A Web-based module and online video for pain management education for caregivers of children with fractures: A randomized controlled trial

Introduction: Over 80% of children experience compromise in functioning following a fracture. Digital media may improve caregiver knowledge of managing fracture pain at home. Objectives: To determine whether an educational video was superior to an interactive web-based module (WBM) and verbal instructions, the standard of care (SOC). Methods: This randomized trial included caregivers of children 0-17 years presenting to the emergency department (ED) with non-operative fractures. Primary outcome was the gain score (pre-post intervention) on a 21-item questionnaire testing knowledge surrounding pain recognition and management for children with fractures. Secondary outcomes included survey of caregiver confidence in managing pain (five-item Likert scale), number of days with difficulty sleeping, before return to a normal diet, and work/school missed. Results: We analyzed 311 participants (WBM 99; video 108; SOC 104) with a mean (SD) child age of 9.6 (4.2) years, of which 125/311 (40.2%) were female. The video (delta =2.3, 95% CI: 1.3, 3.3; p<0.001) and WBM (delta =1.6; 95% CI: 0.5, 2.6; p =0.002) groups had significantly greater gain scores than the SOC group. The mean video gain score was not significantly greater than WBM (delta =0.7; 95% CI: -0.3, 1.8; p=0.25). There were no significant differences in caregiver confidence (p =0.4), number of absent school days (p=0.43), nights with difficulty sleeping (p=0.94), days before return to a normal diet (p=0.07), or workdays missed (p=0.95). Conclusions: A web-based module and online video are superior to verbal instructions for improving caregiver knowledge on management of children's fracture pain without improvement in functional outcomes