治療性遊戲對兒童手術焦慮之改善成效：系統性文獻回顧與統合分析

Effects of Therapeutic Play on Pre-surgical Anxiety in Hospitalized Children: A Systematic Review and Meta-analysis

10.6540/NTJN.202309_25(2).0004

江亭穎(Ting-Ying Chiang)；林碧珠(Pi-Chu Lin)；侯文萱(Wen-Hsuan Hou)；陳昱廷(Yu-Ting Chen)；李綉雲(Hsiu-Yun Li)；林妍妙(Marianne Lin-Lewry)；朱欣蘭(Hsin-Lan Chu)；潘禕琳(Yi-Lin Pan)；陳淑如(Su-Ru Chen)

住院兒童 ； 治療性遊戲 ； 焦慮 ； 手術 ； 統合分析 ； anxiety ； hospitalized children ； therapeutic play ； meta-analysis ； surgery

新臺北護理期刊

25卷2期（2023 / 09 / 01）

35 - 50

繁體中文;英文

目的：手術對兒童造成極大壓力，尋找降低兒童手術前焦慮的方法是亟待解決的，本研究旨在探討治療性遊戲對住院兒童手術前焦慮之改善成效。方法：以系統性文獻回顧與統合分析研究法，搜尋PubMed、CINAHL、Embase、Cochrane Library、PsyINFO及CEPS等資料庫，選取符合評選標準之隨機或臨床對照試驗，以Comprehensive Meta-Analysis3.0版軟體進行資料分析，結果指標分數以Hedges'g估計，測量變項包含兒童與主要照顧者焦慮程度。結果：共15篇文獻符合選取標準，治療性遊戲可改善住院兒童手術前焦慮且達顯著差異，整體Hedges'g效果量為-0.850（95% CI=-1.161～-0.538, p<0.0001），然異質性高（Q=130.97, I^2=88.54，p<0.0001），次族群分析顯示，不同的年齡（Q=4.747, p=0.029）、國家別（Q=8.47, p=0.004）、樣本數（Q=7.916, p=0.005）、評估量表（Q=5.829, p=0.016）呈統計上顯著差異。治療性遊戲也顯著改善主要照顧者之焦慮，整體Hedges'g效果量為-0.665（95% CI=-1.068～-0.262, p=0.001）。結論：治療性遊戲能有效降低住院兒童手術前焦慮程度及主要照顧者之焦慮改善，尤其對於7歲以上學齡期兒童，使用治療性遊戲更具改善住院兒童手術前焦慮成效。

Background: Surgery has caused great pressure on hospitalized children, and it is important to reduce children's surgical anxiety. This study aims to explore the effects of therapeutic play on anxiety in hospitalized children pre-surgery. Method: The study is systematic review and meta-analysis research methods. We searched the PubMed, CINAHL, Embase, Cochrane Library, PsycINFO, and CEPS database. Statistics were computed using Comprehensive Meta-Analysis version 3.0 statistical software. The outcome indicator was anxiety in children and primary caregivers. Results: A total 15 articles were included in the analysis. Therapeutic play can significantly improve anxiety in children undergoing surgery. The overall Hedges'g effect size is -0.850 (95% CI= -1.161~ -0.538, p<0.0001), but it still has higher heterogeneity (Q=130.97, I^2=88.54, p<0.0001). In terms of subgroup analysis, it shows statistically different regarding the different age (Q=4.747, p=0.029), countries (Q=8.47, p=0.004), sample size (Q=7.916, p=0.005), and evaluation scales (Q=5.829, p=0.016). Therapeutic play can also significantly improve the anxiety of primary caregivers. The overall Hedges'g effect size is -0.665 (95% CI= -1.068~ -0.262, p=0.001) Conclusion: Therapeutic play can effectively reduce the anxiety of hospitalized children pre-surgery and improve the anxiety of primary caregivers. Especially for school-age children over 7 years old, the use of therapeutic paly is more effective in improving hospitalized children presurgical anxiety.

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