A Pilot Randomized Controlled Trial of Virtual Reality Distraction to Reduce Procedural Pain During Subcutaneous Port Access in Children and Adolescents With Cancer.

OBJECTIVES: We aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. We also aimed to estimate preliminary treatment effects of VR compared with an active distraction control (iPad). MATERIALS AND METHODS: A single-site pilot randomized controlled trial comparing VR to iPad distraction was conducted. Eligible children and adolescents were aged 8 to 18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using preprocedure scores as covariates. RESULTS: Twenty participants (mean age 12 y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children and adolescents (62%) participated, and 1 withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared with the iPad group. Fear was similar across groups, with ~60% of the sample indicating no fear. DISCUSSION: VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared with iPad distraction. These data will inform design of a future full-scale randomized controlled trial.

Pain Squad+ smartphone app to support real-time pain treatment for adolescents with cancer: protocol for a randomised controlled trial.

INTRODUCTION: Pain negatively affects the health-related quality of life (HRQL) of adolescents with cancer. The Pain Squad+ smartphone-based application (app), has been developed to provide adolescents with real-time pain self-management support. The app uses a validated pain assessment and personalised pain treatment advice with centralised decision support via a registered nurse to enable real-time pain treatment in all settings. The algorithm informing pain treatment advice is evidence-based and expert-vetted. This trial will longitudinally evaluate the impact of Pain Squad+, with or without the addition of nurse support, on adolescent health and cost outcomes. METHODS AND ANALYSIS: This will be a pragmatic, multicentre, waitlist controlled, 3-arm parallel-group superiority randomised trial with 1:1:1 allocation enrolling 74 adolescents with cancer per arm from nine cancer centres. Participants will be 12 to 18 years, English-speaking and with ≥3/10 pain. Exclusion criteria are significant comorbidities, end-of-life status or enrolment in a concurrent pain study. The primary aim is to determine the effect of Pain Squad+, with and without nurse support, on pain intensity in adolescents with cancer, when compared with a waitlist control group. The secondary aims are to determine the immediate and sustained effect over time of using Pain Squad+, with and without nurse support, as per prospective outcome measurements of pain interference, HRQL, pain self-efficacy and cost. Linear mixed models with baseline scores as a covariate will be used. Qualitative interviews with adolescents from all trial arms will be conducted and analysed. ETHICS AND DISSEMINATION: This trial is approved by the Hospital for Sick Children Research Ethics Board. Results will provide data to guide adolescents with cancer and healthcare teams in treating pain. Dissemination will occur through partnerships with stakeholder groups, scientific meetings, publications, mass media releases and consumer detailing. TRIAL REGISTRATION NUMBER: NCT03632343 (ClinicalTrials.gov).

E-mentoring for youth with physical disabilities preparing for employment: a content analysis of support exchanged between participants of a mentored and non-mentored group.

Background: Peer-mentoring is a method of delivering support that may ameliorate some of the challenges that youth with physical disabilities experience when preparing for future employment. This qualitative study compared and described forum content of an employment-focused peer e-mentoring intervention for youth with physical disabilities with a focus on support provided within a mentored group (an experimental group) and a non-mentored group (a control group).Methods: Using a descriptive qualitative approach, textual data from discussion forums of two groups within a peer e-mentoring intervention were analyzed through a content analysis. This qualitative study was part of a larger mixed-method pilot-randomized control trial on peer e-mentoring.Results: The mentored group consisted of nine youth with physical disabilities, aged 15-21 (mean age, 17.8) and two paid-peer mentors, and the non-mentored group included seven youth with physical disabilities, aged 15-19 (mean age = 16.1). We analyzed 151 posts. The types of support exchanged differed between the two groups. Two overarching themes emerged: (1) solution-focused support and (2) catalysts for supportConclusion: Peer e-mentoring can offer youth unique forms of support to help them prepare for employment. Clinicians may explore the opportunity for peer e-mentoring to complement current practice in preparing youth with physical disabilities for future employment.Implications for rehabilitationClinicians such as social workers, occupational therapists, and life skill coaches who are interested in preparing youth with physical disabilities for employment should consider the unique types of support provided in an online-mentored group.Peer e-mentoring has the potential to offer youth with physical disabilities distinct types of support and addresses concerns raised from face-to-face mentoring programs, such as accessibility and time.

A scoping review of the role of LEGO® therapy for improving inclusion and social skills among children and youth with autism.

BACKGROUND: LEGO® therapy uses children's natural interest in play to help motivate behavioural change and may be an effective teaching tool to increase social competency and communication skills. Although the literature is growing it has not been synthesized. OBJECTIVES: To review the literature on the role of LEGO® therapy on social skills and inclusion among children and youth with Autism Spectrum Disorder (ASD). METHODS: A scoping review was conducted, involving comprehensive searches of international databases. Eligible articles included: (a) youth aged 19 or younger, with ASD; (b) empirical research on LEGO® therapy interventions; (c) published from 1996 to 2016 in a peer-reviewed journal, conference proceedings, or dissertation. RESULTS: Of the 6964 studies identified, 15 articles-involving 293 participants, aged 5-16 (mean age 8.7 years), across five countries-met the inclusion criteria. Although the outcomes of the LEGO® therapy varied across the studies, 14 studies reported at least one improvement in social and communication skills (e.g., building friendships, improved social interactions and social competence), ASD-specific behaviors, belonging, family relationships, coping, and reductions in playing alone. CONCLUSIONS: Although LEGO® therapy shows promise as an intervention for children and youth with ASD, more rigorously designed studies are needed to fully understand its impact.