{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:27:32Z","timestamp":1789043252703,"version":"build-2803163510"},"reference-count":31,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2022,6,5]],"date-time":"2022-06-05T00:00:00Z","timestamp":1654387200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100012256","name":"Cerebral Palsy Alliance Research Foundation","doi-asserted-by":"publisher","award":["PG2115"],"award-info":[{"award-number":["PG2115"]}],"id":[{"id":"10.13039\/100012256","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Develop Med Child Neuro"],"published-print":{"date-parts":[[2022,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Aim<\/jats:title><jats:p>To compare biofeedback assisted relaxation training (BART) with distraction therapy for pain during botulinum neurotoxin A (BoNT\u2010A) treatment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Method<\/jats:title><jats:p>This was a crossover randomized controlled trial. Eligible participants were 7\u2009years and older with neurological conditions. Participants were randomized to receive BART or distraction during their first BoNT\u2010A treatment, followed by the alternative intervention in their subsequent BoNT\u2010A treatment. BART was delivered via BrightHearts, an interactive heart\u2010rate\u2010responsive application. Outcomes were pain (Faces Pain Scale \u2013 Revised), fear (Children's Fear Scale), and anxiety (numerical rating scale, State\u2013Trait Anxiety Inventory). Demographics, paired <jats:italic>t<\/jats:italic>\u2010tests, and linear mixed models were used to compare outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Thirty\u2010eight participants (mean [SD] age 13\u2009years 5\u2009months [3\u2009years 4\u2009months], 20 males, 34 with cerebral palsy) completed both interventions. There were non\u2010significant differences in overall pain (mean difference\u2009\u2212\u20090.05, 95% confidence interval [CI] \u22120.91 to 0.80, <jats:italic>p<\/jats:italic>\u00a0=\u20090.902) and worst pain (mean difference 0.37, 95% CI \u22120.39 to 1.13, <jats:italic>p<\/jats:italic>\u00a0=\u20090.334) when using BART and distraction therapy. There were non\u2010significant differences in fear and anxiety between interventions. Younger age, heightened pre\u2010procedural state anxiety, and Gross Motor Function Classification System levels III and IV were associated with poorer outcomes (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05). Participants who received BART before distraction therapy reported lower pain and anxiety scores during both BoNT\u2010A treatments (<jats:italic>p<\/jats:italic>\u00a0&lt;\u20090.05).<\/jats:p><\/jats:sec><jats:sec><jats:title>Interpretation<\/jats:title><jats:p>Children reported similar pain when using BART and distraction therapy. Those who used BART before distraction therapy reported lower pain and anxiety during both treatments.<\/jats:p><\/jats:sec><jats:sec><jats:title>What this paper adds<\/jats:title><jats:p>\n<jats:list list-type=\"bullet\">\n\n<jats:list-item><jats:p>Children reported similar pain (overall; worst) when using biofeedback assisted relaxation training (BART) and distraction therapy.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Children who used BART before distraction therapy reported lower pain and anxiety over both botulinum neurotoxin A treatments.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Younger age, pre\u2010procedural state anxiety, and Gross Motor Function Classification System levels III and IV predicted a worse pain experience.<\/jats:p><\/jats:list-item>\n\n<jats:list-item><jats:p>Distraction therapy and BART were acceptable non\u2010pharmacological interventions for procedural pain management.<\/jats:p><\/jats:list-item>\n<\/jats:list>\n<\/jats:p><\/jats:sec>","DOI":"10.1111\/dmcn.15303","type":"journal-article","created":{"date-parts":[[2022,6,6]],"date-time":"2022-06-06T04:04:39Z","timestamp":1654488279000},"page":"1507-1516","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Biofeedback assisted relaxation training and distraction therapy for pain in children undergoing botulinum neurotoxin A injections: A\u00a0crossover randomized controlled trial"],"prefix":"10.1111","volume":"64","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6436-4936","authenticated-orcid":false,"given":"Katarina","family":"Ostojic","sequence":"first","affiliation":[{"name":"Children's Hospital Westmead Clinical School, Discipline of Child &amp; 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