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Electronic pain diaries for children

Clinical bottom line

Electronic daily pain diaries resulted in better compliance (particularly in boys) and much better accuracy than did paper diaries.


Background

Pain diaries are used to monitor recurrent pain in children. Prospective diaries are thought to be better than retrospective questions. Diaries used have been of pen and paper variety, though these have problems, because they are not always filled in, or not filled in at the correct time. Can electronic diaries do a better job in children? If a child can program the video recorder, then just perhaps a more modern method would be better accepted.

Reference

TM Palermo et al. A randomized trial of electronic versus paper pain diaries in children: impact on compliance, accuracy, and acceptability. Pain 2004 107: 213-219.


Randomised trial

Participants were part of a larger longitudinal study on recurrent pain and disability in children, and were diagnosed with juvenile idiopathic arthritis or headaches, with pain at least once a week for six months, and aged 8-16 years. Sixty children were randomised to e-diary (electronic) or p-diary (paper).

The e-diary consisted of a handheld computer set to record pain over seven consecutive days. Recordings were automatically date and time stamped. Results could be uploaded into a desktop computer for analysis. The e-diary and training was given at a home visit. The device used was a HP Jornada 548.

Paper diaries were given to each family at a clinic visit, with stamped addressed envelopes for returning the diaries. Similar information was required on pain over seven days. Both groups had a reminder telephone call during the seven day period.

With both systems children were asked to record answers to questions on pain and distress, somatic symptoms, and activity limitations. They were also asked to rate how acceptable the method of recording.

Results

Compliance

Overall, children completed 312 diary entries out of a possible 420 (74%). With the e-diary format completion was high, with an average of 6.6 days of recording, and with 83% of children completing all seven days. With the p-diary format only an average of 3.8 days were recorded, and only 47% of children completed all seven days (Figure 1).

Figure 1: Percentage of children completing all seven diary days

There was a particular effect for boys over girls, with boys completing all days with an electronic diary, buy fewer than two days with paper diary (Figure 2).

Figure 2: days completed by boys and girls

Accuracy

Diary recordings with paper diaries contained significant more errors than those with electronic diaries. Only 51% of diary entries were accurate with paper, while 100% were accurate with electronic diary.

Acceptability

There were no differences in acceptability, but 83% of children found it very easy or easy to remember to fill out the diary with the electronic version, compared with 53% with paper, and more children liked e-diary (61%) than did those liking p-diary(33%).

Comment

There were some technical problems with the electronic diaries, with malfunction, power failure, or breakages with the e-diary. This apart, the results were spectacularly better in this randomised trial. The paper has some methodological weaknesses, such as not telling us anything other than it was randomised. But there is a clear indication that electrons beat ink for this purpose.