Are medical clowns effective in reducing pain in pediatric patients undergoing procedures in the ED?
Date of Award
2023
Degree Type
Selective Evidence-Based Medicine Review
Degree Name
Master of Science in Health Sciences - Physician Assistant
Department
Physician Assistant Studies
Abstract
Objective: The objective of this selective EBM review is to determine, “Are medical clowns effective in reducing pain in pediatric patients undergoing procedures in the ED?”
Study Design: A systematic review of two randomized controlled trials (RCT) and one Quasi RCT published between 2015 and 2016.
Data Sources: All three RCTs were discovered using PubMed, published in English, peerreviewed journals, and selected based on their applicability to the clinical question.
Outcome Measured: The outcome measured in all articles was pain. Young patients utilized pain scales with facial images, such as the Wong-Backer Scale or Faces Pain Scale – revised, whereas older patients utilized a Numerical Rating Scale. Meiri et al. used the Visual Analog Scale, a blend of the two forms, catering to both young patients and their parents. Each ranked pain from zero, being “No pain”, to ten, being “The worst pain imaginable”.
Results: The RCT by Felluga et al. found no significant pain reduction with medical clowns compared to the control. The clown group experienced 0.25 mean change from baseline; the control had no change from baseline. P-value during triage was 0.334 and during procedural intervention was 0.183. Meiri et al. also found no significant pain reduction with medical clown distraction. The clown group had a mean change from baseline of 4.1, while that of the control group was 5.3. P-value was >0.05. Therefore, both studies had small, not statistically significant treatment effects. In the RCT by Rimon et al. medical clowns reduced pain levels, reporting mean change from baseline of 2.2, whereas the control group was 7.5. P-value was <0.001 and treatment effect was large.
Conclusions: Only 1 of the 3 studies in this review exhibited statistically significant procedural pain reduction with medical clown intervention. The results of the other 2 studies were not statistically significant, rendering the results of this review inconclusive. The true extent to which medical clowns reduce pain in pediatric patients is undetermined. Future studies should incorporate larger sample sizes, blinded raters, homogenous painful procedures, and uniform pain scales.
Recommended Citation
Goncerz, Olivia N., "Are medical clowns effective in reducing pain in pediatric patients undergoing procedures in the ED?" (2023). PCOM Physician Assistant Studies Student Scholarship. 658.
https://digitalcommons.pcom.edu/pa_systematic_reviews/658