; p<0.001) and 2.6 (95% CI 3.7 to 1.6; p<0.001), respectively.

Conclusion: Therapeutic play effectively reduces anxiety and negative emotional manifestations among children undergoing cast-removal procedures. The findings highlight the importance of integrating therapeutic play into standard care, in particular for children in younger age.

Trial registration number: ChiCTR-IOR-15006822; Pre-results.

Figure 1

The CONSORT diagram of this study. CEMS, Children’s Emotional Manifestation Scale; CR, cast removal; CSAS-C, Chinese version of the State Anxiety Scale for Children; CONSORT, Consolidated Standards of Reporting Trials; VAS, Visual Analogue Scale.