The effect of mandala coloring on pain, stress, and sleep quality in children hospitalized in a burn unit: A randomized controlled trial
Abstract
PURPOSE
This study evaluated the effects of mandala coloring on pain, perceived stress, and sleep quality in children hospitalized in a pediatric burn unit.
DESIGN AND METHODS
A pretest-posttest parallel randomized controlled trial was conducted at the Burn Center of University of Health Sciences Van Training and Research Hospital between July 2025 and February 2026. Forty children aged 7-12 years were randomly assigned to an intervention (n = 20) or control (n = 20) group. The intervention group received 30-min mandala coloring sessions daily for seven days, controls received routine nursing care. Pain, perceived stress, and sleep quality were assessed using the Wong-Baker Faces Pain Rating Scale, Perceived Stress Scale for Children, and Children's Sleep Habits Questionnaire, respectively. Data were analyzed using two-way mixed ANOVA (Group × Time).
RESULTS
Groups were comparable (p > .05). Significant Group × Time interactions were found for pain (F(1,38) = 38.329, p < .001, ηp2 = 0.508), perceived stress (F(1,38) = 65.595, p < .001, ηp2 = 0.639), and sleep quality (F(1,38) = 9.100, p = .005, ηp2 = 0.197). The mandala coloring group showed greater reductions in pain and perceived stress and greater improvement in sleep quality than controls. Effect sizes were large to very large.
CONCLUSIONS
Mandala coloring is an effective, low-cost, non-invasive intervention for reducing pain and perceived stress and improving sleep quality in hospitalized pediatric burn patients.…
How strong is the evidence?
Evidence Hub reads this as a randomized trial, done in people. Its evidence level is 3 of 5 (Moderate · trial / cohort / secondary analysis). Trials without a large randomized design, cohorts and secondary analyses give moderate evidence. Reported size: 20 participants or records.
Read the paper
Related studies
- Tryptophan Metabolism and Gut-Brain Homeostasis
- Rationale for a Multi-Factorial Approach for the Reversal of Cognitive Decline in Alzheimer’s Disease and MCI: A Review
- Prioritized Research for the Prevention, Treatment, and Reversal of Chronic Disease: Recommendations From the Lifestyle Medicine Research Summit
- Relationship between sleep disorders and gut dysbiosis: what affects what?
- The role of CLOCK gene in psychiatric disorders: Evidence from human and animal research
- Genetic, Transcriptome, Proteomic, and Epidemiological Evidence for Blood-Brain Barrier Disruption and Polymicrobial Brain Invasion as Determinant Factors in Alzheimer’s Disease
Go deeper in Evidence Hub
Evidence Hub adds a study data sheet (design, sample size, evidence level, key numbers), an AI summary and a chat grounded in the paper's text.