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Giannelli A, Moscato S, Ostan R, Pannuti R, Chiari L, Biasco G, Varani S. Virtual Reality for advanced cancer patients assisted at home: A randomized controlled interventional study. Psychooncology 2024; 33:e6368. [PMID: 38937094 DOI: 10.1002/pon.6368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Revised: 05/27/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Virtual Reality (VR) has been demonstrated to be an effective option for integrating psychological interventions in different therapeutic settings. This randomized controlled interventional study aims to assess the effects of VR, compared to tablet controlled intervention, on anxiety, depression, pain, and short-term psychophysical symptoms in advanced cancer patients assisted at home. METHODS Participants were provided with a VR headset or a tablet (TAB) for 4 days. On the first and last day, anxiety and depression were measured by Hospital Anxiety and Depression Scale and pain by Brief Pain Inventory. Before and after each VR and tablet session, symptoms were collected by the Edmonton Symptom Assessment Scale (ESAS). RESULTS Fifty-three patients (27 VR vs. 26 TAB) completed the study. Anxiety significantly decreased in the VR group after the 4-day intervention. The analysis of ESAS showed a significant improvement in pain (p = 0.013), tiredness (p < 0.001), and anxiety (p = 0.013) for TAB group, and a significant reduction in tiredness (p < 0.001) in the VR group. CONCLUSIONS Technological and user-friendly tools, such as VR and tablets, might be integrated with traditional psychological interventions to improve anxiety and cancer-related short-term symptoms. Further studies are needed to better consolidate the possible beneficial effects of VR.
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Affiliation(s)
| | - Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Rita Ostan
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Guido Biasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Silvia Varani
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
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Bexson C, Oldham G, Wray J. Safety of virtual reality use in children: a systematic review. Eur J Pediatr 2024; 183:2071-2090. [PMID: 38466416 DOI: 10.1007/s00431-024-05488-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2023] [Revised: 01/25/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
The study aimed to systematically review available literature regarding the safety of virtual reality (VR) use via head-mounted display in children under 14 years of age. The study was a systematic review including all study designs. A search was conducted in January 2023 in PubMed and EMBASE using key terms referring to 'virtual reality', 'paediatrics' and 'safety'. Following title and abstract and full-text screening, data were extracted and a narrative synthesis undertaken. Twenty-six studies met criteria for inclusion in the final review. Limited data suggest that VR may cause mild cybersickness symptoms (not severe enough to cause participants to discontinue use of VR) and that for children with existing amblyopia using VR may result in double vision, which resolves on cessation of VR exposure. Two randomised control trials did not report differences in adverse events between the intervention (VR use) and control groups. Reporting of safety data was poor; only two studies used a validated measure, and in the remaining studies, it was often unclear how adverse events were defined (if at all), how they were categorised in terms of severity and how they were recorded. Conclusion: There is limited evidence regarding any potential harms from short exposure to VR in children under 14 years under supervision. Additional research is required to understand increases in cybersickness during and after VR exposure, and the impact of repeated exposure. Adverse events need to be accurately and routinely recorded to determine any hitherto unknown safety concerns for children < 14 years using VR. What is Known: • Virtual reality (VR) is increasingly being applied in paediatrics, with benefits in terms of anxiety reduction, improved pain management associated with procedures, as an adjunct to physiotherapy and supporting treatments in autistic spectrum disorder.. • Safety guidance in relation to VR use, particularly in younger children, is limited. What is New: • A systematic review of available literature regarding the safety of VR use via head-mounted display in children under 14 years of age demonstrated limited evidence regarding any potential harms from short exposure to VR.. • Studies rarely report safety data and adverse side effects are poorly defined, measured and/or reported. • The lack of a validated measure for evaluating VR-associated symptoms in children compounds the challenging ethical issues of undertaking research into the effects of VR on younger children.
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Affiliation(s)
- Charlotte Bexson
- Data Research, Innovation and Virtual Environments, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Geralyn Oldham
- Data Research, Innovation and Virtual Environments, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
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Wang L, Chen X, Zheng W, Yang Y, Yang B, Chen Q, Li X, Liang T, Li B, Hu Y, Du J, Lu J, Chen N. The possible neural mechanism of neuropathic pain evoked by motor imagery in pediatric patients with complete spinal cord injury: A preliminary brain structure study based on VBM. Heliyon 2024; 10:e24569. [PMID: 38312693 PMCID: PMC10835172 DOI: 10.1016/j.heliyon.2024.e24569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Revised: 11/26/2023] [Accepted: 01/10/2024] [Indexed: 02/06/2024] Open
Abstract
In this study, we observed pediatric complete spinal cord injury (CSCI) patients receiving MI training and divided them into different groups according to the effect of motor imagery (MI) training on neuropathic pain (NP). Then, we retrospectively analysed the differences in brain structure of these groups before the MI training, identifying brain regions that may predict the effect of MI on NP. Thirty pediatric CSCI patients were included, including 12 patients who experienced NP during MI and 18 patients who did not experience NP during MI according to the MI training follow-up. The 3D high-resolution T1-weighted images of all subjects were obtained using a 3.0 T MRI system before MI training. A two-sample t-test was performed to evaluate the differences in gray matter volume (GMV) between patients who experienced NP and those who did not experience NP during MI. Receiver operating characteristic (ROC) analysis was performed to compute the sensitivity and specificity of the imaging biomarkers for the effect of MI on NP in pediatric CSCI patients. MI evoked NP in some of the pediatric CSCI patients. Compared with patients who did not experience NP, patients who experienced NP during MI showed larger GMV in the right primary sensorimotor cortex (PSMC) and insula. When using the GMV of the right PSMC and insula in combination as a predictor, the area under the curve (AUC) reached 0.824. Our study demonstrated that MI could evoke NP in some pediatric CSCI patients, but not in others. The individual differences in brain reorganization of the right PSMC and insula may contribute to the different effects of MI on NP. Moreover, the GMV of the right PSMC and insula in combination may be an effective indicator for screening pediatric CSCI patients before MI training therapy.
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Affiliation(s)
- Ling Wang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
| | - Xin Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
| | - Weimin Zheng
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
| | - Yanhui Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
| | - Beining Yang
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
| | - Qian Chen
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, 100050, China
| | - Xuejing Li
- Department of Radiology, China Rehabilitation Research Center, Beijing, 100068, China
| | - Tengfei Liang
- Department of Medical Imaging, Affiliated Hospital of Hebei Engineering University, Handan, 056008, China
| | - Baowei Li
- Department of Medical Imaging, Affiliated Hospital of Hebei Engineering University, Handan, 056008, China
| | - Yongsheng Hu
- Department of Functional Neurosurgery, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jubao Du
- Department of Rehabilitation Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
| | - Jie Lu
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
| | - Nan Chen
- Department of Radiology and Nuclear Medicine, Xuanwu Hospital, Capital Medical University, Beijing, 100053, China
- Beijing Key Laboratory of Magnetic Resonance Imaging and Brain Informatics, Beijing, 100053, China
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Jeffs DA, Spray BJ, Baxley L, Braden E, Files A, Marrero E, Teague T, Teo E, Yelvington M. Comparing novel virtual reality and nursing standard care on burn wound care pain in adolescents: A randomized controlled trial. J SPEC PEDIATR NURS 2024; 29:e12419. [PMID: 38095116 DOI: 10.1111/jspn.12419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 11/13/2023] [Accepted: 11/20/2023] [Indexed: 01/30/2024]
Abstract
PURPOSE This study compared the effectiveness of age-appropriate, high technology, interactive virtual reality (VR) distraction with standard care (SC) provided by the nurse on adolescents' acute procedural pain intensity perception during burn wound care treatment in the ambulatory clinic setting. DESIGN This randomized controlled trial included 43 adolescents ages 10-21 from the ambulatory burn clinic of a large children's hospital. METHODS Blinded study participants were randomly assigned to either VR or SC (non-significantly different, current mean burn surface area, 1.3 and 1.7, respectively) during the first burn wound care procedure in the burn clinic. Blinded research staff collected pre-procedure data including Spielberger's State-Trait Anxiety Inventory and postprocedure wound care pain intensity using the Adolescent Pediatric Pain Tool. A total of 41 participants completed all study procedures. RESULTS No statistically significant difference in burn wound care procedural pain was noted between the VR and SC groups after adjusting for several factors. Pre-procedure state and trait anxiety correlated with reported pre-procedure pain. Wound care pain was found to be significantly associated with pre-wound care pain score, time from original burn to clinic burn care treatment, and length of wound care treatment. These factors accounted for approximately 45% of the variation in pain scores during wound care treatment. PRACTICE IMPLICATIONS VR distraction can be a useful pain management strategy but may not take the place of the unique nurse-patient relationship that occurs during clinical encounters. Tailoring pain management during burn wound care requires consideration of anxiety, time from the burn injury to the wound care procedure, length of time of the wound care procedure, and pretreatment pain level. Knowing patients' needs, desires, and temperaments along with the specifics about the healthcare procedures are critical to formulating individualized care plans that may or may not include VR. Newer technology, such as easier-to-use, less expensive VR, may assist with translation into practice making its clinical use more routine.
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Affiliation(s)
| | - Beverly J Spray
- Arkansas Children's Research Institute, Little Rock, Arkansas, USA
| | - Lauren Baxley
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Eric Braden
- Arkansas Children's, Little Rock, Arkansas, USA
| | - Amber Files
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | | | - Tiffany Teague
- Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Esther Teo
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
- Burn Surgery, Arkansas Children's Hospital, Little Rock, Arkansas, USA
| | - Miranda Yelvington
- Rehabilitation Services, Arkansas Children's Hospital, Little Rock, Arkansas, USA
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Ozturk CS, Toruner EK. Effectiveness of Virtual Reality in Anxiety and Pain Management in Children and Adolescents Receiving Cancer Treatment: A Systematic Review and Meta-analysis of Randomized Controlled Trials. J Med Syst 2023; 47:103. [PMID: 37815610 DOI: 10.1007/s10916-023-01995-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 09/13/2023] [Indexed: 10/11/2023]
Abstract
TRIALS The study aimed to investigate the effect of virtual reality interventions on relieving pain and anxiety in children and adolescents receiving cancer treatment. A search that involved Cochrane Library (comprising Cochrane Central Register of Controlled Trials (CENTRAL)), PubMed, ProQuest, MEDLINE, Web of Sciences, Science Direct, and Scopus electronic databases covering the records from January 1, 2000 up to May, 2023 was conducted to determine randomized controlled trials that could be included in our study. The results of the search were limited to "anxiety and pain, adolescents, children, virtual reality, cancer." Of the 160 articles that were reached during the search, seven were found eligible based on inclusion criteria. Hedges' g effect size was calculated for each article. Random effects model was used to test effect sizes and moderator variables. The registration number of this meta-analysis on PROSPERO is CRD42022304737. The outcomes were pain and anxiety. Compared with standard care, virtual reality had a medium and significant effect on anxiety (g = 0.60, 95% CI: [- 1.05 - 0.15]) and pain (g = - 0.667, 95% CI: [- 1.08- -0.24]). In addition, age has been identified as an important moderator in the use of virtual reality in pain management. This meta-analysis shows that virtual reality applications are effective interventions for reducing pain and anxiety in the field of pediatric oncology. However, it is necessary to carry out randomized controlled trials that have large samples for evidence-based virtual reality applications in pediatric oncology.
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Affiliation(s)
- Cigdem Sari Ozturk
- Gazi University, Nursing Faculty, Pediatric Nursing Department, Ankara, Turkey.
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van den Berg S, Hoogeveen MO, van Winden TMS, Chegary M, Genco MS, Jonkman NH. Virtual reality hypnosis for needle-related procedural pain and fear management in children: a non-inferiority randomized trial. Eur J Pediatr 2023; 182:4421-4430. [PMID: 37486409 DOI: 10.1007/s00431-023-05116-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 07/11/2023] [Accepted: 07/12/2023] [Indexed: 07/25/2023]
Abstract
Needle-related procedures can cause pain and fear in children and may lead to avoidance of future medical care. The aim of this study is to investigate whether virtual reality hypnosis (VRH) is non-inferior to medical hypnosis (MH) by a trained healthcare provider in reducing pain in children. This non-inferiority randomized trial was conducted at a teaching hospital in the Netherlands. Children aged 6 to 18 years were randomized to treatment with VRH or MH. The primary outcome was self-reported pain, using the Wong-Baker FACES Scale (WBFS) with the non-inferiority margin defined as a difference of 1.5 points. Secondary outcomes included observer-reported pain (Numeric Rating Scale), fear (scored by children and observers with the Children's Fear Scale), blood pressure, heart rate, treatment satisfaction, and adverse effects. We randomized 138 children to VRH or MH treatment and included 114 children in the analyses (VRH n = 60, MH n = 54). We found non-inferiority for VRH compared to MH on patient-reported pain (mean difference = - 0.17, 95%CI - 1.01;0.66). Secondary outcomes were comparable between VRH and MH groups. Both treatments scored high on patient satisfaction (VRH median = 9.0, MH median = 10.0, p = 0.512). CONCLUSION VRH may be an effective and safe treatment option besides MH for reducing patient-reported pain in children during a needle-related procedure. VRH was non-inferior to MH in patient-reported fear and both treatments were comparable in terms of patient-reported fear, observer-reported pain and fear, physical distress, and patient satisfaction. TRIAL REGISTRATION ICTRP https://trialsearch.who.int/ , trial ID NL9385; date registered: 03/04/2021. WHAT IS KNOWN • Medical hypnosis is effective in reducing procedural distress in children during needle-related procedures. • Virtual reality (VR) is an audiovisual electronic device that guides users into an immersive three-dimensional environment. WHAT IS NEW • This study shows that VR hypnosis is non-inferior to medical hypnosis in reducing pain and fear in children undergoing a needle-related procedure. • Both VR hypnosis and medical hypnosis were appreciated highly by children to distract them during needle-related procedures.
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Affiliation(s)
- Sharron van den Berg
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands.
| | - Maurits O Hoogeveen
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Tijn M S van Winden
- Department of General Practice, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, Amsterdam, 1105 AZ, The Netherlands
| | - Malika Chegary
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Mehmet S Genco
- Department of Pediatrics, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
| | - Nini H Jonkman
- Department of Research and Epidemiology, OLVG Hospital, Oosterpark 9, Amsterdam, 1091 AC, The Netherlands
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Li X, Huang Z, Lu T, Liang J, Guo H, Wang L, Chen Z, Zhou X, Du Q. Effect of virtual reality combined with repetitive transcranial magnetic stimulation on musculoskeletal pain and motor development in children with spastic cerebral palsy: a protocol for a randomized controlled clinical trial. BMC Neurol 2023; 23:339. [PMID: 37752420 PMCID: PMC10521467 DOI: 10.1186/s12883-023-03359-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 08/03/2023] [Indexed: 09/28/2023] Open
Abstract
PURPOSE This trial aims to investigate the efficacy and safety of virtual reality (VR) combined with repetitive transcranial magnetic stimulation (rTMS) for improving musculoskeletal pain and motor development in children with unilateral spastic cerebral palsy (CP). METHODS This study protocol is for a randomized controlled trial consisting of 2 treatment sessions (3 days/week for 4 weeks in each session, with a 1-week interval between sessions). We will recruit children aged 3-10 years with unilateral spastic CP (Gross Motor Function Classification System level I or II). Participants will be randomly divided into 3 groups: the VR + rTMS group (immersive VR intervention, rTMS and routine rehabilitation therapy), rTMS group (rTMS and routine rehabilitation therapy), and control group (sham rTMS and routine rehabilitation therapy). VR therapy will involve a daily 40-minute movement training session in a fully immersive environment. rTMS will be applied at 1 Hz over the primary motor cortex for 20 min on the contralateral side. The stimulation intensity will be set at 90% of the resting motor threshold, with 1200 pulses applied. A daily 60-minute routine rehabilitation therapy session including motor training and training in activities of daily living will be administered to all participants. The primary outcome will be pain intensity, assessed by the Revised Face, Legs, Activity, Cry, and Consolability Scale (R-FLACC). The secondary outcomes will include motor development, evaluated by the 66-item version of the Gross Motor Function Measure (GMFM-66) and Fine Motor Function Measure (FMFM); balance capacity, measured by the interactive balance system; activities of daily living; and quality of life, measured by the Barthel index and the Chinese version of the Cerebral Palsy Quality of Life scale for Children (C-CP QOL-Child). Safety will be monitored, and adverse events will be recorded during and after treatment. DISCUSSION Combined application of VR therapy and rTMS may reveal additive effects on pain management and motor development in children with spastic CP, but further high-quality research is needed. The results of this trial may indicate whether VR therapy combined with rTMS achieves a better analgesic effect and improves the motor development of children with spastic CP. TRIAL REGISTRATION Registration number: ChiCTR230069853. Trial registration date: 28 March 2023. Prospectively registered.
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Affiliation(s)
- Xin Li
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
- School of Exercise and Health, Shanghai University of Sport, Shanghai, China
| | - Zefan Huang
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
- Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Tijiang Lu
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Juping Liang
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Haibin Guo
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Lixia Wang
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China
| | - Zhengquan Chen
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Xuan Zhou
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China.
| | - Qing Du
- Department of Rehabilitation Medicine, Xinhua Hospital, School of Medicine, Shanghai Jiao Tong University, 1665 Kongjiang Road, Shanghai, 200092, China.
- Chongming Hospital, Shanghai University of Medicine & Health Sciences, Shanghai, China.
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Fougère M, Greco-Vuilloud J, Arnous C, Abel F, Lowe C, Elie V, Marchand S. Sensory stimulations potentializing digital therapeutics pain control. FRONTIERS IN PAIN RESEARCH 2023; 4:1168377. [PMID: 37745799 PMCID: PMC10511651 DOI: 10.3389/fpain.2023.1168377] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
For the past two decades, using Digital Therapeutics (DTx) to counter painful symptoms has emerged as a novel pain relief strategy. Several studies report that DTx significantly diminish pain while compensating for the limitations of pharmacological analgesics (e.g., addiction, side effects). Virtual reality (VR) is a major component of the most effective DTx for pain reduction. Notably, various stimuli (e.g., auditory, visual) appear to be frequently associated with VR in DTx. This review aims to compare the hypoalgesic power of specific stimuli with or without a VR environment. First, this review will briefly describe VR technology and known elements related to its hypoalgesic effect. Second, it will non-exhaustively list various stimuli known to have a hypoalgesic effect on pain independent of the immersive environment. Finally, this review will focus on studies that investigate a possible potentialized effect on pain reduction of these stimuli in a VR environment.
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Affiliation(s)
| | | | | | | | | | | | - Serge Marchand
- Lucine, Bordeaux, France
- Faculté de Médecine et des Sciences de la Santé, Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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Bolgeo T, Gardalini M, Libener R, Bonvicini P, Crivellari S, Simonelli N, Vettore L, Lika O, Casaccia G, Gatti D, Maconi A, Timmins F. Nursing and distraction techniques during needle-related interventions on children: Identification of strategies for optimal care. J Clin Nurs 2023; 32:6755-6756. [PMID: 37179528 DOI: 10.1111/jocn.16744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 04/21/2023] [Indexed: 05/15/2023]
Affiliation(s)
- Tatiana Bolgeo
- Health Professions Research Unit - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Menada Gardalini
- Health Professions Research Unit - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Roberta Libener
- Biobank - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS Antonio e Biagio e Cesare Arrigo, Public Hospital Alessandria, Alessandria, Italy
| | - Paolo Bonvicini
- Biobank - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS Antonio e Biagio e Cesare Arrigo, Public Hospital Alessandria, Alessandria, Italy
| | - Stefania Crivellari
- Environmental Diseases - Research Training Innovation Infrastructure - Department of Research and Innovation (DAIRI) - SS Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Niccolò Simonelli
- SC Cardiology - SS Antonio e Biagio e Cesare Arrigo Public Hospital, Alessandria, Italy
| | - Luca Vettore
- SC Neurorehabilitation - Borsalino - SS Antonio e Biagio e Cesare Arrigo Public Hospital, Alessandria, Italy
| | - Orjada Lika
- SC Pediatric Accident & Emergency - SS Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Germana Casaccia
- SC Pediatric Surgery - SS Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Denise Gatti
- Health Professions Research Unit - Research Training Innovation Infrastructure, Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Antonio Maconi
- Director - Research and Innovation Department (DAIRI) - SS. Antonio e Biagio e Cesare Arrigo, Public Hospital, Alessandria, Italy
| | - Fiona Timmins
- Full Professor of Nursing, Dean, Head of School - School of Nursing and Midwifery, UCD School of Nursing, Midwifery & Health Systems, Trinity College Dublin, Dublin, Ireland
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10
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Shen T, Wang X, Xue Q, Chen D. Active versus passive distraction for reducing procedural pain and anxiety in children: a meta-analysis and systematic review. Ital J Pediatr 2023; 49:109. [PMID: 37653423 PMCID: PMC10472688 DOI: 10.1186/s13052-023-01518-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Accepted: 08/24/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Procedural pain is very important in clinical children care. We aimed to evaluate the effects of active versus passive distraction for reducing procedural pain and anxiety in children. METHODS Two researchers searched the Web of Science, PubMed, EMBASE, Cochrane, SinoMed, Wanfang, China National Knowledge Infrastructure, Weipu databases for the randomized controlled trials(RCTs) on the active versus passive distraction affecting procedural pain and anxiety in children until May 18, 2023. The literature screening and data extraction were carried out by two researchers independently. Review Manager 5.3 software was used for data analysis. RESULTS 13 RCTs were finally included. 553 children received active distraction intervention and 551 children received passive distraction intervention. There were no significant differences in the children self-reported procedural pain betweent active and passive distraction. The parent-reported procedural pain, medical staff-reported procedural pain, children-reported procedural anxiety, parent-reported procedural anxiety, medical staff-reported procedural anxiety in the active distraction were significant less than that of active distraction. Egger regression analysis showed that there was no publication bias in the results. CONCLUSIONS Existing evidence suggests that active distraction may be more effective in reducing operational pain and anxiety in children than passive distraction. More studies on the effects of active distraction versus passive distraction in children with larger sample size are needed in the future.
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Affiliation(s)
- Ting Shen
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Xixi Wang
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Qiaoyun Xue
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China
| | - Dan Chen
- Department of Emergency, Children's Hospital of Nanjing Medical University, No. 72, Guangzhou Road, Gulou District, Nanjing, Jiangsu Province, China.
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Oh N, Parrish N, Lee IW, Temple S, Perkins O, Kokkinakis M. Using Virtual Reality to Reduce Anxiety and Improve Hospital Experience in Paediatric Orthopaedic Patients and Their Parents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1409. [PMID: 37628408 PMCID: PMC10453231 DOI: 10.3390/children10081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
The hospital environment can be a stressful environment for paediatric patients and their parents, which is often characterised by heightened levels of pain and anxiety. To address these challenges, many innovative intervention methods has been explored. For example, immersive virtual reality (VR) headsets as a distraction method has become an increasingly popular intervention in recent years. This study aimed to evaluate the effectiveness of VR using 'Rescape DR.VR Junior' in reducing pain, anxiety, and enhancing the overall hospital experience for paediatric orthopaedic patients and their parents. A total of 64 patients aged 4-18 years were included in this study, which utilised a control group (interacting with a play specialist) and a VR intervention group (including pre-operative patients and fracture clinic patients). Anxiety and pain levels were measured using a 10-point Likert scale before and after the intervention, and validated questionnaires were used to assess parental anxiety and overall hospital experience. The results indicated that VR intervention significantly reduced patient and parental anxiety both before surgery and in the fracture clinic setting (p < 0.5). However, no significant reduction in pain scores was observed in either environments. Comparatively, VR intervention was found to be comparable to traditional play methods in terms of reducing anxiety in the pre-operative environment. All patients and parents agreed that the use of VR distraction methods significantly improved their hospital experience. In conclusion, VR is an effective method for reducing child and parental anxiety and enhancing the hospital experience and can be used alone or in conjunction with a play specialist.
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Affiliation(s)
- Natasha Oh
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - Nina Parrish
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - In Woo Lee
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - Sasha Temple
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
| | - Oliver Perkins
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
| | - Michail Kokkinakis
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
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Aulenkamp JL, Mosch L, Meyer-Frießem CH, Malewicz-Oeck NM. [Application possibilities of digital tools in postoperative pain therapy]. Schmerz 2023:10.1007/s00482-023-00732-7. [PMID: 37430071 PMCID: PMC10368541 DOI: 10.1007/s00482-023-00732-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2022] [Revised: 04/15/2023] [Accepted: 05/11/2023] [Indexed: 07/12/2023]
Abstract
BACKGROUND Recently, digital tools, such as smartphone-based applications and the use of artificial intelligence have increasingly found their way into pain medicine. This could enable new treatment approaches in postoperative pain management. Therefore, this article provides an overview of various digital tools and their potential application options in postoperative pain management. MATERIAL AND METHODS An orienting literature search was carried out in the MEDLINE and Web of Science databases, and a targeted selection of essential key publications was made in order to provide a structured presentation of different current possible applications and a discussion based on the most recent knowledge. RESULTS Today, possible applications of digital tools, even if they mostly have only a model character, include pain documentation and assessment, patient self-management and education, pain prediction, decision support for medical staff, and supportive pain therapy, for example in the form of virtual reality and videos. These tools offer advantages such as individualized treatment concepts, addressing specific patient groups, reduction of pain and analgesics, and the potential for early warning or detection of postoperative pain. Furthermore, the challenges of the technical implementation and appropriate user training are highlighted. CONCLUSION The use of digital tools, although so far integrated in clinical routine in a relatively selective and exemplary manner, promises to be an innovative approach for personalized postoperative pain therapy in the future. Future studies and projects should help to integrate the promising research approaches into everyday clinical practice.
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Affiliation(s)
- Jana L Aulenkamp
- Klinik für Anästhesiologie und Intensivmedizin, Universitätsklinikum Essen, Universität Duisburg-Essen, Hufelandstr. 55, 45122, Essen, Deutschland.
| | - Lina Mosch
- Klinik für Anästhesiologie mit Schwerpunkt operative Intensivmedizin, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
- Institut für Medizinische Informatik, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Deutschland
| | - Christine H Meyer-Frießem
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Universitätsklinikum Bergmannsheil Bochum gGmbH, Bochum, Deutschland
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, St. Marien Hospital, Lünen, Deutschland
| | - Nathalie M Malewicz-Oeck
- Klinik für Anästhesiologie, Intensiv- und Schmerzmedizin, Universitätsklinikum Bergmannsheil Bochum gGmbH, Bochum, Deutschland
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Xu N, Chen S, Liu Y, Jing Y, Gu P. The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e36695. [DOI: 10.2196/36695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/04/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background
Extreme labor pain has negative effects; pharmacologic analgesic modalities are effective but are accompanied by adverse effects. Virtual reality (VR) works as a distracting nonpharmacologic intervention for pain and anxiety relief; however, the effects of VR use in laboring women is unknown.
Objective
Our study aimed to determine the safety and effectiveness of VR technology during labor and delivery and investigate whether it impacts labor and patient satisfaction.
Methods
In all, 7 databases (PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, and Wan-Fang Database) were systematically searched for randomized controlled trials of VR use in pregnancy and childbirth from the time of database construction until November 24, 2021. Two researchers extracted data and evaluated study quality using the Cochrane Risk of Bias tool 2.0. Outcome measures were labor pain, anxiety, duration, satisfaction, and adverse events. Meta-analyses were performed where possible.
Results
A total of 12 studies with 1095 participants were included, of which 1 and 11 studies were rated as “Low risk” and “Some concerns” for risk of bias, respectively. Of the 12 studies, 11 reported labor pain, 7 reported labor anxiety, and 4 reported labor duration. Meta-analysis revealed that VR use could relieve pain during labor (mean difference –1.81, 95% CI –2.04 to –1.57; P<.001) and the active period (standardized mean difference [SMD] –0.41, 95% CI –0.68 to –0.14; P=.003); reduce anxiety (SMD –1.39, 95% CI –1.99 to –0.78; P<.001); and improve satisfaction with delivery (relative risk 1.32, 95% CI 1.10-1.59; P=.003). The effects of VR on the duration of the first (SMD –1.12, 95% CI –2.38 to 0.13; P=.08) and second (SMD –0.22, 95% CI –0.67 to 0.24; P=.35) stages of labor were not statistically significant.
Conclusions
VR is safe and effective in relieving maternal labor pain and anxiety; however, due to the heterogeneity among studies conducted to date, more rigorous, large-scale, and standardized randomized controlled trials are required to provide a higher-quality evidence base for the use of VR technology in maternal labor, with the aim of improving experience and outcomes.
Trial Registration
PROSPERO CRD42021295410; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295410
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He ZH, Yang HM, Dela Rosa RD, De Ala MB. The effects of virtual reality technology on reducing pain in wound care: A meta-analysis and systematic review. Int Wound J 2022; 19:1810-1820. [PMID: 35318806 PMCID: PMC9615291 DOI: 10.1111/iwj.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 12/11/2022] Open
Abstract
Virtual reality (VR) technology has been widely used in clinical nursing care in recent years. We aimed to systematically evaluate the effect and safety of VR technology on pain control in wound care, to provide evidence and support for clinical wound care. We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal databases for randomised controlled trials (RCTs) on the application of VR technology in wound care up to December 20, 2021. Two researchers independently assessed the quality of the included RCTs and extracted associated data. RevMan5.3 statistical software was used for data analysis. 13 RCTs involving 1258 adult patients were included, of whom 588 patients underwent VR intervention. VR technology intervention could reduce the VAS score(MD = -1.13, 95%CI:-2.01~-0.26, P < .001), pain cognition score(MD = -3.94, 95%CI:-4.59 ~ -3.30, P < .001), pain emotion score(MD = -5.21, 95%CI: -10.46 ~ -0.04, P < .001), pain sensation score (MD = -4.94, 95%CI: -9.46 ~ -0.42, P = .03) and blood pressure(MD = -4.66, 95%CI: -8.63 ~ -0.69, P = .02) during would care. There were no significant differences on the heart rate (MD = -1.85, 95%CI: -5.71 ~ -2.01, P = .45) and VR interestingness (MD = 28.96, 95%CI: -22.10 ~ 80.02, P = .27) of the VR group and control group. No publication biases among the synthesised outcomes were found (all P > .001). VR technology can effectively reduce the pain degree and sensation of patients during wound care, which may be an effective auxiliary non-drug method used for pain relief during wound care.
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Affiliation(s)
- Zhen-Hua He
- Faculty of Medicine and Health, Shaoxing University Yuanpei College, Shaoxing, China.,School of Nursing, Philippine Women's University, Manila, Philippines
| | - Hong-Mei Yang
- Department of One Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Ronnell D Dela Rosa
- School of Nursing, Philippine Women's University, Manila, Philippines.,College of Nursing and Midwifery, Bataan Peninsula State University, Bataan, Philippines
| | - Minerva B De Ala
- School of Nursing, Philippine Women's University, Manila, Philippines
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15
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Lluesma-Vidal M, Carcelén González R, García-Garcés L, Sánchez-López MI, Peyro L, Ruiz-Zaldibar C. Effect of Virtual Reality on Pediatric Pain and Fear During Procedures Involving Needles: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e35008. [PMID: 35943776 PMCID: PMC9399850 DOI: 10.2196/35008] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2021] [Revised: 03/19/2022] [Accepted: 05/13/2022] [Indexed: 11/13/2022] Open
Abstract
Background Virtual reality (VR) is used as a distraction measure during painful clinical procedures associated with the use of needles. These procedures include vaccinations, blood draws, or the administration of medications, which can cause children to feel increased levels of pain and fear. Objective The objective of this study was to collect and analyze the current evidence regarding the effectiveness of VR as a tool to distract children from pain and fear during needle procedures as compared to that of standard techniques. Methods A systematic review and meta-analysis was performed. We included randomized clinical trials (RCTs) or quasi-RCTs with participants younger than 21 years who underwent needle procedures in which the main distraction measure used was VR and where the main outcome measure was pain. The databases searched included the PubMed, Web of Science, Scopus, PsycINFO, CINAHL, and Cochrane libraries. In this systematic review, the studies were analyzed by applying the Critical Appraisal Skills Program guide in Spanish and the Jadad scale. In the meta-analysis, the effect size of the studies was analyzed based on the results for pain and fear in children. Results From 665 unique search results, 21 studies were included in this systematic review, most of which reported low methodological quality. The study sample cohorts ranged from a minimum of 15 participants to a maximum of 220 participants. Ten studies were included in the meta-analysis. The global effect of using VR as a distraction measure was a significant reduction in pain (inverse variance [IV] –2.37, 95% CI –3.20 to –1.54; Z=5.58; P<.001) and fear (IV –1.26, 95% CI –1.89 to –0.63; Z=3.92; P<.001) in children in the experimental groups. Conclusions The quality of the studies was mostly low. The main limitations were the impossibility of blinding the participants and health care personnel to the VR intervention. Nonetheless, the use of VR as a distraction measure was effective in reducing pain and fear in children during procedures involving needles.
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Affiliation(s)
- Marta Lluesma-Vidal
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Raquel Carcelén González
- Department of Medicine and Surgery, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Laura García-Garcés
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - María I Sánchez-López
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Loreto Peyro
- Department of Nursing, Faculty of Health of Science, Universidad Cardenal Herrera-CEU, CEU Universities, Alfara del Patriarca, Valencia, Spain
| | - Cayetana Ruiz-Zaldibar
- Department of Nursing, Faculty of Health, University of Camilo José Cela, Villanueva de la Cañada, Madrid, Spain
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Goyal C, Vardhan V, Naqvi W. Non-Immersive Virtual Reality as an Intervention for Improving Hand Function and Functional Independence in Children With Unilateral Cerebral Palsy: A Feasibility Study. Cureus 2022; 14:e26085. [PMID: 35875273 PMCID: PMC9295637 DOI: 10.7759/cureus.26085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Non-immersive virtual reality (NIVR) is emerging as an advantageous intervention in the arena of neurorehabilitation. Promising results have been obtained by the application of NIVR in adults with various chronic neurological conditions such as stroke and Parkinson’s disease, but studies on the use of NIVR in children with unilateral cerebral palsy (CP) are limited. Materials and methods This preliminary study included 10 school-aged participants with unilateral CP who were allocated into experimental and control groups. In accordance with the allocation ratio of 1:1, there were five participants in each group. During six weeks of intervention, children in the experimental group received NIVR intervention in addition to conventional physiotherapy, while those in the control group received only conventional physiotherapy, with a goal to improve hand function and functional independence. Nine-hole peg test (9HPT), box and block test (BBT), ABILHAND kids, and self-care section of functional independence measure for children (WeeFIM) were used as outcome measures. Results There was significant improvement in all outcome measures in both groups. However, the improvement in the hand function and functional independence was significantly more in the experimental group than in the control group. Conclusion It can be concluded that NIVR intervention in the management of children with unilateral CP seems to be feasible and useful. Further research with a larger sample size must be undertaken to reinforce these preliminary findings.
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17
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Hadjiat Y, Marchand S. Virtual Reality and the Mediation of Acute and Chronic Pain in Adult and Pediatric Populations: Research Developments. FRONTIERS IN PAIN RESEARCH 2022; 3:840921. [PMID: 35599969 PMCID: PMC9120608 DOI: 10.3389/fpain.2022.840921] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/13/2022] [Indexed: 11/28/2022] Open
Abstract
The use of virtual reality (VR) in the mediation of acute pain in adults has shown real benefit to patients for the past 20 years. This review of the literature provides a descriptive synthesis of the types of VR technology, the mechanisms by which VR mediates pain, and a history of early research in the area. A review of the use of VR to mediate chronic pain in adults, and both acute and chronic pain in pediatric populations follows. The studies reviewed provide mixed results and it is noted that many studies have small sample sizes, are case studies, and do not control for extraneous variables such as the dosage and type of VR technology used. Although VR is an exciting area of inquiry that promises to yield multiple applications, there is a necessity to conduct larger random controlled trials to better understand the use cases for which VR is most effective.
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Affiliation(s)
- Yacine Hadjiat
- Department of Surgery, Service of Neurosurgery, French National Institute of Health and Medical Research (Inserm) U987, Paris-Saclay University (EDSP), Paris, France
- *Correspondence: Yacine Hadjiat
| | - Serge Marchand
- Inserm U987, Pharmacology & Physiopathology, University de Sherbrooke University Hospital, Quebec, QC, Canada
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Ross AM, Jones RJF. Simulated Forest Immersion Therapy: Methods Development. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19095373. [PMID: 35564767 PMCID: PMC9105281 DOI: 10.3390/ijerph19095373] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 04/25/2022] [Accepted: 04/27/2022] [Indexed: 02/01/2023]
Abstract
Shinrin-yoku, forest bathing, may provide relief from chronic and breakthrough pain in patients with axial spondyloarthritis and improve immune function through increasing NK cell numbers and activity and their downstream effectors, perforin and granulysin, after chemo- or radiation therapy in breast and prostate cancer patients. The aim of this paper is to describe the study protocol for a simulated forest immersion therapy using virtual reality and atomized phytoncides, volatile organic compounds found in forested areas designed to effect positive change for these two patient populations. The setting, including the room set up and samples with inclusion/exclusion specific to this type of intervention, is outlined. Measures and calibration procedures pertinent to determining the feasibility of simulated forest immersion therapy are presented and include: ambient and surface room temperatures and relative humidity in real time, ambient ultrafine particulate matter, ambient droplet measurement that coincides with volatile organic compounds, specific phytoncides, and virtual reality and atomization of phytoncide set up. Particular lessons learned while training and setting up the equipment are presented. Simulated forest immersion therapy is possible with attention to detail during this early phase when development of methods, equipment testing, and feasibility in deploying the intervention become operational. The expected outcome of the development of the methods for this study is the creation of a standardized approach to simulating forest therapy in a controlled laboratory space.
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Ali S, Rajagopal M, Stinson J, Ma K, Vandermeer B, Felkar B, Schreiner K, Proctor A, Plume J, Hartling L. Virtual reality-based distraction for intravenous insertion-related distress in children: a study protocol for a randomised controlled trial. BMJ Open 2022; 12:e057892. [PMID: 35354617 PMCID: PMC8968513 DOI: 10.1136/bmjopen-2021-057892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Intravenous (IV) insertions are among the most performed procedures for children seeking medical care; they are often a painful and stressful experience for both children and their caregivers. Paediatric distress and pain that is inadequately treated may lead to a frightened and uncooperative child, repeated IV attempts and overall frustration with care for both the family and clinical team. We hypothesise that distraction via an immersive virtual reality (VR) experience may reduce the associated distress for children undergoing IV insertions. METHODS AND ANALYSIS This two-armed randomised controlled superiority trial will be conducted in a Canadian paediatric emergency department and will aim to enrol 80 children overall. Children will be randomised to receive either departmental standard of care alone or standard of care plus an immersive VR experience. Children 6-17 years of age who are undergoing IV insertion and have topical anaesthetic application will be considered for inclusion. Our primary objective is to compare the reduction of distress between the two study arms. The primary outcome will be the child's observed distress score as measured by the Observational Signs of Behavioral Distress-Revised tool. Secondary outcomes include the child's pain intensity and fear, parental anxiety, satisfaction with the IV procedure, as well as adverse events. Recruitment launched in September 2020 and is expected to end in March 2022. ETHICS AND DISSEMINATION This study has been approved by the Health Research Ethics Board (University of Alberta). Informed consent will be obtained from parents or guardians, and assent from children. Study data will be submitted for publication irrespective of results. This study is funded through a Women and Children's Health Research Institute Innovation grant. Purchase of the VR equipment was facilitated through a Stollery Children's Hospital Foundation small equipment grant. TRIAL REGISTRATION NUMBER NCT04291404Cite Now.
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Affiliation(s)
- Samina Ali
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Manasi Rajagopal
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Jennifer Stinson
- Child Health Evaluative Sciences, Research Institute, The Hospital for Sick Children and the Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Keon Ma
- Pediatrics, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
| | - Ben Vandermeer
- Alberta Research Centre for Health Evidence, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Bailey Felkar
- London Health Sciences Centre Children's Hospital, London, Ontario, Canada
| | - Kurt Schreiner
- Pediatric Parents' Advisory Group, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Amanda Proctor
- Stollery Youth Advisory Council and Patient and Family Centred Care, Alberta Health Services, Edmonton, Alberta, Canada
| | - Jennifer Plume
- Stollery Children's Hospital, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lisa Hartling
- Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Alberta Research Centre for Health Evidence, Pediatrics, University of Alberta, Edmonton, Alberta, Canada
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Bu X, Ng PH, Xu W, Cheng Q, Chen PQ, Cheng AS, Liu X. The Effectiveness of Virtual Reality-Based Interventions in Rehabilitation Management of Breast Cancer Survivors: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e31395. [PMID: 35225817 PMCID: PMC8922144 DOI: 10.2196/31395] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2021] [Revised: 10/14/2021] [Accepted: 10/23/2021] [Indexed: 12/25/2022] Open
Abstract
Background Breast cancer survivors (BCSs) can present with various physical and psychological symptoms and functional deficits that impact their quality of life. Virtual reality (VR) technology is being used in breast cancer rehabilitation management to improve the emotional, cognitive, and physical well-being of BCSs. Objective This systematic review aimed to examine the effectiveness of VR-based interventions on health-related outcomes in BCSs. A meta-analysis was conducted to evaluate the effectiveness of VR-based interventions in the rehabilitation management of BCSs. Methods A systematic search was conducted on PubMed, Web of Science, EMBASE, CINAHL with Full Text, the Cochrane Central Register of Controlled Trials, CNKI, WanFang, VIP, and CBM, from inception to May 25, 2021. The inclusion criteria of the selected studies were as follows: (1) adults diagnosed with breast cancer; (2) any type of VR-based interventions (immersive and nonimmersive virtual environment); (3) comparison of traditional rehabilitation methods; (4) outcomes including pain, depression, anxiety, fatigue, cognitive function, shoulder range of motion (ROM), hand grip strength, lymphedema, cybersickness symptoms, fear of movement, bleeding, effusion, and flap necrosis, both during and after treatment; and (5) randomized controlled trials (RCTs), case-controlled trials, and quasi-experimental studies. The Cochrane Collaboration Tool was used to evaluate the risk of bias. Review Manager version 5.3 (Cochrane Collaboration) was used to conduct the meta-analysis. The mean difference (MD) and SDs with 95% CIs were used to calculate continuous variables. Results Twelve articles were included in this systematic review, of which 10 contributed information to the meta-analysis. A total of 604 participants were analyzed. The statistical analysis showed significant results for flexion (standard mean difference [SMD] 1.79; 95% CI 0.55 to 3.03; P=.005), extension (SMD 1.54; 95% CI 0.83 to 2.25; P<.001), abduction (MD 17.53; 95% CI 14.33 to 20.72; P<.001), adduction (MD 15.98; 95% CI 14.02 to 17.94; P<.001), internal rotation (MD 7.12; 95% CI 5.54 to 8.70; P<.001), external rotation (SMD 0.96; 95% CI 0.62 to 1.29; P<.001), anxiety (MD −6.47; 95% CI −7.21 to −5.73; P<.001), depression (MD −4.27; 95% CI −4.64 to −3.91; P<.001), pain (MD −1.32; 95% CI −2.56 to −0.09; P=.04), and cognitive function (MD 8.80; 95% CI 8.24 to 9.36; P<.001). The meta-analysis indicated little to no difference in hand grip strength (MD 1.96; 95% CI –0.93 to 4.85; P=.18). Conclusions Findings of this review noted a weak but consistent positive association between VR-based interventions and outcomes. However, these results must be interpreted with caution due to the limited number of controlled trials analyzed, small sample sizes, and poor methodological quality. Well‐designed, large, high‐quality trials may have a significant impact on our confidence in the results. Future studies should identify specific aspects that improve the clinical impact of VR-based interventions on major outcomes in BCSs in the clinical setting. Trial Registration PROSPERO International Prospective Register of Systematic Reviews CRD42021250727; https://tinyurl.com/2p89rmnk
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Affiliation(s)
- Xiaofan Bu
- Nursing Teaching and Research Section, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
| | - Peter Hf Ng
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Wenjing Xu
- Xiangya School of Nursing, Central South University, Changsha, China
| | - Qinqin Cheng
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Peter Q Chen
- Department of Computing, The Hong Kong Polytechnic University, Hong Kong, China
| | - Andy Sk Cheng
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong, China
| | - Xiangyu Liu
- Department of Health Service Center, Hunan Cancer Hospital/The Affiliated Cancer Hospital of Xiangya School of Medicine, Central South University, Changsha, China
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de la Cruz Herrera M, Fuster-Casanovas A, Miró Catalina Q, Cigarrán Mensa M, Alcántara Pinillos P, Vilanova Guitart I, Grau Carrión S, Vidal-Alaball J. Use of virtual reality in the reduction of pain after the administration of vaccines in children in primary care centers: a randomized clinical trial (Preprint). JMIR Res Protoc 2021; 11:e35910. [PMID: 35388793 PMCID: PMC9030982 DOI: 10.2196/35910] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 11/29/2022] Open
Abstract
Background Pain and anxiety caused by vaccination and other medical procedures in childhood can result in discomfort for both patients and their parents. Virtual reality (VR) is a technology that is capable of entertaining and distracting the user. Among its many applications, we find the improvement of pain management and the reduction of anxiety in patients undergoing medical interventions. Objective We aim to publish the protocol of a clinical trial for the reduction of pain and anxiety after the administration of 2 vaccines in children aged 3 to 6 years. Methods We will conduct a randomized, parallel, controlled clinical trial with 2 assigned groups. The intervention group will wear VR goggles during the administration of 2 vaccines, while the control group will receive standard care from a primary care center for the procedure. Randomization will be carried out by using the RandomizedR computer system—a randomization tool of the R Studio program. This trial will be an open or unblinded trial; both the subjects and the investigators will know the assigned treatment groups. Due to the nature of the VR intervention, it will be impossible to blind the patients, caregivers, or observers. However, a blind third-party assessment will be carried out. The study population will include children aged 3 to 6 years who are included in the patient registry and cared for in a primary care center of the region of Central Catalonia. They will receive the following vaccines during the Well-Child checkup: the triple viral+varicella vaccine at 3 years of age and the hepatitis A+diphtheria-tetanus-pertussis vaccine at 6 years of age. Results The study is scheduled to begin in January 2022 and is scheduled to end in January 2023, which is when the statistical analysis will begin. As of March 2022, a total of 23 children have been recruited, of which 13 have used VR during the vaccination process. In addition, all of the guardians have found that VR helps to reduce pain during vaccination. Conclusions VR can be a useful tool in pediatric procedures that generate pain and anxiety. International Registered Report Identifier (IRRID) PRR1-10.2196/35910
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Affiliation(s)
- Mercedes de la Cruz Herrera
- Centre d'Atenció Primària Súria, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Aïna Fuster-Casanovas
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Queralt Miró Catalina
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | | | - Pablo Alcántara Pinillos
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Isabel Vilanova Guitart
- Centre d'Atenció Primària Súria, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
| | - Sergi Grau Carrión
- Digital Care Research Group, Centre for Health and Social Care Research, University of Vic-Central University of Catalonia, Vic, Spain
| | - Josep Vidal-Alaball
- Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Health Promotion in Rural Areas Research Group, Gerència Territorial de la Catalunya Central, Institut Català de la Salut, Sant Fruitós de Bages, Spain
- Unitat de Suport a la Recerca de la Catalunya Central, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina, Sant Fruitós de Bages, Spain
- Faculty of Medicine, University of Vic-Central University of Catalonia, Vic, Spain
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22
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Ran L, Zhao N, Fan L, Zhou P, Zhang C, Yu C. Application of virtual reality on non-drug behavioral management of short-term dental procedure in children. Trials 2021; 22:562. [PMID: 34425901 PMCID: PMC8381489 DOI: 10.1186/s13063-021-05540-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 08/13/2021] [Indexed: 12/11/2022] Open
Abstract
Background Due to the inherent characteristics of immersion, imagination, and interactivity in virtual reality (VR), it might be suitable for non-drug behavior management of children in dental clinics. The purpose of this trial was to measure the role of VR distraction on behavior management in short-term dental procedures in children. Methods A randomized clinical trial design was carried out on 120 children aged between 4 and 8 years to identify the comparative efficacy of VR and tell-show-do (TSD) to improve behavioral management during dental procedures. The primary outcomes were evaluated anxiety, pain, and compliance scores in perioperative children. The levels of operative anxiety and pain were assessed using the Children’s Fear Survey Schedule-Dental Subscale (CFSS-DS) and Wong Baker FACES Pain Rating Scale (WBFS), respectively. The Frankl Behavior Rating Scale (FBRS) was tested before and during dental procedures. The length of the dental procedure was compared between both groups after treatment. Results The average anxiety and behavioral scores of the VR group significantly reduced compared with the control. The decreased anxiety score for the VR group and control group were 8 (7, 11) and 5 (5, 7), p < 0.05. The compliance scores of the control group during treatment were 3 (2, 3), and the same in the VR intervention were 3 (3, 4), p = 0.02. A significant reduction in pain was observed when using VR distraction (p < 0.05). Comparing the length of the dental procedure, the VR group (19.0 2 ± 5.32 min) had a shorter treatment time than the control group (27.80 ± 10.40 min). Conclusion The use of VR significantly reduced the anxiety and pain of children and the length of the dental procedure and improved the compliance of children that underwent short-term dental procedures without an adverse reaction. Trial registration Chinese Clinical Trial Registry, ChiCTR2000029802. Registered on February 14, 2020
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Affiliation(s)
- Longkuan Ran
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Nan Zhao
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Lin Fan
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Pinping Zhou
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Chao Zhang
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China.,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China.,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China
| | - Cong Yu
- Department of Anesthesiology, Stomatological Hospital of Chongqing Medical University, Chongqing, China. .,Chongqing Key Laboratory of Oral Diseases and Biomedical Sciences, Chongqing, China. .,Chongqing Municipal Key Laboratory of Oral Biomedical Engineering of Higher Education, Chongqing, China.
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23
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Joukhadar N, Lalonde D. How to Minimize the Pain of Local Anesthetic Injection for Wide Awake Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3730. [PMID: 34367856 PMCID: PMC8337068 DOI: 10.1097/gox.0000000000003730] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/08/2021] [Indexed: 01/03/2023]
Abstract
After reading this article, the participant should be able to (1) almost painlessly inject tumescent local anesthesia to anesthetize small or large parts of the body, (2) improve surgical safety by eliminating the need for unnecessary sedation in patients with multiple medical comorbidities, and (3) convert many limb and face operations to wide awake surgery. We recommend the following 13 tips to minimize the pain of local anesthesia injection: (1) buffer local anesthetic with sodium bicarbonate; (2) use smaller 27- or 30-gauge needles; (3) immobilize the syringe with two hands and have your thumb ready on the plunger before inserting the needle; (4) use more than one type of sensory noise when inserting needles into the skin; (5) try to insert the needle at 90 degrees; (6) do not inject in the dermis, but in the fat just below it; (7) inject at least 2 ml slowly just under the dermis before moving the needle at all and inject all local anesthetic slowly when you start to advance the needle; (8) never advance sharp needle tips anywhere that is not yet numb; (9) always inject from proximal to distal relative to nerves; (10) use blunt-tipped cannulas when tumescing large areas; (11) only reinsert needles into skin that is already numb when injecting large areas; (12) always ask patients to tell you every time they feel pain during the whole injection process so that you can score yourself and improve with each injection; (13) always inject too much volume instead of not enough volume to eliminate surgery pain and the need for "top ups."
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Affiliation(s)
- Nadim Joukhadar
- From theDivision of Plastic and Reconstructive Surgery, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Donald Lalonde
- Division of Plastic and Reconstructive Surgery, Dalhousie University, Saint John, New Brunswick, Canada
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24
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Alqudimat M, Mesaroli G, Lalloo C, Stinson J, Matava C. State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients. CURRENT ANESTHESIOLOGY REPORTS 2021; 11:265-274. [PMID: 34276254 PMCID: PMC8277426 DOI: 10.1007/s40140-021-00472-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/02/2021] [Indexed: 12/18/2022]
Abstract
Purpose of Review This review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology’s (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics. Recent Findings Researchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the use of augmented reality for preoperative anxiety. Most studies showed that virtual reality intervention is effective and safe for perioperative anxiety, acute, and chronic pain. However, the studies are heterogeneous with relatively small sample sizes. Summary This review shows that more high-quality studies (i.e., randomized controlled trials with larger sample sizes and standardized methods for measuring and reporting outcomes) are needed to examine the effectiveness and adverse effects of virtual reality intervention on perioperative anxiety, acute, and chronic pain in pediatrics.
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Affiliation(s)
- Mohammad Alqudimat
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada.,Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Giulia Mesaroli
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.,Department of Rehabilitation Services, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Chitra Lalloo
- Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Jennifer Stinson
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, 155 College Street, Suite 130, Toronto, ON M5T 1P8 Canada.,Child Health Evaluation Sciences, Research Institute, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.,Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada
| | - Clyde Matava
- Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8 Canada.,Temerty Faculty of Medicine, Department of Anesthesiology and Pain Medicine, University of Toronto, 123 Edwards Road, Toronto, ON M5G 1E2 Canada
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25
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Saliba T, Schmartz D, Fils JF, Van Der Linden P. The use of virtual reality in children undergoing vascular access procedures: a systematic review and meta-analysis. J Clin Monit Comput 2021; 36:1003-1012. [PMID: 34052954 DOI: 10.1007/s10877-021-00725-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2021] [Accepted: 05/21/2021] [Indexed: 10/21/2022]
Abstract
Venous access procedures are painful and feared by children and their parents. Virtual reality has become increasingly prominent and has been shown to be effective in various procedures. The aim of this meta-analysis was to examine virtual reality's effect on pain and fear in children from 4 to 12 in the context of vascular access. From the 20th to the 26th December 2020, we searched Sciencedirect, Springerlink, CENTRAL, Pubmed and PMC. Studies using virtual reality versus a control in vascular access for children were included in a meta-analysis to evaluate the effect of virtual reality regarding pain as a primary and fear/anxiety as a secondary endpoint during the procedures. The Jadad scale and Delphi List were used to assess study quality. 20,894 citations were identified, 9 met our inclusion criteria. One publication was conducted in two different situations and was thus considered as 2 studies. Compared to standard of care, virtual reality significantly reduced pain (10 studies, 930 participants: standardized mean difference [SMD] 2.54, 95%CI 0.14-4.93, p = 0.038), and fear/anxiety (6 studies, 648 participants: SMD 0.89, 95%Cl 0.16-1.63, p = 0.017). For both parameters, we found significant heterogeneity between studies. This is the first meta-analysis to look at the use virtual reality in young children undergoing vascular access procedures, providing weak to moderate evidence for its use. Although large effect sizes provide evidence for a positive effect of virtual reality in reducing pain and fear, there is significant heterogeneity between studies. More research with larger groups and age stratification is required.
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Affiliation(s)
| | - D Schmartz
- Brugmann University Hospital, Brussels, Belgium
| | - J-F Fils
- Ars Statistica, Nivelles, Belgium
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26
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Logan DE, Simons LE, Caruso TJ, Gold JI, Greenleaf W, Griffin A, King CD, Menendez M, Olbrecht VA, Rodriguez S, Silvia M, Stinson JN, Wang E, Williams SE, Wilson L. Leveraging Virtual Reality and Augmented Reality to Combat Chronic Pain in Youth: Position Paper From the Interdisciplinary Network on Virtual and Augmented Technologies for Pain Management. J Med Internet Res 2021; 23:e25916. [PMID: 33667177 PMCID: PMC8111507 DOI: 10.2196/25916] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 12/14/2020] [Accepted: 03/04/2021] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions. However, in this young field, there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. OBJECTIVE The INOVATE-Pain (Interdisciplinary Network on Virtual and Augmented Technologies for Pain management) consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. METHODS An interdisciplinary meeting of 16 academics, clinicians, industry partners, and philanthropy partners was held in January 2020. RESULTS Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR and AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR and AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions. CONCLUSIONS To realize the promise of this realm of innovation, key ingredients for success include productive partnerships among industry, academic, and clinical stakeholders; a uniform set of outcome domains and measures for standardized evaluation; and widespread access to the latest opportunities, tools, and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children.
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Affiliation(s)
- Deirdre E Logan
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, United States
- Department of Psychiatry, Harvard Medical School, Boston, MA, United States
| | - Laura E Simons
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Thomas J Caruso
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Jeffrey I Gold
- Department of Anesthesiology, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States
- Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
- Department of Psychiatry and Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States
| | | | - Anya Griffin
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Maria Menendez
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Vanessa A Olbrecht
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Samuel Rodriguez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Megan Silvia
- Department of Physical Therapy and Occupational Therapy Services, Boston Children's Hospital, Boston, MA, United States
- Pediatric Pain Rehabilitation Center, Boston Children's Hospital, Boston, MA, United States
| | | | - Ellen Wang
- Department of Anesthesiology, Perioperative, and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
- Lucile Packard Children's Hospital Stanford, Stanford University, Stanford, CA, United States
| | - Sara E Williams
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
- Center for Understanding Pediatric Pain (CUPP), Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Luke Wilson
- Mighty Immersion, Inc., New York, NY, United States
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