On‐line preparatory information for children and their families undergoing dental extractions under general anesthesia: A phase III randomized controlled trial

BACKGROUND: Family‐centered interactive on‐line games are increasingly popular in healthcare, but their effectiveness for preoperative preparation needs further research. www.scottga.org is the new on‐line version of a proven nonweb‐based game for children and parents/caregivers. AIMS: The aim of this study was to evaluate if www.scottga.org improved children's anxiety and families' satisfaction compared with controls. METHODS: In this phase III double‐blind randomized controlled trial, children/parents/caregivers received (i) www.scottga.org, (ii) standard care, or (iii) a placebo hand‐washing game. The intervention and placebo games were available online for home usage and provided again on the ward before surgery. All children were accompanied by parent/caregivers at induction and observed and scored using validated measures. Stratified randomization and generalized linear models were used. An intention‐to‐treat approach was adopted. RESULTS: Overall, 52/176 children had baseline “psychological disturbance.” Children's anxiety increased preinduction, but there were no differences between groups (Facial Image Scale: video‐standard OR = 1.08, P = .82, 95% CI [0.56, 2.1]; video‐placebo OR = 0.9, P = .77 95% CI [0.46, 1.8]). There were no differences in induction behavior (visual analog scale: video mean = 3.5; standard care mean = 3.5; placebo mean = 3.7: video‐standard OR = 2.0, P = .42, 95% CI [−0.6, 1.3]; video‐placebo OR = 1.53, P = .65, 95% CI [−0.8, 1.1]) or induction anxiety (modified Yale Preoperative Anxiety Scale: video‐standard OR 1.02, P = .97, 95% CI [0.61, 2.6]; video‐placebo OR 1.38, P = .49, 95% CI [0.87, 3.81]). Families favored the intervention regarding the “child handling the visit better” (Treatment Evaluation Inventory: video‐standard OR = 12; 95% CI 4.7‐32; P < .001; video‐placebo OR = 8.2; 95% CI 3‐22; P < .001) and “improving the child's ability to cope” (Treatment Evaluation Inventory: video‐standard OR = 21; 95% CI 8‐56; P < .001 and video‐placebo OR = 13; 95% CI 5‐34; P < .001). CONCLUSION: Families believed that a video‐game preparation helped their child's perioperative anxiety, but there were no objective measures of behavioral improvement associated with this intervention.