By Dr Shewikar Farrag Dr Nehad Sabry Decreasing Anxiety for Young Egyptian Children Undergoing Magnetic Resonance Imaging (MRI) By Dr Shewikar Farrag Dr Nehad Sabry

Mansoura University

Alexandria University

Problems: Children undergoing MRI are often frightened and anxious prior to and during the magnetic resonance imaging. The MRI scanner has a long, narrow tube and creates a loud noise. The length of time required to complete the scan can be intimidating for children. The need for the child to lie completely still, combined with the child’s fear and anxiety make it difficult for full cooperation. All of these events cause potential stress and anxiety for children as well as their parents.

Significance: Preparation is the key component to helping children cope with a medical procedure. Preparation through rehearsal has proven to be an effective mechanism for helping children cope with medical procedures. Egyptian nurses utilized an evidence based practice, in applying behavioural interventions in order to reduce the anxiety experienced by those children.

Why is MRI a challenging medical procedure for young children?

MRI Machine

Aim of the study: The purpose of this study was to assess whether pre-procedural education decreases pre-procedural anxiety for young children 4-7 years old undergoing MRI.

Methodology: Parents completed the Child Adult Medical Procedure Interaction Scale-Revised (CAMPIS-R) questionnaire and rated their child’s anticipatory fear. Children rated their anticipatory fear (baseline phase). After completion of the questionnaires, families assigned to the intervention condition received information about the MRI procedures.

Methodology: Children used Children’s Self-Report, while parents used Parent Report likert scale. Observation Scale of Behavioral Distress (OSBD) is a scale developed and used to measure children's’ behavioral responses to painful medical procedures.

Assessment tools

Checklist comprised 12 operationally defined behaviors, which included: verbal (e.g., "I’m scared," "No, wait"). vocal (e.g., crying, moaning, whining). nonverbal (e.g., physical resistance) behaviors.

The video demonstrated a young child successfully completing each stage of MRI. The video, which is narrated by a young model patient, instructed children on three points: The modalities and machines to be used. The importance of remaining still during MRI-related procedures. That the nurse would accompany the child during each phase of MRI treatment.

Understanding Your Child's MRI Scan

Tailoring Needs To Fit Each Child

Replacing Fear With Understanding

Results: A Pearson correlation analysis was done and the p value was taken (p< 0.01) across raters. The sum of these behaviors was used as the OBD dependent measure. There were highly statistical significant differences regarding sedation score at baseline and all over the period of MRI procedure.

Results: Also, control group was statistically higher than studied group regarding sedation score at baseline and all over the period of MRI procedure. Control group was statistically higher than studied groups at 1st time during MRI, 2nd time during MRI, 3rd time during MRI and 4th time during MRI compared to baseline regarding heart rate.

Results: Control groups was statistically higher values than studied groups regarding OBD at baseline and allover the period of MRI procedure. Also, control groups was statistically higher concerning the values for anxiety scale than studied groups pre procedure and during procedure respectively.

Table (1): Demographic data of the two studied groups. Control group "n=32" Studied group "n=33" P Age Range Mean S.D. 4-7 5.88 1.16 5.52 1.06 0.078 Sex Male Female 20 (62.50%) 12 (37.50%) 18 (54.55%) 15 (45.45%) 0.63 Total 32 33

Table (2): Comparison between the two studied groups regarding sedation score at base line and all over the period of MRI procedure. Sedation score Base line Pre procedure 1st time during MRI 2nd time during MRI 3rd time during MRI 4th time during MRI Control gp. Mean ±S.D. 0.3±0.41 0.8±0.46 1.4±0.6 1.88±0.74 2.62±0.62 2.41±0.92 p 0.013* 0.022* 0.01* 0.001* Studied gp. 0.24±0.33 0.51±0.36 0.93±0.44 0.82±0.52 1.08±0.61 1.11±0.81 0.031* 0.042* >0.05 P2 0.221 0.033*

Table (3): Comparison between the two studied groups regarding heart rate at base line and all over the period of MRI procedure. Heart rate Base line Pre procedure 1st time during MRI 2nd time during MRI 3rd time during MRI 4th time during MRI Control gp. Mean ±S.D. 84.2±5.22 86.6±4.98 95.3±5.6 101.8±6.98 106.8±7.01 105.6±8.12 p >0.05 0.013* 0.008* 0.041* Studied gp. 83.6±5.1 84.6±5.1 86.5±4.3 92.6±7.1 93.6±6.21 92.7±6.88 0.01* P2 0.012* 0.022* 0.003*

Table (4): Comparison between the two studied groups regarding OBD (as a percent) at base line and all over the period of MRI procedure. OBD Base line Pre procedure 1st time during MRI 2nd time during MRI 3rd time during MRI 4th time during MRI Control gp. Mean ±S.D. 32.3±4.1 45.3±5.11 52.8±12.6 66.5±8.98 67.6±7.95 70.1±8.2 p 0.021* 0.032* 0.001* >0.05 Studied gp. 30.6±3.9 35.2±4.66 40.2±5.65 41.3±6.98 42.3±6.98 48.6±6.9 0.038* P2 0.012*

Table (5): Comparison between the two studied groups regarding anxiety scale at base line, pre and during procedure. Anxiety scale Base line Pre procedure During procedure No. % Control gp.   No 7 21.88 4 12.50 Mild 11 34.38 9 28.13 Moderate 8 25.00 Severe 5 15.63 12 37.50 p >0.05 0.032* Studied gp. 27.27 21.21 14 42.42 15 45.45 1 3.03 2 6.06 P2 0.001*

DISCUSSION

Research results proved that pre-procedural education decreases pre-procedural stress and anxiety for school-age children 7-12 years old undergoing MRI. 

Some behavioural interactive interventions were noticed to be effective in reducing stress related to invasive procedures: - Filmed modeling. - positive incentives. - breathing exercises. - Passive auditory distraction.

Trained clinical observers independently rated participants’ distress behavior and recorded the frequency of these behaviors during 5-min intervals over a 10-min baseline period and simulation procedure.

Heart rate (HR) was found as a valid, reliable, and sensitive measure of distress. HR of participants was recorded every 30 sec via an oxisensor attached at the patient’s finger. Mean HR-per-minute scores was used in data analyses.

Although the value of using Cognitive Behavioural Therapy (CBT) techniques in the reduction of invasive procedural distress has been established, much less is known about their role in reducing distress related to noninvasive medical procedures.

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