Hypnosis for Children Undergoing Anorectal Manometry

Study Overview
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Brief Summary
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Partially blinded randomized controlled trial investigating the effect of a brief session of hypnosis prior to anorectal manometry in children

Official Title
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Using Medical Hypnotherapy in Children With Defecation Disorders

Conditions
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Constipation

Intervention / Treatment
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* Behavioral: Hypnosis


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Children aged 4-18 who are scheduled to undergo anorectal manometry testinf. ASA classification I to II. Both parents and children have sufficient English language proficiency. Both parents and children are willing to fill out the questionnaires involved in this study. Exclusion Criteria: ASA classification III, IV (children with a chronic or severe disease). Children with a metabolic, endocrine or neuromuscular disorder or mental illness. Children with anorectal malformations or previous anorectal surgery. Children with developmental delay Children with diagnosed emotional or behavioral disorders

Ages Eligible for Study
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Minimum Age: 4 Years
Maximum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Hypnosis<br>A brief session of hypnosis just before child starts with anorectal manometry | Behavioral: Hypnosis<br> <br> |
| No Intervention: Control<br>No hypnosis session, standard care | |

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome of this study will be the assessment of distress as measured by the non-blinded observer. | The non-blinded observer will use the Observation Scale of Behavioral Distress (OSBD) to assess the periprocedural distress of the child. The OSBD records the presence or absence of thirteen operationally-defined behaviors, which indicate discomfort (e.g. cry, verbal resistance, information seeking) at 15-second intervals throughout the procedure. The behaviors are given a score ranging from 1 to 4 according to the severity of distress that is expressed by that behavior. The recorded score during a 15-second interval can range from zero (no distress) to 33.5 (extreme distress). The total scores will be summed up and then divided by the number of 15-second intervals to obtain a mean distress score. | Periprocedural | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Periprocedural distress as measured by the blinded observer | The blinded observer rates the child's distress on a 4-point Likert scale ranging from 0 (not anxious at all) to 3 (extremely anxious). Ratings are based on facial features, crying, and physical movements. The blinded observer reports the highest (i.e. peak), most common (i.e. typical),and the lowest level of distress. We will compare the highest and most common levels of distress between groups, as we believed these levels of distress are most clinically relevant. | Periprocedural | 
| Child-reported levels of distress | The child will be asked to rate the amount of distress experienced (unpleasantness, nervousness, and anxiety) during the manometry on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). They are also asked to rate the pain of the procedure on an analogous scale of 0 (no pain) to 10 (extremely painful). Children who received hypnosis are asked if they believed that it helped them to relax on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). | Right after anorectal manometry (same day) | 
| Parent-reported levels of distress | The parent accompanying the child will be asked to rate the amount of distress of the child (unpleasantness, nervousness, and anxiety) during the manometry on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). They are also asked to rate the pain of the procedure on an analogous scale of 0 (no pain) to 10 (extremely painful). Parents of children who received hypnosis are asked if they believed that it helped the child to relax on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). | Right after anorectal manometry (same day) | 
| Difficulty of procedure | The motility nurse will report if all parts of the procedure could be performed properly and rates the degree of difficulty of the procedure on a 5-point Likert scale ranging from 0 (not at all) to 4 (very much). | Right after anorectal manometry (same day) | 
| Difficulty of hypnosis | The hypnotherapist rates the degree of difficulty of the hypnosis on a similar 5-point Likert scale ranging from 0 (not at all) to 4 (very much). | Right after anorectal manometry (same day) | 
| Manometry outcomes | Procedural outcomes of the children undergoing anorectal manometry will be recorded and compared between groups. This includes: resting pressure, squeeze pressure, squeeze duration, push test, duration of procedure. | Periprocedural | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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hypnosis, anorectal manometry, child