Using Mediation Analysis to Understand How Treatments for Paediatric Pain Work: A Systematic Review and Recommendations for Future Research

Abstract

Clinicians have an increasing number of evidence-based interventions to treat pain in youth. Mediation analysis offers a way of investigating how interventions work, by examining the extent to which an intermediate variable, or mediator, explains the effect of an intervention. This systematic review examined studies that used mediation analysis to investigate mechanisms of interventions on pain-relevant outcomes for youth (3–18 years) with acute or chronic pain, and provides recommendations for future mediation research in this field. We searched five electronic databases for clinical trials or observational longitudinal studies that included a comparison group and conducted mediation analyses of interventions on youth and assessed pain outcomes. We found six studies (N = 635), which included a total of 53 mediation models examining how interventions affect pain-relevant outcomes for youth. Five studies were secondary analyses of randomized controlled trials of psychological interventions for chronic pain; one was a longitudinal observational study of morphine for acute pain. The pain conditions studied were irritable bowel syndrome, functional abdominal pain, juvenile fibromyalgia, mixed chronic pain, and post-operative pain. Fourteen putative mediators were tested, of which three partially mediated treatment effect; seven did not significantly mediate treatment effect and four had mixed results. Methodological and reporting limitations were common. There are substantial gaps in the field with respect to investigating, and therefore understanding, how paediatric interventions work.

Comparison Between the Effects of Continuous and Intermittent Light-Intensity Aerobic Dance Exercise on Mood and Executive Functions in Older Adults

“…Moreover, as dance is cognitively and physically demanding (Brown et al, 2006), it is attracting attention as a type of exercise to enhance cognitive function effectively (Hewston et al, 2021). Kimura and Hozumi (2012) reported that acute light-intensity (40% V ˙o2peak ) aerobic dance exercise (LADE) could enhance spatial working memory performance in older adults. Moreover, our recent study revealed that acute LADE improved vitality and pleasure levels as well as executive functions as evaluated by Stroop task performance (Hyodo et al, 2019).…”