2 123 REVIEW OF APPLIED & CASUAL GAMES FOR MENTAL HEALTH Paper Country Target group N % male Age, mean (SD) Age range Intervention arms Intervention characteristics Assessments Variables measured Findings relevant for current review Patel et al. 2006 USA Children undergoing general anaesthesia for ambulatory surgery 112 61.6 6.84 (0.43) 4-12 years 1. Parent presence + video game of their choice (game distraction). 2. Parent presence + midazolam (standard care). 3. Parent presence only. 1-2. Participants started playing the video game or were medicated in the holding area. At least 20 minutes after the (start of the) intervention, they were escorted into the operating room. Participants assigned to the video game group were allowed to play through the introduction of the anaesthesia mask. Pre and during anaesthesia, and 7-10 days after surgery (postoperative behaviour only). Anxiety, parent satisfaction, postoperative behaviour changes; age and gender (moderators). The midazolam and parent presence only groups showed an increase in anxiety from baseline to induction of anaesthesia, while participants in the video game group showed a decrease in anxiety. Sahin & Karkiner, 2022 Turkey Children scheduled for their first elective surgery for phimosis, inguinal hernia, hydrocele, undescended testis, hypospadias, and undergoing general anaesthesia 300*l 87.4 6.57 (1.95) 4-10 years 1. Midazolam group (standard care). 2. Computer tablet-based age-appropriate games of their choice (game distraction). 3. Control group. 1. Approximately 30 minutes before mask induction, participants received Midazolam. 2. Participants played games for 20 minutes and continued to play while leaving their families to go to the operating room. They were encouraged to play with the tablet until they lost consciousness during mask induction. 3. Participants were not given any anxiolytic. Pre and post intervention, during separation from families, during mask induction, one week after discharge (postoperative behaviour only). Anxiety, separation anxiety, recovery time from anaesthesia, postoperative behaviour changes; anxiety (moderator/covariate). Significant differences in anxiety scores after the intervention and percentages of decrease from baseline were found. The highest anxiety scores and lowest percent decreases were found in the control group, and Midazolam was more effective than playing games. Significantly more children separated easily from their parents in the Midazolam group, as well as accepted the masks more readily.
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