How Effective is Cognitive Behavioural Therapy (CBT) in Helping Paediatric with Sickle Cell Disease to Manage Chronic Pain, Improve Their ability to Cope and Enhance Their Quality of Life? A Systematised Literature Review

Abstract

Abstract:

Background: Evidence on the use of cognitive behavioural therapy (CBT) to relieve chronic paediatric conditions are increasing. However, chronic pain management in paediatric sickle cell disease (SCD) has received little attention, despite its role in functional and social morbidity.

Aim: To evaluate CBT’s effectiveness for managing chronic pain ,improve coping and enhance quality of life in paediatric SCD.

Methods: A systematised literature review was conducted, using PICO to develop the review question. The reviewer searched six databases (Medline, PubMed, CENTRAL, CINAHL, PsycINFO, Web of Science) for primary studies in English, dated November 2009-April 2020. Study selection and screening were enabled by Covidence software, involving one independent reviewer. Cochrane’s risk-of-bias tools for randomised and non-randomised studies were implemented for quality appraisal, using the Cochrane framework in narrative synthesis to address the review question.

Results: A total of 264 participants were included across six studies (three RCTs; two pilot-RCTs, and one quasi-experimental study. In three studies, CBT was used face-to-face, while online or smartphone-delivered CBT was adopted in the other three. The score for ‘risk of bias’ was high across the studies (lack of allocation concealment, blinding with selective reporting). Synthesis revealed two modes of CBT delivery (technological, traditional), demonstrating a small-medium effect on pain intensity and coping, but no effect on quality of life. ‘No effect’ was estimated, given the limited and underpowered body of evidence.

Conclusion: Inconclusive proof of CBT’s efficacy for managing chronic pain in paediatric SCD was found. Therefore, further well-conducted and adequately-powered randomised trials are necessary.