UTILIZATION OF A WEB-BASED MODULE FOR CAREGIVER PAIN MANAGEMENT FOLLOWING FRACTURES IN CHILDREN: A RANDOMIZED CONTROLLED TRIAL

BACKGROUND: Fractures are common painful conditions in childhood. The most severe pain following a fracture occurs within 48 hours of discharge and over 80% of children experience compromise in at least one functional domain. A third of parents are dissatisfied with pain management at home following ED care and fail to provide analgesia. Web-based platforms easily incorporate new information that caregivers can readily access at home. An interactive web-based module (WBM) may provide an educational medium that improves knowledge surrounding home management of fracture pain.

OBJECTIVES: This trial was designed to test the hypothesis that caregiver education on pain management at home facilitated through a novel interactive educational WBM was superior to video instructions and the standard of care (SOC): verbal and paper instructions.

DESIGN/METHODS: We designed this open-label, randomized, controlled, three-arm trial to include caregivers of children with non-operative fractures presenting to the ED. Primary outcome was the gain score (pre-post intervention) on a novel 21-item questionnaire testing knowledge surrounding pain recognition and management for children with fractures. Secondary outcomes included a 96-hour assessment of caregiver confidence in managing pain (five-item Likert scale), number of sleep-interrupted nights, and number of work/school days missed.

RESULTS: 246 participants were recruited (WBM 74; Video 88; SOC 84). There were 97 females (39.4%) and the mean (SD) age was 9.9 (4.1) years. There were no significant differences in baseline knowledge scores between groups (p=0.51). The SOC group had significantly lower mean (SD) gain scores: 0.3 (2.2) versus WBM: 2.3 (3.1) and Video: 2.6 (3.9) (95% CI: -3.2, -0.8, p<0.001 for WBM versus SOC; 95% CI: -3.4, -1.2, p<0.001 for Video versus SOC). There was no significant difference between WBM and Video (95% CI: -0.9, 1.5, p=0.83). The impact on functional outcomes at 96 hours was minimal across groups and there were no significant differences in caregiver confidence (p=0.41), number of absent school days (p=0.48), sleep-interrupted nights (p=0.68), or workdays missed (p=0.96).

CONCLUSION: Among caregivers of children with fractures presenting to the ED, education on pain management at home using both an interactive WBM and a video was associated with superior knowledge acquisition to verbal and paper instructions. However, there were no significant between-group differences in functional outcomes. Interactive WBMs should be utilized for caregivers managing children’s pain at home. Future studies should be adequately powered to detect changes in functional outcomes.