The effects of therapeutic play on alleviating preoperative anxiety in preschool children with congenital heart disease: A cluster-randomized controlled trial.

PURPOSE: This study aimed to examine the effects of preoperative therapeutic play on alleviating preoperative anxiety in preschool children with congenital heart disease.

DESIGN AND

METHODS

This cluster-randomized controlled trial was conducted between October 2022 and April 2023. A total of 82 preschool children aged 3-5 years with congenital heart disease were recruited from two pediatric cardiac wards in China. Children in the intervention group (n = 40) received a preoperative therapeutic play intervention, while those in the control group (n = 40) received routine preoperative care. Anxiety was evaluated using the mYPAS-SF before and after the intervention at five assessment points (baseline, T1, T2, T3, and T4). Cooperation during anesthesia induction was assessed at T4 using the Induction Compliance Checklist (ICC). Data were analyzed using independent-samples t, chi-squared, Mann-Whitney U, and Kruskal-Wallis H tests. A p-value <0.05 was considered statistically significant.

RESULTS

The anxiety levels of the children in the intervention and control groups were similar at baseline (p > 0.05). After the intervention, the incidence of anxiety did not differ significantly between the two groups at any of the four assessment points (T1-T4) (p > 0.05). However, the mYPAS-SF scores were significantly higher in the control group than in the intervention group at T4 (p < 0.05). A significant difference was also observed in the ICC scores: the median (P25, P75) was 1 (1,3) in the control group and 0 (0,2) in the intervention group (p < 0.05).

CONCLUSION

Preoperative therapeutic play reduced anxiety levels in preschool children with congenital heart disease during anesthesia induction and improved their compliance with the procedure.

PRACTICE IMPLICATIONS: Bedside nurse-led therapeutic play reduced preoperative anxiety and improved anesthesia compliance in children with CHD. The use of wearable devices offers a practical method for monitoring preoperative heart rate in preschool children.

REGISTRATION: chictr.org.cn (ChiCTR2200062267). Registration date: July 31, 2022.