The Royal Children's Hospital Brisbane Centre for Burns Research have developed a number of clinical papers sponsored by Diversionary Therapy Technologies. Those that have been published and are available for public perusal are as follows:
Multi-modal Distraction: Using Technology to Combat Pain in Young Children with Burn Injuries
The Efficacy of an Augmented Virtual Reality System to Alleviate Pain in Children Undergoing Burns Dressing Changes: A Randomised Controlled Trial
The Emergence of Multi-Modal Distraction as a Paediatric Pain Management Tool
The Development of a Paediatric Pain Management Device
The Design of a Tangible Interaction Device to Alleviate Anxiety and Pain in Paediatric Burns Patients
A Novel Technology Approach to Pain Management in Children with Burns: A prospective randomized controlled trial
General Information
There is an emphasis in the current clinical arena to establish appropriate pain management for children undergoing medical treatment and procedures. With advancements in the understanding of pain, protocols have adapted to involve a mixture of medication and distraction principles to ensure holistic pain management. ditto is a multi-modal sensory based distraction technology device that was developed from Virtual Reality concepts of "immersive distraction" but has been specifically designed to meet developmental and clinical challenges. It uses 3-Dimensional active-exploratory content within an open faced console that allows touch screen and full navigation about a scene.
Recent Published Trial Results 2009
Diversionary Therapy Technologies maintains close links to the Royal Children's Hospital Brisbane, and continues to monitor feedback gained in regular clinical trials. Research is currently continuing with Professor Roy Kimble and staff at the Royal Children's Hospital Brisbane, Australia. The following information is drawn from the most recent study performed at the Royal Children's, Brisbane. These results have been published and are concerned with evaluating pain levels and clinic productivity.
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Pain Reduction
Children's pain and anxiety levels were measured during burns dressing application and removal over 3 separate outpatient visits. Pain scores were gathered from the child, the carer and the nurse. Two groups of patients used ditto™ one group used Procedural Preparation content and the other used Distraction content. The two control groups used either a PlayStation Portable or standard distraction techniques such as bubbles, songs and television. The graph demonstrates that use of ditto™ with Procedural Preparation content produced the lowest pain and anxiety scores prior to commencement of the procedure. Use of ditto™ with Distraction content produced the lowest pain and anxiety scores during the procedure. This was consistent across subsequent visits to the outpatient department where children continued to report less pain at each procedure.
[Miller K, et al., Multi-modal distraction. Using technology to combat pain in young children with burn injuries, Burns, Volume 36, Issue 5, August 2010, Pages 647-658]
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Clinic Productivity
The productivity graph on the right shows that ditto™ Distraction and ditto™ Procedural Preparation reduced the procedural times (time taken to remove and apply a dressing). This length of treatment continued to reduce over the three subsequent procedures (visits for dressing changes). Clinic efficiency is increased.
• ditto™ Preparation reduced treatment times by between 24 and 29%- ditto™ Preparation can reduce a 60 minute clinic to approximately 45 minutes.
• ditto™ Distraction reduced treatment times by between 21 and 34%- ditto™ Distraction can reduce a 60 minute clinic to approximately 40 minutes.
[Miller K, et al., Multi-modal distraction. Using technology to combat pain in young children with burn injuries, Burns, Volume 36, Issue 5, August 2010, Pages 647-658] |
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Cost Analysis
The efficacy, in terms of financial implications alongside patient outcomes, of pain management approaches is an important perspective within healthcare systems. Results of a Cost Effectiveness Analysis performed by Queensland Health’s Royal Childrens Hospital, November 2010, indicate that using the ditto™ device during outpatient dressing changes significantly reduces the financial burden to both the acute tertiary centre and the family.
• ditto™ reduced the total annual costs (including nursing staff costs and dressing consumables) by $45,952, associated with reduced length of treatments and healing times. * • ditto™ reduced the total costs of treating a child until healing (including nursing staff costs and dressing consumables) by $76.59. • ditto™ reduced length of time treating children with burn injuries by 328.9 hours annually compared to current standard practice. * • ditto™ reduced healing time by 20% compared to current standard practice.
A cost-benefit equation over a ten year projection has shown that ditto™ saves the budget $461,740 over the ten years (this includes initial purchase price and annual service costs).
* Based on a Change of Dressing, every 3 days on a 2% Total Body Surface Area burn (requiring a 10x10 Acticoat™ dressing) to healing with a mean of 10 patients at each clinic, 5 clinics a week and an annual admission rate of 600 new patients each year.
Miller K, et al., Cost Effectiveness Analysis of ditto™, November 2010 (to be submitted for publication 2011).
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Preliminary Trial Results 2009: Orthopaedics
To date randomised control trials, with children aged 3-8 years, have assessed ditto™'s potential in reducing pain and anxiety during medical procedures in 2 acute clinical settings: burns outpatient clinic and orthopaedic outpatient clinic. The results are discussed in the graphs below.
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Orthopaedic Outpatient Study
In the Orthopaedic study (n=60), results indicated that ditto™ had a significant (p<0.05) effect in reducing child and clinician pain reports during cast removal/application. ditto™ also reduced care giver reports of child anxiety during these procedures (p<0.05).
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Clinical trials will continue across a variety of medical domains and procedures such as pre-op, emergency and x-ray.
ditto is an interactive electronic device intended to distract the child; informing him/her about the procedures they may be about to undergo resulting in improved patient compliance and improved clinical productivity. While ditto has been studied for pain management, the product is not indicated for pain control
NOTE: ditto™ is not intended for use in the diagnosis of disease or other conditions, or in the cure, mitigation, treatment or prevention of disease.