Prehabilitation: The underutilised weapon for chronic pain management.

Objective: Prehabilitation encompasses preparatory clinical intervention(s) delivered during the period between diagnosis and treatment commencement. Despite widespread successful usage preoperatively, psychological prehabilitation is neglected in outpatient chronic pain management. Although pain management waitlists are associated with treatment attrition and psychological and physical decline, this time window is underutilised in preventing escalation. Waitlists present an under-explored opportunity to 'prehabilitate' patients waiting for treatment. This topical review aimed to: (1) examine the effectiveness of psychological prehabilitation for pain services; (2) evaluate the psychological and physical decline associated with waiting for pain management; (3) highlight key psychological prehabilitative targets for increasing treatment engagement; (4) promote pain management psychological prehabilitation within personalised pain medicine, building recommendations for future interventions. Methods: Studies regarding the impact of waitlists and prehabilitation for chronic pain were reviewed. Results: Findings demonstrated that the psychological constructs of patient expectations, health locus of control, self-efficacy and pain catastrophizing dynamically influence attrition, treatment engagement and outcomes while waiting. These constructs are amenable to change, emphasising their potential utility within a targeted waitlist intervention. Conclusions: Prehabilitating chronic pain patients towards treatment engagement could circumvent cycles of failed treatment seeking, preventing psychological and physical decline, and reducing healthcare utilisation. Utilising the waitlist to identify psychosocial risk factors (external health locus of control, low self-efficacy and high pain catastrophizing) would identify who requires additional support to prevent increased risk of treatment failure, enhancing personalised care before prescribed treatment is accessed. This review cements the urgent need for pain services to engage proactively with prehabilitation innovation.

Predisposición psicológica de heptatletas y decatletas cubanos, evidencias de su asociación con el rendimiento competitivo

La preparación psicológica para las competencias es un proceso que potencia las capacidades y cualidades del deportista durante la preparación para alcanzar el estado óptimo de predisposición psíquica. Son escasas las investigaciones que ofrecen evidencias empíricas de la relación existente entre el estado de predisposición psíquica y el rendimiento competitivo de atletas de pruebas combinadas. El objetivo de este trabajo fue determinar cómo se relacionan el estado de predisposición psicológica y el rendimiento competitivo de los atletas cubanos de pruebas combinadas. La investigación fue no experimental y transversal. La muestra la integraron ocho atletas de pruebas combinadas de la selección nacional cubana de atletismo. Se emplearon el Cuestionario de Predisposición Psicológica para la Competencia y la Escala de rendimiento en la competencia de pruebas combinadas. La claridad de objetivos correlacionó de manera positiva y directa con el rendimiento competitivo en las carreras con vallas (,793 sig. = ,019). La significación de la competencia percibida por los atletas correlacionó de manera positiva y directa con las carreras con vallas y el salto de altura (,826 sig. = ,012 y ,717 sig. = ,045). A medida que aumentó la claridad de objetivos en los atletas estudiados también lo hizo el rendimiento percibido por sus entrenadores en las carreras con vallas que realizaron en la Copa Cuba 2020. A medida que fue mayor la significación de la competencia, también lo fue el rendimiento en carreras con vallas y salto de altura.

SÍNTESE A preparação psicológica para as competições é um processo que aumenta as habilidades e qualidades do atleta durante a preparação para alcançar o estado ideal de predisposição psíquica. Há poucas pesquisas que ofereçam evidências empíricas da relação entre o estado de predisposição psicológica e o desempenho competitivo dos atletas em eventos combinados. O objetivo deste trabalho foi determinar como o estado de predisposição psicológica e o desempenho competitivo dos atletas cubanos em eventos combinados estão relacionados. A pesquisa foi não-experimental e transversal. A amostra consistiu de oito atletas de eventos combinados da equipe nacional de atletismo de Cuba. Foram utilizados o Questionário de Predisposição Psicológica para Competição e a Escala de Desempenho em Competição de Julgamentos Combinados. Clareza de propósito correlacionada positivamente e diretamente com o desempenho competitivo em obstáculos (.793 sig. = .019). A percepção do significado da competência dos atletas se correlacionou positiva e diretamente com obstáculos e saltos em altura (.826 sig. = .012 e .717 sig. = .045). medida que a clareza das metas aumentava nos atletas estudados, também aumentava o desempenho percebido por seus treinadores nas corridas de obstáculos que realizaram na Copa Cuba 2020. medida que a importância da concorrência aumentava, aumentava também o desempenho em obstáculos e saltos altos.

Psychological preparation for competitions is a process that enhances the capacities and qualities of the athlete during the preparation to reach the optimal state of mental predisposition. There are few researches that offer empirical evidence of the relationship between the state of mental predisposition and the competitive performance of athletes in combined events. The objective of this work was to determine how the state of psychological predisposition and the competitive performance of Cuban athletes in combined events are related. The research was non-experimental and cross-sectional. The sample was made up of eight athletes from the combined events of the Cuban national athletics team. The Questionnaire of Psychological Predisposition for Competition and the Performance Scale in the competition of combined tests were used. Goal clarity was positively and directly correlated with competitive performance in hurdles (.793 sig. = .019). The significance of the athletes' perceived competition was positively and directly correlated with hurdles and high jump (.826 sig. = .012 and .717 sig. = .045). As the clarity of objectives increased in the athletes studied, so did the performance perceived by their coaches in the hurdles races they carried out in the 2020 Cuba Cup. As the significance of the competition was greater, so was the performance in hurdle races and high jump.

Prehabilitation: high-quality evidence is still required.

Prehabilitation comprises multidisciplinary healthcare interventions, including exercise, nutritional optimisation, and psychological preparation, which aim to dampen the metabolic response to surgery, shorten the period of recovery, reduce complications, and improve the quality of recovery and quality of life. This editorial evaluates the potential benefits and limitations of and barriers to prehabilitation in surgical patients. The results of several randomised clinical trials and meta-analyses on prehabilitation show differing results, and the strength of the evidence is relatively weak. Heterogeneity in patient populations, interventions, and outcome measures, with a wide range for compliance, contribute to this variation. Evidence could be strengthened by the conduct of large-scale, appropriately powered multicentre trials that have unequivocal clinically relevant and patient-centric endpoints. Studies on prehabilitation should concentrate on recruiting patients who are frail and at high risk. Interventions should be multimodal and exercise regimens should be tailored to each patient's ability with longitudinal measurements of impact.

The P3-model of perioperative psychological preparation: Pre-surgical and pre-medical procedural psychological preparation and psychophysiological interventions.

Applied psychophysiological and psychological interventions can support successful post-surgical outcomes among patients who undergo surgical or medical procedures. However, more translational research is needed to extend the current understandings and practices of evidence-based and evidence-informed behavioral interventions to improve the outcomes of surgical and medical procedures. As healthcare becomes increasingly integrative, biopsychosocial oriented practitioners (e.g., health psychologists, neuropsychologists, pain psychologists, psychiatrists, nurses) will play an integral role with surgical and interventional professionals (e.g., neurosurgeons, bariatric surgeons, anesthesiologist, transplant surgeons, interventionalist, radiologist). These roles include pre-surgical evaluations, identifying pre-emptive concerns and implementing behavioral interventions, which ultimately act to improve the outcome of the surgery or medical procedure. In this paper, the authors 1) review the status of the broader practice of perioperative behavioral interventions; 2) review the pre-surgical and pre-procedural behavioral risk factors and translate psychophysiological and behavioral interventions to optimize post-surgical and post-procedural outcomes; and 3) provide a general framework (P3-Model) that can be used in a perioperative practice to carry out pre-surgical and pre-procedural behavioral interventions. Specifically, the role of behavioral and biofeedback interventions in the preparation of patients who are undergoing surgeries and medical procedures will be detailed. Psychological preparation that addresses pre-surgical and pre-medical procedure behavioral risk factors help perioperative healthcare providers and patients to have maximal post-operative success.

Adaptation and Validation of the Arabic Version of the Mindfulness Inventory for Sport.

Our goal for this study was to adapt the Mindfulness Inventory for Sport (MIS) into written Arabic that would be easily understood in North African countries (Tunisia, Algeria and Morocco or TAM). Assessment tools in Arabic, such as this MIS-TAM version, are rare but essential for evaluating the effectiveness of sport psychology interventions. We adopted a committee approach to obtain a first Arabic version of the MIS. We asked a team of translators to adapt the items to the level of understanding of 13-year-old athletes by selecting words common to the culture of the three countries. The validation process underwent three phases. In Study 1, we tested MIS-TAM for clarity and deemed it acceptable. In Study 2 we tested the construct validity of two different models with confirmatory factorial analyses. These analyses confirmed that the structure of the 15-item MIS-TAM was psychometrically similar to the original version; it had a first order model encompassing three dimensions: Awareness, Non-Judgement and Refocusing. Analyses also found the internal consistency of the MIS-TAM acceptable. We assessed convergent validity in Study 3 with the Mindfulness Attention Awareness Scale, but no correlations between the two instruments were significant. In conclusion, the MIS-TAM has acceptable psychometric properties, though further work is needed regarding convergent validity. The rigorous work of translation and adaptation focused on shared linguistics in three target countries, and this questionnaire will also prove useful in other countries where Arabic is the main language.

The Role of Psychological Factors in Judo: A Systematic Review.

(1) Background: Psychological parameters are relevant in the practice of judo. Previous studies have shown that parameters such as anxiety or motivation can have a negative or positive impact on the athlete's performance and general well-being, depending on the athlete's perception. This systematic review aimed to summarize the studies examining the influence of various psychological parameters on well-being and performance in judo athletes; (2) Methods: We followed preferred reporting elements for systematic reviews and meta-analyses. We searched the Web of Science database for studies that explained the role of these parameters in elite athletes. Of the 286 articles initially identified, 17 met our eligibility criteria and were included in the review. In total, we analyzed data from 721 judo athletes; (3) Results: The studies found have demonstrated the impact of various psychological parameters during high-level performance and how these parameters can influence and lead an athlete to win or lose a competition. The feelings of tension, anger, anxiety, and nervousness were significantly increased in athletes who were facing defeat, while a decrease in the same segments and an increase in motivation among athletes who were experiencing better performance was observed. Further research under standardized conditions is needed to better understand the effects of these parameters on judo athletes; (4) Conclusions: Considering the athlete's psychological state can affect performance, and it is therefore important to monitor and train these factors.

An initial preparation for human cadaveric dissection ameliorates the associated mental distress in students.

It is universally recognized that cadaveric dissection is an essential part of anatomy training. However, it has been reported to induce mental distress in some students and impair their intrinsic motivation (IM) to study. One of the postulated reasons for this behavior is the lack of adequate information and preparation of students for cadaveric dissection. Therefore, it is hypothesized that providing relevant information prior to cadaveric dissection will ameliorate the mental distress, enhance the IM of students, and improve their academic performance. A cohort of occupational therapy students enrolled in an anatomy course were psychologically prepared for cadaveric dissection. Students were provided with a curated list of YouTube videos and peer-reviewed journal articles related to cadaveric dissection prior to the commencement of the anatomy course. All students were also required to attend an oral presentation immediately before commencing dissection. The control group included students who had not been provided with any resources in preparation for cadaveric dissection. Compared to the control group, students who had been prepared demonstrated better quality of cadaveric dissection, improved academic performance, reported less mental distress and greater IM. Moreover, students reported the oral presentation to be most relevant and journal articles to be least useful in their preparation. Therefore, this is an effective approach in the amelioration of mental distress and improvement of performance in anatomy students. Consequently, this study represents a paradigm shift in the pedagogy of anatomy, and could represent a vital element in the evolution of a revitalized anatomy curriculum.

The Effectiveness of the Psychological Intervention in Amateur Male Marathon Runners.

Background: The Marathon runners must have the proper technical preparation to reach excellence and to achieve adequate psychological preparation for the race. Against this background, the current study aims to describe the implementation results of a cognitive-behavioral intervention based on psychological skills training for marathon runners. Methods: Fourteen amateur male marathoners with an average age of 30 (SD = 5.75) were trained with various emotional and cognitive control techniques to enhance their performance in competition. Various psychological variables, related to the subjects level of perceived stress, and to qualitative characteristics of their thoughts were measured before and after the target marathon race. Results were analyzed through non-parametric tests for two related samples. The Cohen's d effect size for single-group pretest-posttest repeated measures were also performed. Results: Statistical analysis reveals that, controlling for age and running experience, the intervention decreased significantly the level of perceived stress and the occurrence of negative thoughts before the race, during, and after the race. Conclusion: Training in cognitive control and relaxation techniques, as part of the psychological skills training could determine the quality of performance of marathon runners.

Psychological Preparation for Cardiac Surgery.

PURPOSE OF REVIEW: To review the current state of preoperative psychological preparation to improve outcomes after cardiac surgery. RECENT FINDINGS: Preoperative psychosocial factors are associated with short- and long-term outcomes after cardiac surgery. There are several approaches to optimize patients' preoperative psychological status with promising effects on postoperative outcomes (e.g., less complications, improved quality of life). Preoperative psychological preparation often aims to improve patients' knowledge or social support and to modify and optimize expectations and illness beliefs. Preoperative psychological preparation is gaining importance for cardiac surgery. However, patients' psychological status still does not get as much attention as it deserves. Preoperative psychological preparation seems to have positive effects on postoperative outcomes. Since overall evidence is still weak, further studies are warranted to understand which intervention works best for whom and why.

A comparison of preoperative psychological preparation with midazolam premedication to reduce anxiety in children undergoing adenotonsillectomy.

INTRODUCTION: Considering the multiplicity of adenotonsillectomy in children 2-10-year old at the paediatric surgery centres, patient anxiety leads to an increase in surgical and anaesthetic complications. Patients' unfamiliarity with surgical and anaesthetic interventions may increase their stress. Midazolam premedication reduces patient anxiety. In previous studies, psychological preparation before surgery using understandable terms to children, has reduced their anxiety. The aim of this study was to compare and study behavioural reflections among the children in two groups: the first group was prescribed oral midazolam, and the second group received psychological preparation with the booklet about anaesthesia and anaesthesia-resident explanation. MATERIALS AND METHODS: This study is a clinical trial conducted on 48 children undergoing adenotonsillectomy. Children in the first group (midazolam group) received oral midazolam 0.5 mg/kg, 20 min before surgery. A booklet containing pictures and information about anaesthesia and the operating room was given to the second group (psychological preparation group) the night before surgery and anaesthesia resident explained the booklet to the children. The anxiety level was measured in both groups using the State-Trait Anxiety Inventory for Children questionnaire the night before surgery and on the morning of surgery (after giving midazolam to Group II). The results were analysed using SPSS. RESULTS: In this study, 58.3% of the first group and 45.8% of the second group were male. The mean age of the first and second groups was 8.45 ± 1.86 and 9.12 ± 1.72 years, respectively. The anxiety in the first group significantly decreased in the morning before surgery compared to the night before operation (P < 0.001). The anxiety in the second group significantly decreased in the morning before surgery compared to the night before as well (P < 0.001). CONCLUSION: The results showed that midazolam and psychological preparation prior to surgery can reduce the anxiety of children before adenotonsillectomy.

Evaluation of the validity of psychological preparation for children undergoing polysomnography.

STUDY OBJECTIVES: Nocturnal polysomnography (PSG) is an essential diagnostic technique to assess sleep abnormalities, including sleep-disordered breathing (SDB). Although low in invasiveness, it is extremely difficult to conduct PSG with children who are not cooperative with wearing electrodes and sensors. Particularly, it is difficult to conduct PSG on children with autism spectrum disorder (ASD) because they have poor predictive ability, exhibit extreme anxiety about novel and unfamiliar things, and have difficulty understanding verbal instructions. Recently, the usefulness of psychological preparation was reported. The primary aim of this study was to assess the usefulness of psychological preparation for PSG. METHODS: The goal of our study was to assess the usefulness of psychological preparation for PSG. A total of 253 children were enrolled in the study: 131 in the control group (19 with ASD) and 122 selected for psychological preparation (51 with ASD). RESULTS: In the preparation group, 110 of 122 (90.2%) could undergo regular PSG, a significantly higher percentage than the control group at 104 of 131 (79.4%), P = .018. Regarding hypnotic drugs, in the preparation group 111 of 122 (91.0%) underwent PSG without hypnotic drugs, which was a significantly higher percentage than in the control group at 107 of 131 (81.7%), P = .032. Additionally, 45 of 51 children with ASD in the preparation group (88.2%) could undergo PSG without hypnotic drugs. CONCLUSIONS: This study indicated that psychological preparation was effective in facilitating PSG without hypnotic drugs in children who have difficulty cooperating with PSG, including those with ASD.

Crianças e procedimentos cirúrgicos: efeitos da informação / Children and surgical procedures: effects of information / Los niños y los procedimientos quirúrgicos: efectos de la información

A falta de conhecimentos e informações entre crianças expostas a procedimentos cirúrgicos pode estar relacionada funcionalmente a manifestações de ansiedade. O presente trabalho descreve uma revisão de literatura acerca dos efeitos da disponibilização de informação sobre os comportamentos de crianças expostas a cirurgias eletivas. Foram consultados os portais dos Periódicos CAPES, PROQUEST e SciELO, sem restrição de bases de dados. Os resultados, organizados em categorias funcionais, destacam: (a) crianças se beneficiam da familiarização prévia com a equipe e instruções sobre como lidar com situações desconfortáveis; (b) passeios guiados pelo hospital, livretos, teatro de fantoches, jogos e vídeos são formatos potencialmente eficazes para redução de ansiedade; e (c) a informação parece constituir um preditor de maior colaboração e redutor de preocupações dos acompanhantes. No entantoainda não há consenso sobre critérios de escolha de informação e efeitos sobre a colaboração comportamental das crianças com os procedimentos a serem executados.

Lack of knowledge and information among children exposed to surgical procedures may be functionally related to manifestations of anxiety. This paper describes a literature review on the effects of providing information on the behavior of children exposed to elective surgeries. The portals of CAPES, PROQUEST and SciELO journals were consulted, without restriction of databases. The results, organized in functional categories, highlight: (a) children benefit from prior familiarization with the team and instructions on how to deal with uncomfortable situations; (b) tours through hospital, booklets, puppet theater, board games and videos are potentially effective formats for anxiety reduction; and (c) information seems to be a predictor of greater collaboration and lesser concern of the companions. However, there is still no consensus on the criteria for choosing information and effects on children's behavioral collaboration with the procedures to be performed.

La falta de conocimientos e información entre niños expuestos a procedimientos quirúrgicos puede estar relacionada funcionalmente con manifestaciones de ansiedad. El presente trabajo describe una revisión de literatura sobre los efectos de la disponibilidad de información sobre los comportamientos de niños expuestos a las cirugías electivas. Se consultaron los portales de los Periódicos CAPES, PROQUEST y SciELO, sin restricción de bases de datos. Los resultados, organizados en categorías funcionales, destacan: (a) niños se benefician de la familiarización previa con el equipo e instrucciones sobre cómo lidiar con situaciones incómodas; (b) paseos guiados por el hospital, folletos, teatro de títeres, juegos y videos son formatos potencialmente eficaces para reducir la ansiedad; y (c) la información parece constituir un predictor de mayor colaboración y reductor de preocupaciones de los acompañantes. Sin embargo, aún no hay consenso sobre criterios de elección de información y efectos sobre la colaboración comportamental de los niños con los procedimientos a ser ejecutados..

Psychological preparation reduces preoperative anxiety in children. Randomized and double-blind trial / Preparação psicológica reduz ansiedade pré-operatória de crianças. Ensaio randomizado e duplamente encoberto

Abstract Objective: To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety. Method: After the approval of the institutional Research Ethics Committee and written consent of the children's parents or guardians, 118 children of both genders were prospectively selected, aged between 2 and 8 years, physical condition classification ASA I, who were treated in the pre-anesthetic evaluation ambulatory of the University Hospital and who underwent ambulatory surgeries at the same hospital. Two controlled groups of 59 children were randomized: control group basic preparation and psychological preparation group. On the day of surgery, all selected children were evaluated regarding their level of anxiety using the modified Yale Preoperative Anxiety Scale and their parents were evaluated regarding their level of anxiety through the Visual Analog Scale. The evaluator was blinded to which study group the child and family member belonged to. Results: Nine children and their family members were excluded per group when the results were analyzed. Children from the prepared group showed significant reductions in their level of anxiety in relation to the control group (p = 0.04). There was no correlation between the level of anxiety of children and their parents' levels (p = 0.78). Conclusion: The psychological preparation was effective in reducing the level of anxiety of children. However, there was no relation between the level of anxiety of children and their parents' level.

Resumo: Objetivos: Verificar o efeito da preparação psicológica no alívio da ansiedade pré-operatória de crianças e avaliar se há correlação com a ansiedade dos pais. Método: Após a aprovação do Comitê de Ética e Pesquisa da Faculdade de Medicina e obtenção do consentimento pelos responsáveis dos pacientes, foram selecionadas prospectivamente 118 crianças, de ambos os sexos, entre dois e oito anos, classificação de estado físico ASA I, atendidas no ambulatório de avaliação pré-anestésica do Hospital Universitário e submetidas a cirurgias ambulatoriais. Foram randomizados dois grupos controlados de 59 crianças: grupo de preparação básica e grupo de preparação psicológica. No dia da cirurgia, todas as crianças foram avaliadas em relação ao seu grau de ansiedade através da Escala de Ansiedade Pré-operatória de Yale Modificada e seus pais, avaliados quanto ao seu nível de ansiedade pela Escala Visual Analógica. O avaliador era cego sobre qual grupo do estudo a criança e seu familiar pertenciam. Resultados: Na análise dos resultados, foram excluídas nove crianças e familiares de cada grupo. As crianças do grupo preparado tiveram reduções significativas no grau de ansiedade em relação ao grupo controle, (p = 0,04). Não houve correlação entre os graus de ansiedade das crianças e seus pais (p = 0,78). Conclusão: A preparação psicológica foi eficaz na redução do grau de ansiedade das crianças no momento da cirurgia. Não houve, entretanto, relação entre os graus de ansiedade dos pais e seus filhos.

Psychological preparation reduces preoperative anxiety in children. Randomized and double-blind trial.

OBJECTIVE: To verify the effect of psychological preparation on the relief of preoperative anxiety in children and to correlate parents' and children's levels of anxiety. METHOD: After the approval of the institutional Research Ethics Committee and written consent of the children's parents or guardians, 118 children of both genders were prospectively selected, aged between 2 and 8 years, physical condition classification ASA I, who were treated in the pre-anesthetic evaluation ambulatory of the University Hospital and who underwent ambulatory surgeries at the same hospital. Two controlled groups of 59 children were randomized: control group basic preparation and psychological preparation group. On the day of surgery, all selected children were evaluated regarding their level of anxiety using the modified Yale Preoperative Anxiety Scale and their parents were evaluated regarding their level of anxiety through the Visual Analog Scale. The evaluator was blinded to which study group the child and family member belonged to. RESULTS: Nine children and their family members were excluded per group when the results were analyzed. Children from the prepared group showed significant reductions in their level of anxiety in relation to the control group (p=0.04). There was no correlation between the level of anxiety of children and their parents' levels (p=0.78). CONCLUSION: The psychological preparation was effective in reducing the level of anxiety of children. However, there was no relation between the level of anxiety of children and their parents' level.

Preparação psicológica pré-cirúrgica: estresse e ansiedade em crianças submetidas a cirurgias eletivas / Psychological preparation pre-surgical: stress and anxiety in children under the surgery

Este artigo apresenta uma pesquisa que avaliou os efeitos da preparação psicológica pré-cirúrgica sobre o estresse e a ansiedade de crianças submetidas a cirurgias eletivas, utilizando-se de três programas distintos de preparação e um grupo de controle. A pesquisa foi realizada com 80 participantes, divididos em quatro grupos, usuários de um Hospital infantil e utilizou-se a Escala de Stress Infantil (ESI) e o Inventário de Ansiedade Traço-Estado (IDATE-C). Realizaram-se três etapas distintas: a) aplicação da ESI e do IDATE-C antes da preparação para cirurgia, no dia anterior a mesma; b) a preparação psicológica pré-cirúrgica; e c) a reaplicação da ESI e do IDATE-C, depois da preparação. Os resultados mostraram que há significativa redução do nível de estresse e da ansiedade, embora não tenha havido diferença estatística significativa quanto ao tipo de programa utilizado, seja vídeo, boneco ou informação. Discute-se as implicações práticas para o atendimento psicológico das crianças em situação pré-cirúrgica e as limitações desta pesquisa. Conclui-se que o preparo psicológico pré-cirúrgico foi efetivo, independente da metodologia utilizada.

This article presents a study that evaluated the effects of the pre-surgical psychological preparation for the stress and anxiety of children undergoing elective surgery, using three different preparation programs and a control group. The research had a quantitative delineation, and made intra and inter-group comparisons. It was performed with 80 participants, divided into four groups, users of a Children's Hospital and used the Child Stress Scale (ESI) and the Trait Anxiety Inventory-State (STAI-C). There were three distinct steps: a) application of ESI and IDATE-C before preparation, the day before the surgery; b) the preparation itself, in groups submitted to different preparation programs; c) reapplying from STAI and ESI-C after preparation. The results showed that there is a significant reduction in the level of stress and anxiety after preparation, although there was no statistically significant difference in the type of program used. It is argued that there were practical implications for the psychological care of children in pre-surgical situation and limitations to consider when researching this area of pediatric psychology. We conclude that the preoperative psychological preparation is effective, regardless of the methodology used.

Efeitos de Preparações Psicológicas Pré-Cirúrgicas sobre o Estresse e a Ansiedade de Meninos e Meninas / Efectos de la preparación psicológica prequirúrgica sobre el estrés y la ansiedad en niños y niñas / Effects of pre-surgical psychological preparations on stress and anxiety in boys and girls

Resumo A preparação infantil para a cirurgia é foco de atenção da equipe de saúde pelo potencial traumático dos procedimentos cirúrgicos e por ser fonte de estresse e ansiedade na infância. O impacto de três preparações psicológicas pré-cirúrgicas sobre o estresse e a ansiedade de crianças submetidas a cirurgias eletivas foi avaliado. A amostra foi composta por 80 crianças de um hospital infantil, a qual foi dividida em dois blocos de 40 sujeitos de acordo com o sexo e alocados aleatoriamente num dos quatro grupos: controle, preparação por informações verbais, preparação por jogo com kit de preparação ou preparação por vídeo informativo. O estresse e a ansiedade foram mensurados por meio da Escala de Stress Infantil (ESI) e do Inventário de Ansiedade Traço-Estado (Idate-c). A intervenção foi implementada em três etapas distintas: (a) aplicação da ESI e do Idate-c antes da preparação, no dia anterior a cirurgia; (b) a preparação propriamente dita nos grupos submetidos aos diferentes programas de preparação, também no dia anterior, e (C) a reaplicação da ESI e do Idate-c no dia da cirurgia. Os dados foram analisados por meio de equações de regressão simultâneas, e as estimativas são apresentadas em termos de diferença média padronizada e erro-padrão. Os resultados permitem inferir que a preparação com o vídeo reduziu o estresse (Tvídeo1= -38 ± .18) e a ansiedade (Tvídeo2 = - .54 ± .27), especialmente entre os meninos (TvídeoM1 = - .66 ± .25; TvídeoM2 = - .71 ± .38). Implicações práticas para a preparação psicológica das crianças em situação pré-cirúrgica e limitações da pesquisa são discutidas.

Resumen La preparación infantil para una cirugía es el centro de atención del equipo de salud debido al potencial traumático de los procedimientos quirúrgicos y debido a que es una fuente de estrés y ansiedad en la infancia. En la presente investigación se evaluó el impacto de tres formas de preparación psicológica prequirúrgica ante el estrés y la ansiedad de los niños sometidos a cirugía electiva. La muestra estuvo constituida por 80 niños de un hospital infantil, divididos en dos bloques de 40 sujetos según el sexo, y asignados al azar a uno de cuatro grupos: control, preparación a través de información verbal, preparación a través de juego con el kit de preparación, o preparación a través de video informativo. Se utilizó la Escala de Estrés Infantil (ESI) y el Inventario Ansiedad Estado-Rasgo para niños (STAIC) para medir el estrés y la ansiedad de los niños. La intervención se llevó a cabo en tres etapas distintas: (a) aplicación del ESI y el STAIC antes de la preparación, el día anterior a la cirugía; (b) preparación propiamente dicha en los grupos de los diferentes programas de preparación el día anterior; y (C) reaplicación del ESI-C y el STAIC el día de la cirugía. El análisis de los datos se hizo mediante ecuaciones de regresión simultáneas y las estimaciones se presentan por medio de la diferencia entre medias estandarizada y de la desviación estándar. Los resultados permiten inferir que la preparación con video redujo el estrés (Tvideo1 = -.38 ± .18) y la ansiedad (Tvideo2 = -.54 ± .27), especialmente en los niños (TvideoMl = -.66 ± .25; TvideoM2 = -.71 ± .38). Al final se discuten las implicaciones prácticas para la preparación psicológica de los niños en situación prequirúrgica y las limitaciones de la investigación.

Abstract Child preparation for surgery is a focus of attention of health teams due to the traumatic potential of surgical procedures and for being a source of stress and anxiety in childhood. The impact of three pre-surgical psychological preparations on stress and anxiety of children undergoing elective surgery were evaluated. The sample consisted of 80 children from a children's hospital, divided into two blocks of 40 subjects according to gender and randomly assigned to one of four groups: control, preparation by verbal information, preparation by game and preparation kit or preparation by informational video. Stress and anxiety were measured using the Escala de Stress Infantil (ESI) (Child Stress Scale) and the State-Trait Anxiety Inventory for Children (STAIC). The intervention was implemented in three distinct stages: a) application of ESI and STAIC before preparation, the day before surgery; b) actual preparation, in groups submitted to different preparation programs, also on the previous day; and c) reapplication of ESI and STAIC on the day of surgery. Data were analyzed using simultaneous regression equations, and estimates are presented in terms of standardized mean difference and standard error. Results allow to infer that preparation by video reduced stress (Tvideo1 = -0.38±0.18) and anxiety (Tvideo2 = -0.54±0.27), especially among boys (TvideoM1 = -0.66±0.25; TvideoM2 = -0.71±0.38). Practical implications for the psychological preparation of children in pre-surgical situations and the limitations of this study are discussed.

A mixed-method systematic review of the effectiveness and acceptability of preoperative psychological preparation programmes to reduce paediatric preoperative anxiety in elective surgery.

AIM: To explore the effectiveness of preoperative psychological preparation programmes aimed to reduce paediatric preoperative anxiety and the potential factors that could have an impact on parent and children's acceptance of such interventions. BACKGROUND: Various preoperative psychological preparation programmes are available to address paediatric preoperative anxiety. No mixed-method review has been conducted to explore the effectiveness and acceptability of these programmes. DESIGN: A mixed-method systematic review. DATA SOURCES: Seven bibliographic databases were searched from inception to September 2016, complemented by hand searching of key journals, the reference lists of relevant reviews, search for grey literature and the contacting of associated experts. REVIEW METHODS: The review process was conducted based on the framework developed by the Evidence for Policy and Practice Information and Co-ordinating Centre. A narrative summary and a thematic synthesis were developed to synthesize the quantitative and qualitative data respectively, followed by a third synthesis to combine the previous syntheses. RESULTS: Nineteen controlled trials and eleven qualitative studies were included for data synthesis. The controlled trials reveal that educational multimedia applications and web-based programmes may reduce paediatric preoperative anxiety, while the effectiveness of therapeutic play and books remains uncertain. Qualitative studies showed parent-child dyads seek different levels of information. CONCLUSIONS: Providing matched information provision to each parent and child, actively involving children and their parents and teaching them coping skills, may be the essential hallmarks of a successful preoperative psychological preparation. Further research is necessary to confirm the effectiveness of therapeutic play and books.

Component network meta-analysis identifies the most effective components of psychological preparation for adults undergoing surgery under general anesthesia.

OBJECTIVES: To apply component network meta-analysis (CNMA) models to an existing Cochrane review of psychological preparation interventions for adults undergoing surgery and to extend the models to account for covariates to identify the most effective components for improving postoperative outcomes. STUDY DESIGN AND SETTING: Interventions consisted of between one and four components of psychological preparation: procedural information (P), sensory information (S), behavioral instruction (B), cognitive interventions (C), relaxation (R), and emotion-focused techniques (E). We used CNMA models to assess the effect of each component for three outcomes: length of stay, pain, and negative affect. RESULTS: We found evidence that the most effective component for reducing length of stay depends on the type of surgery and that R may improve pain. There was insufficient evidence that individual components contributed to the overall reduction in negative affect, but P and S emerged as the most likely beneficial components. Overall, we were unable to identify any one component as the most effective across all three outcomes. CONCLUSION: The CNMA method allowed us to address questions about the effects of specific components that could not be answered using standard Cochrane methodology.

Children's experiences and responses towards an intervention for psychological preparation for radiotherapy.

BACKGROUND: Children can experience distress when undergoing radiotherapy as a reaction to being scared of and unfamiliar with the procedure. The aim was to evaluate children's experiences and responses towards an intervention for psychological preparation for radiotherapy. METHODS: A case control design with qualitative content analysis of semi-structured interviews and statistical analysis of anxiety ratings were used for evaluating a strategy for psychological preparation and distraction. Fifty-seven children aged 2 to 18 years and their parents participated - 30 children in the baseline group and 27 in the intervention group. Child interviews were performed and the child and their parents rated the child's anxiety. RESULTS: The intervention was most appropriate for the younger children, who enjoyed the digital story, the stuffed animal and training with their parents. There were some technical problems and the digital story was not detailed enough to fit exactly with various cancer diagnoses. Children described suggestions for improvement of the intervention. The ratings of the child's anxiety during radiation treatment showed no differences between the baseline group and the intervention group. CONCLUSIONS: The children of all the age groups experienced their interventions as positive. The strength of the intervention was that it encouraged interaction within the family and provided an opportunity for siblings and peers to take part in what the child was going through. Future research on children's experiences to interventions should be encouraged. The intervention and the technical solutions could improve by further development. TRIAL REGISTRATION: The study design was structured as an un-matched case-control study, baseline group vs. intervention group. TRIAL REGISTRATION: ClinicalTrials.gov NCT02993978 , Protocol Record 2012-113-31 M. Retrospectively registered - 21 November 2016.

Where science meets practice: Olympic coaches' crafting of the tapering process.

Although there is research providing physiologically-based guidance for the content of the taper, this study was the first to examine how coaches actually implement the taper. The purpose of this study was to examine the taper planning and implementation processes of successful Olympic coaches leading up to major competitions and how they learned about tapering. Seven track and field coaches participated in semi-structured interviews exploring their tapering processes. To be considered for inclusion, coaches were required to have coached one or more athletes to an Olympic or Paralympic medal. Through a process of axial and open coding interview transcripts were analysed and lower and higher order themes developed describing the coaches' tapering processes. Our findings indicate that the strategies employed to achieve the desired physiological adaptions of the taper were consistent with research (e.g., reduction in volume whilst maintaining intensity and frequency). However, our findings also suggest that tapering is far from a straight forward "textbook" process. The taper was not restricted to physiological outcomes with coaches considering athletes' psychological as well as physical state. Coaches also involved the athlete in the process, adapted the taper to the athlete, continually monitored its progress, and adapted it further as required.