Abstract

Evidence supporting the efficacy of psychosocial interventions after paediatric burns is inconclusive. Establishing a methodological synthesis of the evidence for psychosocial support interventions is an important contribution, especially for a resource-constrained setting such as South Africa with a high child burn burden. The aim of the study was to conduct a systematic review of the effectiveness of psychosocial interventions for child and adolescent burn victims. All-language studies were systematically identified using Medline (Ovid), PsycInfo (Ovid), Embase (Elsevier), CINAHL (Ebsco), Web of Science (Thomson Reuters) and Cochrane (Wiley). By means of the PRISMA checklist, titles, abstracts and full-text articles were independently screened based on inclusion/exclusion criteria. The methodological strength of each study was assessed using the Cochrane Risk of Bias Tool at study level by two reviewers in an independent and un-blinded manner. Out of a total of 3437 articles initially identified, 286 underwent full review resulting in 25 included studies. All studies included in this review (interventions delivered at in-patent hospital and dual in- and out-patient hospital settings) were assessed to have ‘low risk’ for attrition, reporting and other bias while allocation concealment and blinding bias were evaluated as ‘high’ or ‘unclear’. Risk for allocation and blinding may be due to the intrinsic characteristic of psychological intervention studies requiring different domains of assessment. Interventions delivered at in-patient setting were shown to have most effect, with multimodal distraction and virtual reality distraction therapy associated with significant alleviation of pain and anxiety during burn wound care procedures. Little to no evidence exists for low-to-middle income countries highlighting the need for contextually relevant findings. The evidence base for interventions providing psychosocial recovery support for burns in children is promising, however, further methodologically robust research is required to strengthen existing evidence.