Behavioral Medicine Approaches to Pediatric Acute Pain

行为医学方法治疗小儿急性疼痛

• 批准号: 6580951
• 负责人: KEITH J. SLIFER
• 金额: $ 39.82万
• 依托单位: HUGO W. MOSER RES INST KENNEDY KRIEGER
• 依托单位国家: 美国
• 财政年份: 1998
• 资助国家: 美国
• 起止时间: 1998-04-01 至 2005-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6580951
• 关键词: age difference; anxiety; autogenic training; avoidance behavior; behavior prediction; behavior test; behavior therapy; behavioral /social science research tag; behavioral medicine; chronic disease /disorder; clinical research; coping; counseling; gender difference; human subject; injection /infusion; insulin dependent diabetes mellitus; middle childhood (6-11); pain; pain threshold; parent offspring interaction; psychological stressor; questionnaires; self concept; statistics /biometry

DESCRIPTION (provided by applicant): Children requiring repeated injections might develop behavioral disturbances despite the use of topical anesthetic (e.g. EMLA). Behavioral distress disrupts injections, quality of life and parent-child relationships. Various medical protocols prescribe parent-administered injections, but the effects on child and parent behavior are poorly understood. Ninety-nine parent-child dyads will be studied across two contexts: (1) parent performs injections, and (2) nonmedical parent-child activities. A group experimental design with repeated measures (baseline, post-treatment module 1, post-treatment module 2, and follow-up) will be used to study the effects on parent and child of behavioral parent training. The three experimental groups will include (1) Behavioral Intervention Sequence A (General Behavior Management Training First, N = 33), Behavioral Intervention Sequence B (Training in Procedural Distress Reduction Strategies First, N=33), and (3) Usual Care Control (N=33). Children aged 4-7 years requiring repeated parent administered injections (with EMLA preparation) for diabetes mellitus will participate. Experimental groups will be stratified by child age, gender, baseline distress, length of time receiving injections, diabetes control hemoglobin A]c level at baseline) and parent years of education. Between groups comparisons will be conducted using Multivariate Analysis of Covariance (MANCOVA) for repeated measures. The moderating effects of both parent and child characteristics on parent use of recommended child management tactics and child distress and compliance will be studied using Multiple Regression. Parent characteristics will include (1) parent self-competence (2) parent-perceived consequences of child noncompliance, and (3) parent anxiety about harming the child. Child Characteristics will include (1) externalizing behavior, (2) medical approach-avoidance behavior and (3) pain sensitivity. The impact of these variables on intervention effects will be analyzed across injection and non-medical situations. The predictive validity of brief, parent-report measures of child characteristics (externalizing behavior, medical approach-avoidance behavior, pain sensitivity) and parent characteristics (performance anxiety, self-competence) also will be tested. The results will help to: (1) identify variables influencing parent-child interactions during injections, (2) guide future selection of interventions for child/parent distress during injections, (3) contribute knowledge needed to achieve greater treatment effectiveness, economy, durability, and (4) facilitate identification of children and parents most in need of behavioral intervention.

描述（由申请人提供）：尽管使用局部麻醉（例如EMLA），但需要重复注射的儿童可能会产生行为干扰。行为困扰会破坏注射，生活质量和亲子关系。各种医疗方案开出了父母管理的注射，但对孩子和父母行为的影响知之甚少。将在两种情况下研究九十九个父子二元组：（1）父母进行注射，以及（2）非医学亲子活动。具有重复测量的小组实验设计（基线，处理后模块1，处理后模块2和随访）将用于研究对行为父母训练的父母和子女的影响。这三个实验组将包括（1）行为干预序列A（首先是一般行为管理训练，n = 33），行为干预序列B（首先是程序遇险策略中的训练训练，n = 33）和（3）通常的护理控制（n = 33）。年龄在4-7岁的儿童需要重复给予糖尿病的注射（EMLA准备）的父母将参加。实验组将按照儿童年龄，性别，基线困扰，接受注射时间的时间长时间进行分层，糖尿病控制基线时血红蛋白A] C水平）和父母的教育年代。两组之间的比较将使用协方差的多元分析（MANCOVA）进行重复措施进行。父母和子女特征对父母使用推荐的儿童管理策略以及儿童困扰和依从性的调节作用将使用多重回归进行研究。父母的特征将包括（1）父母的自我能力（2）父母感知的儿童不符合依从的后果，以及（3）父母对伤害孩子的焦虑。儿童特征将包括（1）外部化行为，（2）医学方法避免行为和（3）疼痛敏感性。这些变量对干预效果的影响将在注射和非医学情况下进行分析。还将测试短暂的，父母报告的预测有效性（外在行为，避免医疗方法，疼痛敏感性）和父母特征（绩效焦虑，自我能力）的预测有效性。结果将有助于：（1）确定在注射过程中影响亲子互动的变量，（2）指导注射过程中儿童/父母痛苦的干预措施的未来选择，（3）促进所需的知识，以实现更大的治疗效果，经济，耐用性，（4）（4）促进对行为干预的儿童和父母的识别。