Use of Virtual Reality in Burn Rehabilitation: A Systematic Review and Meta-analysis

Virtual Reality for Postoperative Pain Management: A Review of Current Evidence

PURPOSE OF REVIEW

With the ongoing opioid crisis, there is a continued need to develop multimodal pain management strategies inclusive of non-pharmacological treatments. Virtual reality (VR) offers a non-invasive treatment approach for the management of acute and chronic pain including postoperative pain. The aim of this review is to describe the use of VR and its effect on pain-related outcome measures compared to routine care in various types of surgical procedures.

RECENT FINDINGS

Severe postoperative pain is associated with an increased risk of medical complications and may lead to the development of chronic pain. VR-based interventions are a form of distraction therapy that attenuates pain perception and have been shown to reduce activity in central pain-processing regions. In patients undergoing cardiac surgery, VR may reduce postoperative pain and improve physiological parameters such as heart rate and blood pressure. VR technology was found to have a high satisfaction rate in patients undergoing laparoscopic abdominal surgeries. Three-dimensional (3D) VR interventions may be useful for postoperative pain control in patients undergoing head and neck surgery. VR technology has revealed mixed results for postoperative pain control following orthopedic procedures although it has beneficial effects on functional outcomes during postoperative rehabilitation. In the pediatric population, VR is notable for its applicability in postoperative pain control and anxiety. VR technology is a novel, non-pharmacologic adjunct in the management of postoperative pain. Current studies are limited regarding therapy adaptations for the elderly population. High-quality randomized controlled trials are needed to establish the clinical effectiveness of VR-based therapies in the postoperative setting.

Virtual reality as a promising method of pain relief in patients with venous leg ulcers

Pain in patients suffering from hard-to-heal wounds is a serious problem that hinders the healing process and affects their quality of life. Virtual reality (VR) is increasingly being used for pain relief. The aim of the study was to assess whether the use of VR during mechanical cleansing of venous leg ulcers would result in a reduction in patients' pain. Sixty patients were randomly divided into two groups. The experimental group included patients who used VR goggles during wound cleansing, and the control group included patients who did not use such equipment during wound cleansing. The Oculus Quest 2 VR Goggles were used in the experiment. After wound cleaning, the patient assessed the intensity of his pain on a numerical pain rating scale from 0 to 10 points. The difference between the intensity of pain during wound cleansing in patients from the experimental and control group turned out to be statistically significant (p < 0.001). It was on average 1.13 ± 0.68 points in the experimental group, and in the case of people from the control group, it was 4.73 ± 1.2 points. To conclude, the use of VR in patients with venous leg ulcers reduces pain during wound cleansing.

Virtual Reality Videos for Symptom Management in Hospice and Palliative Care

Objective

To learn more about the effect of virtual reality videos on patients' symptoms near the end of life, including which are most effective, how long the effect lasts, and which patients benefit the most.

Patients and Methods

We conducted a prospective study of 30 patients in a regional hospice and palliative care program from March 11, 2022, through July 14, 2023. Using a head-mounted display virtual reality, all participants viewed a 15-minute video of serene nature scenes with ambient sounds. Fifteen patients also participated in a second session of viewing bucket-list video clips they selected. Symptoms were measured with the revised Edmonton Symptom Assessment Scale before, immediately after, and 2 days after each experience. Participants rated their bucket-list selections by level of previous experience, strength of connection, and overall video quality. Functional status was also recorded.

Results

Nature scenes significantly improved total symptom scores (30% decrease, P<.001), as well as scores for drowsiness, tiredness, depression, anxiety, well-being, and dyspnea. The improved scores were not sustained 2 days later. Overall, bucket-list videos did not significantly improve symptoms. Neither previous experience with an activity nor a strong connection correlated with significant improvement; however, when patients rated video quality as outstanding, scores improved (31% decrease, P=.03). Patients with lower functional status tended to have more symptoms beforehand and improve the most.

Conclusion

Serene nature head-mounted display virtual reality scenes safely reduce symptoms at the end of life. Bucket-list experiences may be effective if they are high-quality. More infirm patients may benefit the most.

Virtual Reality as a Pain Control Adjunct in Orthopedics: A Narrative Review

Orthopedic surgeons typically prescribe opioids for postoperative pain management as they are effective in managing pain. However, opioid use can lead to issues such as overdose, prescription excess, inadequate pain management, and addiction. Virtual reality (VR) therapy is an alternative route for postoperative pain management that has grown in popularity over the years. VR therapy involves immersing patients in a virtual 3D experience that is anticipated to alleviate pain. In this review article, we summarized the findings of numerous PubMed studies on the effectiveness of VR therapy for postoperative pain control. VR therapy is beneficial for reducing anxiety, pain, and opioid use after surgical procedures across various specialties. Further studies should explore VR therapy in orthopedic procedures.

Effects of Virtual Reality on Analgesia in Wound Care and Physical Therapy for Burn Patients: A Systematic Review and Meta-analysis

OBJECTIVES

This systematic review and meta-analysis aimed to determine the effectiveness of virtual reality (VR) in alleviating pain and improving the experience of burn patients during wound care and physical therapy.

DESIGN

A systematic review and meta-analysis.

DATA SOURCES

PubMed, Embase, the Cochrane Database, and the Web of Science.

REVIEW/ANALYSIS METHODS

We searched four electronic databases for randomized controlled trials (RCTs) published from the earliest available date up to March 1, 2022. The primary outcome was worst pain intensity, while secondary outcomes encompassed pain unpleasantness intensity, time spent thinking about pain, and fun experience intensity. Risk of bias was evaluated using the Cochrane Collaboration's tool.

RESULTS

This study included 21 trials. The combined data revealed that the VR group experienced a significant reduction in worst pain intensity, pain unpleasantness intensity, and time spent thinking about pain compared to the control group. Moreover, VR treatment was associated with a significant increase in the fun experience intensity.

IMPLICATIONS FOR NURSING

Virtual reality has the potential value of auxiliary analgesia in burn care, and exploring a more perfect scheme of VR-assisted analgesia is worthwhile.

CONCLUSIONS

The results of this meta-analysis indicate that VR can effectively reduce worst pain intensity, pain unpleasantness intensity, and time spent thinking about pain during wound care and physical therapy for burn patients. Additionally, it enhances fun experience intensity of the treatment period. Therefore, VR shows promise as a valuable complementary pain management intervention for burn patients.

Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis

Background

This systematic review and meta-analysis aims to investigate the effects of virtual reality (VR) exercise compared to traditional rehabilitation on pain, function, and muscle strength in patients with knee osteoarthritis (KOA). Additionally, the study explores the mechanisms by which VR exercise contributes to the rehabilitation of KOA patients.

Methods

We systematically searched PubMed, the Cochrane Library, Embase, Web of Science, Scopus, and PEDro according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search spanned from the library construction to 24 May 2024, focusing on randomized controlled trials Primary outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and muscle strength. Meta-analysis was conducted using RevMan (version 5.4) and Stata (version 14.0). The bias risk of included studies was assessed using the Cochrane RoB 2.0 tool, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach.

Results

This meta-analysis and systematic review included nine studies involving 456 KOA patients. The results indicated that VR exercise significantly improved pain scores (SMD, -1.53; 95% CI: -2.50 to -0.55; p = 0.002), WOMAC total score (MD, -14.79; 95% CI: -28.26 to -1.33; p = 0.03), WOMAC pain score (MD, -0.93; 95% CI: -1.52 to -0.34; p = 0.002), knee extensor strength (SMD, 0.51; 95% CI: 0.14 to 0.87; p = 0.006), and knee flexor strength (SMD, 0.65; 95% CI: 0.28 to 1.01; p = 0.0005), but not significantly for WOMAC stiffness (MD, -0.01; 95% CI: -1.21 to 1.19; p = 0.99) and physical function (MD, -0.35; 95% CI: -0.79 to -0.09; p = 0.12).

Conclusion

VR exercise significantly alleviates pain, enhances muscle strength and WOMAC total score in KOA patients, but improvements in joint stiffness and physical function are not significant. However, the current number of studies is limited, necessitating further research to expand on the present findings.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024540061, identifier CRD42024540061.

What landscape elements are needed for hospital healing spaces? Evidence from an empirical study of 10 compact hospitals

Background

Modern medical research shows that a rationally planned landscape environment helps patients recover. With the growing number of hospital patients and the tightening of per capita medical landscape land, the use of limited landscape resources to serve patients has become challenging.

Methods

This study focused on the landscape environment of 10 hospitals in Guangdong Province, China. Based on the KANO theoretical model, a survey questionnaire was designed and administered to 410 participants. The data were analyzed based on demand attributes, importance, sensitivity, and group differences.

Results

The maintenance requirements were the most important item in the sensitivity ranking. Furthermore, the analysis revealed that the users need a safe, quiet, and private environment, owing to their higher requirements, including visual healing, rehabilitation activities, shading and heat preservation, and medical escort. Moreover, adolescents and older adult patients have common and contradictory environmental needs. For example, the landscape environment should provide both an active space and a quiet rehabilitation environment.

Conclusion

This study evaluates how landscape resources can be better utilized from the perspective of the user and expands the theory of healing landscapes, which has practical implications for hospital renovation and landscape environment strategies.

Effect of virtual reality on pain during burn dressing in children: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Burn dressing, a necessary and regular procedure for burn management, causes significant pain and distress for children. Recent technological advancements in VR have opened up new possibilities for pain management in children undergoing burn dressing. However, there is limited evidence regarding their efficacy in burn dressing specifically. This study aims to synthesize and analyze the effect of VR on pain during burn dressing in children.

METHODS

In this review, we investigated studies from PubMed, Web of Science, Cochrane, MEDLINE, CINAHL, Scopus and Google Scholar databases that met inclusion criteria. We also assessed the studies' methodological quality with the Cochrane and JBI checklists. This study was performed based on the Guidelines of Systematic Reporting of Examination presented in the PRISMA checklist. The search protocol has been registered at the PROSPERO International Prospective Register of Systematic Reviews.

RESULTS

A total of six published studies including 241 pediatric patients were included in this review. The meta-analysis results showed a significant effect of VR intervention on the pain levels of children (Hedge's g = -1199, Q = 31,106, I2 = 83,926%, p < 0.001).

CONCLUSION

Findings from this study show that VR is a promising and effective intervention for reducing pain scores in children undergoing dressing changes for burn injuries.

IMPLACATION TO PRACTICE

Our meta-analysis suggest that the significant potential of integrating VR into clinical practice, presenting a non-pharmacological intervention to reduce pain during dressing changes in pediatric burn patients. Implementing VR in healthcare settings can lead to improved pain management and better patient outcomes for pediatric population.

Special Considerations for Pediatric Burn Injuries

Burns are the fifth leading cause of non-fatal childhood injuries. Physiological differences between children and adults lead to unique considerations when treating young burn survivors. In addition to the physical and psychological concerns which must be considered in adult burn rehabilitation, pediatric burn rehabilitation must also consider the developmental stage of the child, preexisting developmental delays, and the impact of scaring on growth and motor skill attainment. Treatment of pediatric burn survivors requires a multidisciplinary approach centered around caring for not only the child but also for their parents, siblings, and other caregivers. For children who sustain burns early in life, long-term follow-up is essential and should be conducted under the guidance of a burn center for the early identification of needed interventions during periods of growth and development. This article considers pediatric-specific factors, which may present during the rehabilitation of a child with a burn injury.