A pilot study of the effectiveness of a serious game CliniPup® on perioperative anxiety and pain in children

J Pediatr Surg. 2020 Feb;55(2):304-311. doi: 10.1016/j.jpedsurg.2019.10.031. Epub 2019 Nov 5.


Introduction/aim: Children experience important anxiety before surgery. Anxiety and pain are positively correlated. Serious gaming is a non-pharmacological intervention to prepare children and parents for an operation. We aimed to evaluate the effectiveness of the serious game CliniPup® on anxiety and pain in children undergoing ambulatory surgery.

Method: A prospective randomized controlled pilot trial in 72 children aged 5 to 11 years old scheduled for day-care surgery (general surgery, dentistry, otorhinolaryngology, urology) was performed. Participants were randomly assigned into 3 groups: A (CliniPup®), B ("Empty game" without educational information), or C (no game, oral information at the outpatient clinic, current standard of care). Anxiety, pain, and behaviour were evaluated by validated instruments at six time-points: T0: baseline, T1: 1 week preoperatively, T2: at hospital admission, T3: before discharge, T4: 1 week postoperatively, T5: 1 month postoperatively.

Results: After playing the game (T1), the estimated mean anxiety score (VASa) was lower in Group A (1.9 units) versus Group B (2.7 units). The estimated mean VASa at T1 for Group A was 2.6 units lower compared to Group C (p = 0.003). For Group B, VASa levels were 1.8 units lower than in Group C (p = 0.045). After correction for "surgery type", Group A continued to show a significantly lower VASa compared to Group C (p = 0.044). On the other time points, no difference in anxiety and pain were observed, nor in post-hospitalization behaviour.

Conclusion: Children that played the CliniPup® game one week before surgery had a significant reduction in preoperative anxiety after playing the game, but not on the other time points. No differences on peri-operative pain were observed during the different time points.

Type of study: Randomized Trial.

Level of evidence: Level II.

Keywords: Anesthesia; Anxiety; Children; Intervention; Pain; Preparation; Serious gaming; Surgery.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Ambulatory Surgical Procedures / adverse effects*
  • Anxiety* / etiology
  • Anxiety* / therapy
  • Child
  • Child, Preschool
  • Female
  • Humans
  • Male
  • Perioperative Care / methods*
  • Pilot Projects
  • Prospective Studies
  • Video Games*