Efficacy of Helfer Skin Tap (HST) Technique on Pain during Intramuscular Injection among Children Attending Immunisation Clinic - A Randomised Controlled Trial in South India
Background: Injections for vaccinations are found to be the most common cause of iatrogenic pain in childhood and the association of pain with such types of vaccinations may result in anxiety and discomfort for children as well as for their family members and the healthcare providers who administer them.
Aim: This RCT has been conducted to evaluate the efficacy of the Helfer Skin Tap (HST) technique on pain among children receiving intramuscular immunisation.
Materials and Methods: Quantitative research was carried out with the true experimental post-test only control group design among 40 attending the immunisation clinics selected by convenience sampling technique with random assignment. The intervention was administered by tapping at the injection site for 3 minutes before, during, and after vaccination in the experimental group. The pain was assessed with a standardised FLACC pain scale in both groups.
Results: We analysed the data with chi-square test for homogeneity of sample characteristics and association with pain, and an independent t-test for the effectiveness of HST. There was a statistically significant reduction in pain among the experimental group after HST in comparison with the control group, and none of the variables had any association with pain in children.
Conclusion: The study concluded that the HST technique was significantly effective in pain reduction among children undergoing intramuscular injections at an immunisation clinic.
How to cite this article:
Saritha V, Radha MS, Subhashini L, Srinivasan P. Efficacy of Helfer Skin Tap (HST) Technique on Pain
during Intramuscular Injection among Children Attending Immunisation Clinic - A Randomised
Controlled Trial in South India. Chettinad Health City Med J. 2023;12(2):56-62.
Lumley MA, Cohen JL, Borszcz GS, Cano A, Radcliffe AM, Porter LS, Schubiner H, Keefe FJ. Pain and emotion: a biopsychosocial review of recent research. J Clin Psychol [Internet]. 2011 Sep [cited 2022 Oct 4];67(9):942. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3152687/ [PubMed] [Google Scholar]
Taddio A, Appleton M, Bortolussi R, Chambers C, Dubey V, Halperin S, Hanrahan A, Ipp M, Lockett D, MacDonald N, Midmer D, Mousmanis P, Palda V, Pielak K, Riddell RP, Rieder M, Scott J, Shah V. Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline (summary). CMAJ [Internet]. 2010 Dec [cited 2022 Oct 4];182(18):1989. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3001505/ [PubMed] [Google Scholar]
Schechter NL, Zempsky WT, Cohen LL, McGrath PJ, McMurtry CM, Bright NS. Pain reduction during pediatric immunizations: evidence-based review and recommendations. Pediatrics [Internet]. 2007 May [cited 2022 Oct 4];119(5). Available from: https://pubmed.ncbi.nlm.nih.gov/17473085/ [PubMed] [Google Scholar]
Taddio A, Chambers CT, Halperin SA, Ipp M, Lockett D, Rieder MJ, Shah V. Inadequate pain management during routine childhood immunizations: the nerve of it. Clin Ther [Internet]. 2009 [cited 2022 Oct 4];31 Suppl 2. Available from: https://pubmed.ncbi.nlm.nih.gov/19781434/ [PubMed] [Google Scholar]
Verghese ST, Hannallah RS. Acute pain management in children. J Pain Res [Internet]. 2010 [cited 2022 Oct 4];3:105. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3004641/ [PubMed] [Google Scholar]
Ayinde O, Hayward RS, Ross JD. The effect of intramuscular injection technique on injection associated pain; a systematic review and meta-analysis. PLoS One [Internet]. 2021 May [cited 2022 Sep 9];16(5). Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8092782/ [PubMed] [Google Scholar]
Negi P. Effectiveness of Helfer skin tap technique on pain reduction during intramuscular injection among infants. Int J Adv Res Dev [Internet]. 2019 [cited 2022 Oct 5];4(3). Available from: https://www.ijarnd.com/manuscripts/v4i3/V4I3-1146.pdf [Google Scholar]
Brydges CR. Effect size guidelines, sample size calculations, and statistical power in gerontology. Innov Aging [Internet]. 2019 Aug 1 [cited 2023 May 19];3(4):1-8. Available from: https://academic.oup.com/innovateage/article/3/4/igz036/5560156 [Google Scholar]
Peter B, Mathew B. Pain level of infants receiving Helfer Skin Tap during vaccination. Int J Health Sci Res [Internet]. 2019 [cited 2022 Oct 5];9(7):102. Available from: https://www.ijhsr.org/IJHSR_Vol.9_Issue.7_July2019/16.pdf [Google Scholar]
Meera P, Yogesh K, Gurneet K. A study to assess the effectiveness of Helfer Skin Tap technique during immunisation in infants in selected hospital and Anganwadi of Ambala, Haryana. J Nurs Sci Pract [Internet]. 2014 [cited 2022 Oct 5];4(3):1-2. Available from: https://www.researchgate.net/profile/Yogesh-Kumar-29/publication/324477213_A_Study_to_Assess_the_Effectiveness_of_Helfer_Skin_Tap_Technique_during_Immunization_in_Infants_in_Selected_Hospital_and_Anganwadi_of_Ambala_Haryana/links/5acf4a7baca2723a3344e61c/A-Study-to-Assess-the-Effectiveness-of-Helfer-Skin-Tap-Technique-during-Immunization-in-Infants-in-Selected-Hospital-and-Anganwadi-of-Ambala-Haryana.pdf [Google Scholar]
Soliman HM, Hassnein AA. Efficacy of Helfer skin tapping technique on pain intensity as perceived by the patients receiving intramuscular injection. Int J Nurs Didact [Internet]. 2016 [cited 2022 Sep 9];6(2). Available from: http://www.nursingdidactics.com/index.php/ijnd/article/view/1825/1477 [Google Scholar]
Khanra S, Asokan R, Lenka A. Helfer skin tap technique on pain associated with intramuscular injection among adult patients. Int J Nurs Educ [Internet]. 2018 [cited 2022 Sep 9];10(3):12. Available from: https://scholar.google.com/scholar_lookup? journal=International+journal+of+Nursing+Education & Tiitle=Asokan,+Lenka+A+Helfer+Skin+Tap+Technique+ on+Pain+Associated+with+Intramuscular+Injection+ among+Adult+Patients&aut [Google Scholar]
Shah V, Taddio A, McMurtry CM, Halperin SA, Noel M, Riddell RP, Chambers CT; HELPinKIDS Team. Pharmacological and combined interventions to reduce vaccine injection pain in children and adults: systematic review and meta-analysis. Clin J Pain [Internet]. 2015 Oct [cited 2022 Sep 9];31(Suppl 10):S38. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4900424/ [PubMed] [Google Scholar]