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Dilek S, Figen Y, Merve G, Hatice EÖ, Şeyma KT. Technology versus nostalgia; A randomized controlled trial of the effect of virtual reality and kaleidescop on pediatric pain, fear and anxiety management during immunization. J Pediatr Nurs 2024:S0882-5963(24)00291-4. [PMID: 39089900 DOI: 10.1016/j.pedn.2024.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Revised: 07/25/2024] [Accepted: 07/25/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND Routine vaccination procedures, while crucial for public health, can induce pain, fear, and anxiety in children. Distraction techniques such as virtual reality and kaleidoscope have been proposed to alleviate these negative experiences during vaccinations. OBJECTIVE This study aimed to compare the effectiveness of virtual reality and kaleidoscope as distraction methods in reducing pain, fear, and anxiety during routine vaccination in children aged 48 months. DESIGN This randomized controlled trial allocated children aged 48 months receiving the measles-mumps-rubella vaccine into three groups: virtual reality (n = 42), kaleidoscope (n = 42), and control (n = 42). SETTING(S) The study was conducted in a pediatric clinic. PARTICIPANTS The study included a total of 126 children aged 48 months. METHODS Pain and fear levels were assessed by both researchers and children before and after the vaccination procedure, while anxiety was evaluated by children after vaccination. Pain was measured using the Wong Baker Faces Pain Rating Scale, fear with the Children's Fear Scale, and anxiety with the Child Anxiety Scale-State Version. RESULTS Post-vaccination pain, fear, and anxiety scores were significantly lower in the kaleidoscope group compared to both the virtual reality and control groups (p < .05). CONCLUSIONS Using kaleidoscope during vaccination in 48-month-old children effectively reduced pain, fear, and anxiety. Integrating kaleidoscope as a distraction method during routine vaccination procedures may enhance the vaccination experience and potentially improve adherence to vaccination schedules. REGISTRATION Clinical trials number is NCT0611XXXX.
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Affiliation(s)
- Sarı Dilek
- Ege University, Facult of Nursing, İzmir, Turkey
| | | | - Gümüş Merve
- Ege University, Facult of Nursing, İzmir, Turkey.
| | - Erdem Önder Hatice
- Mehmet Akif Ersoy University, Faculty of Health Sciences, Fundamental of Nursing Department, Burdur, Turkey
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Güler S, Şahan S, Öztürk S. The Effect of Video Streaming With Virtual Reality Glasses on on Pain Anxiety and Satisfaction Applied in Peripheral Intravenous Catheter Process. Pain Manag Nurs 2024:S1524-9042(24)00166-8. [PMID: 38955551 DOI: 10.1016/j.pmn.2024.05.009] [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: 08/16/2023] [Revised: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Peripheral intravenous catheter (PIC) implementation is among the most frequent and highly invasive nursing initiatives. PIC leads to anxiety with procedural pain, causing individuals to reject these procedures or negatively affecting the process's success. AIM The study was conducted to determine the effect of virtual reality glasses (VRG) on pain, anxiety, and patient satisfaction during the peripheral intravenous catheter (PIC) process in adults. DESIGN An experimental study. SETTINGS An emergency department of a university hospital. METHODS Individuals who were admitted to the emergency unit of the university hospital were recruited between the data collection dates. Data from individuals' "Patient Information Form," "Visual Pain Scale," "Visual Anxiety Scale," and "Visual Satisfaction Scale" were collected. "VR-Box 3D Glasses" was used as virtual reality glasses. RESULTS In our study, when the pain point averages with VAS were compared during the PIC process, the pain score average of the patients in the control group was 5.78 ± 1.23 visual anxiety scale 5.89 ± 1.23 and patient satisfaction scale 3.86 ± 2.48, The visual pain score average of patients in the VRG group is 4.12 ± 2.16, visual anxiety scale 3.14 ± 1.76 and visual patient satisfaction scale 7.64 ± 3.26. In short, it has been detected that the pain, anxiety, and patient satisfaction score averages of patients in the VRG group are statistically significant compared to the pain score averages of patients in the control group (p < .005). Our study unearthed a statistically significant relationship at an average level of negative direction between PIC post-treatment pain, anxiety, and patient satisfaction (r = - 0.476). CONCLUSION Utilization of VRG has been detected to reduce pain and anxiety felt during the PIC process in adult patients and increase process satisfaction. VRG, a non-pharmacological, non-invasive, inexpensive, and feasible nursing initiative, may be recommended for use in pain and anxiety control in patients undergoing PIC treatment.
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Affiliation(s)
- Sevil Güler
- Department of Nursing, Erciyes University Faculty of Health Sciences, Kayseri, Turkey.
| | - Seda Şahan
- Department of Nursing, Faculty of Health Sciences, Bakırçay University, İzmir, Turkey
| | - Selçuk Öztürk
- Education and Research Hospital Emergency Master Science Branch, Kayseri City, Turkey
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Caballero R, Pasten A, Giménez C, Rodríguez R, Carmona RM, Mora J, Valls-Esteve A, Lustig P, Lombardini F, Balsells S, Krauel L. Beyond Needles: Pioneering Pediatric Care with Virtual Reality (VR) for TIVAD Access in Oncology. Cancers (Basel) 2024; 16:2187. [PMID: 38927893 PMCID: PMC11201373 DOI: 10.3390/cancers16122187] [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: 04/29/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Pediatric oncology patients use totally implantable venous access devices (TIVADs) to enable central venous access. Anxiety, pain and/or discomfort are common despite anesthesia. Virtual reality (VR) is a non-pharmacological approach that may reduce pain and anxiety in these patients. We aimed to assess the use of VR for reducing anxiety/pain in patients with TIVADs while facilitating the task of healthcare providers when accessing a TIVAD. METHODS patients 4-18 years old with a TIVAD were prospectively randomized to an intervention group (IG) or a control group (CG). In the IG, VR goggles (Oculus Quest 2, Meta Platforms®, Menlo Park, CA, USA) were used displaying a relaxing video in the Raja Ampat environment (Ecosphere app from Phoria®) while the TIVAD was accessed. The CG was managed as per standard of care. Satisfaction and pain were measured by FPS-R and STAIC scales, respectively. RESULTS this is the report of a prospective, randomized (60 per group)-unblinded-, single institution study of 120 pediatric oncology patients enrolled from January to April 2022. Median ages for IG and CG were 9.22 and 10.52 years, respectively. Satisfaction was higher in the IG (4.80) compared to the CG (3.92), p ≤ 0.0001. Regarding pain, mean FPS-R scores were 1.79 for the CG and 0.83 for the IG. Significantly different scores were found in the 12 to 18 years group, p ≤ 0.05. The healthcare professionals index of satisfaction was high (4.50 mean Likert score) for the IG compared to accessing the TIVAD without VR (3.73 mean Likert score). CONCLUSION The use of VR helped reduce pain and/or discomfort in pediatric oncology patients, mainly in the older age group as they can better interact with VR. Healthcare providers were satisfied with the help of VR for TIVAD management.
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Affiliation(s)
- Rubén Caballero
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (R.C.)
| | - Albert Pasten
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (R.C.)
| | - Carla Giménez
- Pediatric Oncology Nurse, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (C.G.); (R.R.); (R.M.C.)
| | - Raquel Rodríguez
- Pediatric Oncology Nurse, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (C.G.); (R.R.); (R.M.C.)
| | - Rosa María Carmona
- Pediatric Oncology Nurse, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (C.G.); (R.R.); (R.M.C.)
| | - Jaume Mora
- Pediatric Cancer Center Barcelona, SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain;
| | - Arnau Valls-Esteve
- Innovation Department, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain (P.L.)
| | - Pamela Lustig
- Innovation Department, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain (P.L.)
| | - Federica Lombardini
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Sol Balsells
- Statistical Advising Service, Fundació de Recerca Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Lucas Krauel
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (R.C.)
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Grange L, Grange R, Bertholon S, Morisson S, Martin I, Boutet C, Grange S. Virtual reality for interventional radiology patients: a preliminary study. Support Care Cancer 2024; 32:416. [PMID: 38847962 DOI: 10.1007/s00520-024-08621-0] [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: 02/03/2024] [Accepted: 05/30/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The aim of this prospective study was to evaluate the tolerance and feasibility of using virtual reality headsets with patients during interventional radiology procedures. MATERIAL AND METHOD In this single-center prospective study, the use of a virtual reality headset in addition to the usual analgesic and anxiolytic treatment was proposed to all patients presenting in the interventional radiology department from December 2020 to June 2022. Exclusion criteria were as follows: (1) patients with whom it was not possible to communicate (2) epileptic patients, (3) non-verbal patients, and (4) pregnant women. The main objective was to evaluate the safety of the procedure by screening complications during and after the procedure. The second objective was to evaluate feasibility, as defined by the number of patients using the helmet until the end of the procedure. Effectiveness (patient's self-evaluation of pain and anxiety), comfort, satisfaction, emotions felt, sense of security, and feeling of immersion were also evaluated. Caregivers completed a feedback questionnaire. RESULTS Virtual reality headsets were offered to 100 patients, 9 of whom declined. Procedures were achieved in 93.5% of cases: 6/91 patients removed the headset before the end of the procedure. There were minor adverse events in 2/85 (2.3%) procedures (discomfort and nausea) and no major adverse events. 93.9% of patients found an overall benefit, and 90.2% would recommend virtual reality to another patient. 94.4% of caregivers were satisfied with the virtual reality equipment. The mean pain level was 2.5 ± 2.7 before the procedure, 3.3 ± 2.5 during the procedure, and 1.6 ± 2.7 after the procedure. Mean anxiety scores were 4.6 ± 2.9 before the procedure, 3.1 ± 2.7 during the procedure, and 1.1 ± 1.9 after the procedure. CONCLUSION The use of virtual reality technology as a complement to traditional therapy for procedures under local anesthesia is feasible and safe in interventional radiology and can be beneficial for pain and anxiety management.
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Affiliation(s)
- Loïc Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Sylvain Bertholon
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Stéphanie Morisson
- Department of Supportive Care in Oncology, University Hospital of Saint Etienne, Saint-Priest-En-Jarez, France
| | - Isabelle Martin
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France.
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Diallo S, Marchand S, Dumais A, Potvin S. The impact of an immersive digital therapeutic tool on experimental pain: a pilot randomized within-subject experiment with an active control condition. FRONTIERS IN PAIN RESEARCH 2024; 5:1366892. [PMID: 38903416 PMCID: PMC11187308 DOI: 10.3389/fpain.2024.1366892] [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: 01/07/2024] [Accepted: 05/20/2024] [Indexed: 06/22/2024] Open
Abstract
Background Pain is a complex and multifaced sensory and emotional experience. Virtual reality (VR) has shown promise in reducing experimental pain and chronic pain. This study examines an immersive VR environment initially designed for endometriosis patients, which demonstrated short-term analgesic effects. The research aims to determine the impact of the VR environment on experimental pain intensity and unpleasantness both during and after VR exposure (3D with binaural beats), while using an active control condition (2D with no binaural beats). Additionally, a secondary objective of the study was to identify the psychological and psychophysical factors that predict the analgesic effects of the immersive digital therapeutic tool. Methods The study involved twenty-one healthy individuals and used a within-subject design, comparing a VR treatment with an active control condition. Continuous heat stimulation was applied to the left forearm with a Peltier thermode. Pain ratings were collected for immediate and short-term effects. Results In both the VR and Control conditions, there were no significant differences in pain intensity before, during, and after exposure. However, during VR exposure, there was a significant decrease in pain unpleasantness as compared to before exposure (p < 0.001), with a 27.2% pain reduction. In the Control condition, there were no significant differences in pain unpleasantness during and after exposure. Furthermore, no psychological and psychophysical factors predicted the analgesic effects. Discussion The study investigated how a VR environment affected experimentally induced pain in healthy volunteers. It showed that VR reduced pain unpleasantness during exposure but had no lasting impact. The VR environment mainly influenced the emotional aspect of pain, possibly due to its inclusion of binaural beats and natural stimuli. The study suggests that the VR environment should be tested in chronic pain population with high distress levels. Registration number clinicaltrialsgov NCT06130267.
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Affiliation(s)
- Sanoussy Diallo
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
| | - Serge Marchand
- Department of Surgery, Faculty of Medicine, University of Sherbrooke, Sherbrooke, QC, Canada
| | - Alexandre Dumais
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
- Institut National de Psychiatrie Légale Philippe-Pinel, Montreal, QC, Canada
| | - Stéphane Potvin
- Centre de Recherche de l’Institut Universitaire en Santé Mentale de Montréal, Montreal, QC, Canada
- Department of Psychiatry and Addiction, Faculty of Medicine, University of Montreal, Montreal, QC, Canada
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Czub M, Serrano-Ibáñez ER, Piskorz J, Esteve R, Lydon HK, López-Martínez AE, Mullen B, Ramírez-Maestre C, Heary C, O'Neill C, Sainero G, Ruiz Escalera JF, Caes L, Morales Murcia S, McDarby V, McGuire BE. Virtual Reality Distraction for Needle-Related Pain and Distress in Children: A Multicenter Randomized Controlled Trial. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2024; 27:409-419. [PMID: 38624238 DOI: 10.1089/cyber.2023.0454] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
This international multicenter randomized controlled trial aimed to compare the effectiveness of virtual reality (VR) distraction with an identical non-VR game in reducing needle-related pain and anxiety in children undergoing venous blood draw. The study involved 304 children aged 5-9 years undergoing a blood draw procedure, randomly allocated to one of three groups: VR distraction, non-VR distraction, and control group (usual care). The distraction task was based on the Multiple Object Tracking (MOT) paradigm, and the game was identical in design and gameplay for both VR and non-VR distraction groups. The primary outcome was self-reported pain intensity using the Faces Pain Scale-Revised (FPS-R). Secondary outcomes included child distress, attention/distraction to the blood draw, and parent and medical staff satisfaction with procedure. Analyses were conducted using analysis of variance and multivariable linear regression models. The results showed that VR distraction and non-VR distraction performed similarly, showing large effect sizes compared with standard care. There was no significant difference between the two types of distraction. The study's findings suggest that VR and non-VR distraction are similarly effective in reducing needle-related pain and anxiety in children undergoing venous blood draw. This is the first well-powered study comparing modern VR distraction with an identical task displayed on a smartphone or monitor screen. The study's results have important implications for using VR in clinical settings and suggest that investing in expensive VR equipment for acute pain management may not be necessary. The study protocol was pre-registered on Open Science Framework at https://osf.io/frsyc.
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Affiliation(s)
- Marcin Czub
- Institute of Psychology, University of Wrocław, Wrocław, Poland
| | - Elena R Serrano-Ibáñez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Joanna Piskorz
- Institute of Psychology, University of Wrocław, Wrocław, Poland
| | - Rosa Esteve
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Helena K Lydon
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
| | - Alicia E López-Martínez
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Bertille Mullen
- Haemophilia Department, Children's Health Ireland at Crumlin Hospital, Dublin, Ireland
| | - Carmen Ramírez-Maestre
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | - Caroline Heary
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
| | - Conor O'Neill
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
| | - Gloria Sainero
- Departamento de Personalidad, Evaluación y Tratamiento Psicológico, Facultad de Psicología y Logopedia, Universidad de Málaga, Instituto de Investigación Biomédica de Málaga (IBIMA), Spain
| | | | - Line Caes
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
| | | | - Vincent McDarby
- Department of Psychology, Children's Health Ireland at Crumlin Hospital, Dublin, Ireland
| | - Brian E McGuire
- School of Psychology and Applied Behaviour Research Clinic and Centre for Pain Research, University of Galway, Galway, Ireland
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Alaniz L, Shams A, Sayadi L, Pakvasa M, Stulginski A, Cordero J, Prabhakar N, Wang E. Modernizing ED Care: Virtual Reality Enhances the Patient Experience during Minor Wide-awake Hand Procedures. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5790. [PMID: 38706467 PMCID: PMC11068151 DOI: 10.1097/gox.0000000000005790] [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] [Received: 09/03/2023] [Accepted: 03/12/2024] [Indexed: 05/07/2024]
Abstract
Background Minor procedures in the emergency department (ED) can be distressing for patients. The emergence of virtual reality (VR) offers a promising new tool by immersing patients in an engaging three-dimensional world. Prior studies have shown VR's effectiveness during procedures in reducing pain, anxiety, and procedure duration but have not assessed its efficacy in the ED. This study aims to evaluate the efficacy of VR in managing pain and anxiety during ED minor hand procedures. Methods This was a prospective, interventional study at a level I trauma center examining adult patients requiring minor hand procedures. Patients were provided the Oculus Quest 2 VR headset, offering various immersive three-dimensional experiences. Pre- and postprocedure surveys assessed previous VR use, anxiety and pain levels, VR efficacy, and possible adverse effects. Responses were rated on a 10-point Likert scale with paired t tests used to compare scores. Results The study included sixteen patients, seven of whom were first-time VR users. Patients experienced a significant decrease in both anxiety and pain levels. Survey results indicated overall benefits from VR in several aspects, with no adverse effects reported, and unanimous patient recommendation of the VR experience to others. Conclusions VR is an effective tool to optimize the patient experience during ED hand procedures. The study observed a significant decrease in anxiety and a declining trend in pain levels. Patients believed VR helped manage their pain and would recommend it to others. Given the benefits and high safety profile, VR should become a standard offering in ED minor hand procedures.
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Affiliation(s)
- Leonardo Alaniz
- From the School of Medicine, University of California Irvine, Irvine, Calif
- Department of Plastic Surgery, University of California Irvine Medical Center, Orange, Calif
| | - Abtin Shams
- Department of Plastic Surgery, University of California Irvine Medical Center, Orange, Calif
| | - Lohrasb Sayadi
- Department of Plastic Surgery, University of California Irvine Medical Center, Orange, Calif
| | - Mikhail Pakvasa
- Department of Plastic Surgery, University of California Irvine Medical Center, Orange, Calif
| | - Avril Stulginski
- From the School of Medicine, University of California Irvine, Irvine, Calif
| | - Justin Cordero
- University of California Riverside, School of Medicine, Riverside, Calif
| | - Nikhil Prabhakar
- Department of Plastic Surgery, University of California Irvine Medical Center, Orange, Calif
| | - Eric Wang
- Department of Plastic Surgery, University of California Irvine Medical Center, Orange, Calif
- Plastic Surgery, Long Beach Veterans Affairs, Long Beach, Calif
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Teh JJ, Pascoe DJ, Hafeji S, Parchure R, Koczoski A, Rimmer MP, Khan KS, Al Wattar BH. Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. BMC Med 2024; 22:64. [PMID: 38355563 PMCID: PMC10865524 DOI: 10.1186/s12916-024-03266-6] [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: 04/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses. RESULTS In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018. CONCLUSIONS Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.
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Affiliation(s)
- Jhia J Teh
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Safiya Hafeji
- Kings College Hospital, Denmark Hill, Brixton, London, UK
| | | | - Adam Koczoski
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Michael P Rimmer
- MRC Centre for Reproductive Health, Institute of Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK.
- . Johns Hospital, Livingston, West Lothian, Scotland, UK.
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Bassel H Al Wattar
- University College London, London, UK
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
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Bofanova NS, Saruhanjan AL. [The prospect of using virtual reality technology in combination with psychotherapeutic methods in children with functional abdominalgia]. Zh Nevrol Psikhiatr Im S S Korsakova 2024; 124:40-47. [PMID: 38884428 DOI: 10.17116/jnevro202412405140] [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] [Indexed: 06/18/2024]
Abstract
OBJECTIVE The literature review addresses the effectiveness of psychotherapeutic methods in the treatment of functional abdominal pain syndrome and studying the prospects for using virtual reality technology in combination with psychotherapeutic methods according to the available literature. MATERIAL AND METHODS A search was conducted for available literature in the eLibrary and PubMed databases, published for the period 2017-2022, using the keywords: abdominalgia, psychotherapeutic methods, gut-brain axis, virtual reality technology. RESULTS Currently, the biopsychosocial concept of the etiopathogenesis of abdominal pain syndrome, which is not associated with an organic disease of the gastrointestinal tract, is used. A significant contribution to the formation of the disease is made by genetic, neuropsychological, neurophysiological factors, and disruption of the interaction of the gut-brain axis. Cognitive behavioral therapy, yoga, and hypnotherapy are applicable as effective psychotherapeutic methods in the complex treatment of abdominal pain syndrome in children. A promising direction is the use of virtual reality technology to increase the effectiveness of psychotherapeutic methods and reduce chronic abdominal pain syndrome by influencing the gut-brain axis. Practical research work devoted to this issue is currently rare. CONCLUSION In the complex treatment of functional abdominal pain syndrome in children, various psychotherapeutic methods are used, the most effective are cognitive behavioral therapy and hypnotherapy. It is necessary to stimulate domestic research work studying the joint use of virtual reality technology and psychotherapeutic methods in children aged 7 to 18 years.
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Rygh L, Johal S, Johnson H, Karlson CW. Virtual Reality for Pediatric Oncology Port-A-Cath Access: A Pilot Effectiveness Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:379-385. [PMID: 37386775 DOI: 10.1177/27527530221147875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Introduction: Port-a-cath procedures are among the most distressing aspects of pediatric cancer treatment. The current study aimed to examine the usability of virtual reality (VR) interventions for children undergoing chemotherapy port-access procedures. Methods: Families (N = 20) of children with cancer, 4-17 years old (M = 8.70 years, SD = 3.71), were recruited. Patients and parents rated patients' dizziness, nausea, pain, and distress, and participants were shown how to use VR prior to the use of the procedure. After port-a-cath access, patients and parents rated pain and distress during the intervention. Semistructured interviews were conducted to examine the usability of the intervention. Result: A significant difference was identified for change in children's pain score for younger children, F(2, 11) = 4.16, p < .05. A significant decrease in fear scores was observed on child and parent reports. The VR headset was used during the procedure by 87.5% of the participants, while the rest used it before but took it off during the procedure, and 85.7% wished to use it again. No concerns were reported by 84.6% of the nurses and 92.3% reported no interference with their workflow. Discussion: More research is needed to fully understand the benefits of VR interventions during children's chemotherapy port procedures. The findings of this pilot study suggest that the use of commercially available VR intervention may reduce children's fear and pain levels during the port-a-cath procedure, especially for younger children.
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Affiliation(s)
- Louisa Rygh
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Clinical Psychology, Jackson State University, Jackson, MS, USA
| | - Sonal Johal
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hana Johnson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Biology, Prairie View A&M University, Prairie View, TX, USA
| | - Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
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11
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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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12
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Woo OKL, Lee AM. Case report: Therapeutic potential of Flourishing-Life-Of-Wish Virtual Reality Therapy on Relaxation (FLOW-VRT-Relaxation)-a novel personalized relaxation in palliative care. Front Digit Health 2023; 5:1228781. [PMID: 37674510 PMCID: PMC10477913 DOI: 10.3389/fdgth.2023.1228781] [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: 05/25/2023] [Accepted: 08/07/2023] [Indexed: 09/08/2023] Open
Abstract
In view of the global aging population and growing need of palliative care, innovative intervention for effective symptom management is of urgent need. Flourishing-Life-Of-Wish Virtual Reality Therapy (FLOW-VRT) is a brief, structured, manualized, and personalized psychological intervention with theoretical foundations based on stress coping theory, self-determination theory, flow theory, and attention restoration theory. With a specific focus on relaxation, FLOW-VRT-Relaxation intends to facilitate adaptive end-of-life coping through delivering personalized relaxation. This paper reports a case study of the application of FLOW-VRT-Relaxation, and discusses its therapeutic potential as a cost-effective method for reducing palliative symptoms by addressing patient's unmet needs. The case study is a 51-year-old Chinese female, diagnosed with advanced cervix cancer, and presented with unmet psychological (i.e., unfulfilled wishes) and physical needs (i.e., pain and fatigue) before FLOW-VRT-Relaxation. To address her unmet needs, FLOW-VRT-Relaxation was delivered by a registered clinical psychologist specialized in palliative care. Need assessment was first conducted, followed by a 10-min VR travel of Japan as her own choice. Relaxation was verbally coached during VR. Right after VR, consolidation with psychological components including psychoeducation, cognitive and emotional processing, and reminiscence intervention were delivered. The patient showed improvement in physical and psychological symptoms, lower sense of loneliness and engulfment, as well as enhanced peace after FLOW-VRT-Relaxation. The current findings provide encouraging initial support for the feasibility, acceptability, and therapeutic potential of using FLOW-VRT-Relaxation as a cost-effective, scalable and personalized VR relaxation for patients under palliative care. It is hoped that with its optimal use, FLOW-VRT-Relaxation can serve as an alternative therapeutic tool that effectively improves the end-on-life care.
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Affiliation(s)
- Olive K. L. Woo
- Department of Psychology, The University of Hong Kong, Hong Kong, China
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13
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Orhan E, Gozen D. The Effect of Virtual Reality on Pain Experienced by School-Age Children During Venipuncture: A Randomized Controlled Study. Games Health J 2023; 12:330-339. [PMID: 37466456 DOI: 10.1089/g4h.2022.0232] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Abstract
Objective: The use of virtual reality (VR) as a non-pharmacologic method may enable children to tolerate invasive procedures in a hospital setting easily and feel less pain. This study aimed at determining the effect of using a VR headset during venipuncture on pain level, heart rate (HR), and oxygen saturation values in children aged 7-12 years old. Materials and Methods: This was a randomized controlled experimental study. This study included 102 children (experimental group: 52; control group: 50) who visited a pediatric outpatient clinic of a university hospital in Turkey between May 2018 and May 2019. Data were collected using the Child and Family Information Form, State Anxiety Inventory for Children, Faces Pain Scale-Revised (FPS-R). Before venipuncture, state anxiety and pain scores of the children were evaluated. The children in the experimental group wore VR headsets during venipuncture. The children in the control group underwent standard venipuncture procedure. Pain scores were evaluated again in both groups after the venipuncture. Before, during, and after the venipuncture, pulse and oxygen saturation values were measured. Results: It was determined that post-procedure pain score was 1.46 ± 1.49 in the experimental group and 4.44 ± 2.26 in the control group. Post-venipuncture pain mean scores were significantly lower in the experimental group than those of the children in the control group (Z = -6.574; P = 0.001). Secondary outcomes: The mean HR during the procedure was significantly lower in the experimental group (99.27 ± 18.34/min) than in the control group (108.20 ± 21.42/min) (P = 0.026; t = -2.265). There was no statistically significant difference between the before and after the procedure difference of oxygen saturation values (Experimental group: -0.15 ± 1.54; Control Group: 0.04 ± 0.93) between groups (Z = -0.023; P = 0.982). Conclusion: It was determined that post-venipuncture pain mean scores were significantly lower in the experimental group than in the control group. VR is effective to reduce the pain of children during venipuncture. VR headsets may be recognized as effective instruments to reduce the pain level of children in hospital settings. (Clinicaltrials.gov: NCT04950478).
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Affiliation(s)
- Eda Orhan
- Koc University Hospital, Nursing Education Department, Istanbul, Turkiye
- Pediatric Nursing Department, Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Istanbul, Turkiye
| | - Duygu Gozen
- Pediatric Nursing Department, Istanbul University-Cerrahpasa, Florence Nightingale Faculty of Nursing, Istanbul, Turkiye
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14
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Chen YJ, Wang CJ, Chen CW. Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:2494-2504. [PMID: 35672942 DOI: 10.1111/jocn.16394] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and evaluate the effectiveness of virtual reality interventions in preoperative children. BACKGROUND Children consider operations as a predictable threat and stressful event. Children's anxiety before an operation increases as the time draws closer. Children could understand the operating room environment and process before the operation using virtual reality, which may reduce their anxiety before an operation. DESIGN A systematic review and meta-analysis of randomised controlled trials following the Cochrane method were conducted. METHOD CINAHL, Cochrane Library, Embase, Joanna Briggs Institute, MEDLINE and PubMed databases were searched for randomised controlled trials published before February 2021. A random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals was performed. Conduction of the review adheres to the PRISMA checklist. RESULTS Of 257 articles screened, six interventions involving 529 participants aged 4-12 years were included in the analysis. All study evidence levels were B2/Level 2, the quality was medium to high on the modified Jadad scale, with a low risk of bias. The results revealed that virtual reality significantly reduced preoperative anxiety in children (SMD: -0.91, 95% CI: -1.43 to -0.39, p = .0006). Furthermore, virtual reality significantly improved children's compliance with anaesthesia (SMD: 3.49, 95% CI: 1.32 to 9.21, p = .01). CONCLUSION Children who used virtual reality before an operation felt more familiar with the operating room environment and understood the preoperative preparation procedures. Virtual reality effectively reduced children's anxiety and improved their compliance with anaesthesia. RELEVANCE TO CLINICAL PRACTICE This systematic review and meta-analysis investigated the effect of virtual reality on preoperative anxiety in children and the findings supported its positive effects. The results could provide a reference for incorporating virtual reality into preoperative preparation guidelines.
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Affiliation(s)
- Yen-Ju Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Cheng-Ju Wang
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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15
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Gullo G, Rotzinger DC, Colin A, Frossard P, Gudmundsson L, Jouannic AM, Qanadli SD. Virtually Augmented Self-Hypnosis in Peripheral Vascular Intervention: A Randomized Controlled Trial. Cardiovasc Intervent Radiol 2023:10.1007/s00270-023-03394-1. [PMID: 36944851 PMCID: PMC10030078 DOI: 10.1007/s00270-023-03394-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 02/10/2023] [Indexed: 03/23/2023]
Abstract
PURPOSE Hypnosis is useful for diminishing distress during medical procedures. This study investigated the efficacy of virtually augmented self-hypnosis as an adjunctive non-pharmacological method for procedural pain and anxiety relief during endovascular interventions (EVI). METHODS We compared an immersive distraction experience (clinicaltrials.gov identifier NCT04561596) featuring virtual reality (VR) using a head-mounted display versus treatment as usual (TAU). Patients followed the "Aqua" module (Oncomfort™) consisting of a scuba dive and breathing exercises. They experienced a self-induced dissociative state similar to clinical hypnosis without direct intervention of a professional. Enrollment followed a 1:1 randomized open study (VR or TAU). Patients' feelings were evaluated just before and after the procedure, and 3 months following intervention. Anxiety was evaluated using the State Trait Anxiety Inventory (STAI) and pain (sensory, emotional, and memory) with a visual analogue scale (VAS). RESULTS This study included 100 patients. Mean anxiety (pre-post) was significantly reduced within groups and between groups (difference of 4.2 points, p = 0.016). The percentage of responders to anxiety lowering were 76 and 46% for VR and TAU, respectively (p = 0.004). The two groups did not significantly differ in mean sensory-intensity and affective emotional pain (pre-post) using VAS, in negative memories concerning remembered pain at 3 months (difference > 1 from immediate post-procedural reported pain intensity), mean procedural time, or the need for analgesic or sedative drugs. CONCLUSIONS VR self-hypnosis has the potential to improve the management of patients' distress during radiological procedures. It is safe and effective for reducing anxiety during EVI.
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Affiliation(s)
- Giuseppe Gullo
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
| | - David Christian Rotzinger
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland
| | - Anaïs Colin
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland
| | - Pierre Frossard
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland
| | - Louis Gudmundsson
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland
| | - Anne-Marie Jouannic
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland
| | - Salah Dine Qanadli
- Department of Diagnostic and Interventional Radiology, Cardiothoracic and Vascular Unit, University Hospital, Rue du Bugnon 46, CH - 1011, Lausanne, Switzerland.
- Faculty of Biology and Medicine (FBM), University of Lausanne (UNIL), Lausanne, Switzerland.
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16
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Kosonogov VV, Efimov KV, Rakhmankulova ZK, Zyabreva IA. Review of Psychophysiological and Psychotherapeutic Studies of Stress Using Virtual Reality Technologies. NEUROSCIENCE AND BEHAVIORAL PHYSIOLOGY 2023; 53:81-91. [PMID: 36969359 PMCID: PMC10006560 DOI: 10.1007/s11055-023-01393-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 12/20/2022] [Indexed: 03/13/2023]
Abstract
This review addresses the use of virtual reality technologies in the psychophysiology and psychotherapy of stress. Studies using virtual reality both to introduce subjects into a state of stress and to help reduce stress reactions are reviewed. Methods developed for treating patients suffering from stress-related disorders (in particular, PTSD and phobias) are described. In many cases, reductions in stress reactions with the help of virtual reality systems are achieved not only at the self-report (experiential) level, but also at the level of central and peripheral nervous system measures. This allows virtual reality to be regarded as a modern, inexpensive, and effective method, firstly, for introducing subjects into a state of stress with the aim of testing various hypotheses in psychophysiology and, secondly, to reduce stress reactions.
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Affiliation(s)
- V. V. Kosonogov
- Institute of Cognitive Neurosciences, HSE University, Moscow, Russia
| | - K. V. Efimov
- Institute of Cognitive Neurosciences, HSE University, Moscow, Russia
| | | | - I. A. Zyabreva
- Institute of Cognitive Neurosciences, HSE University, Moscow, Russia
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17
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Comparcini D, Simonetti V, Galli F, Saltarella I, Altamura C, Tomietto M, Desaphy JF, Cicolini G. Immersive and Non-Immersive Virtual Reality for Pain and Anxiety Management in Pediatric Patients with Hematological or Solid Cancer: A Systematic Review. Cancers (Basel) 2023; 15:cancers15030985. [PMID: 36765945 PMCID: PMC9913167 DOI: 10.3390/cancers15030985] [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: 01/02/2023] [Revised: 01/31/2023] [Accepted: 02/01/2023] [Indexed: 02/09/2023] Open
Abstract
Invasive and painful procedures, which often induce feelings of anxiety, are necessary components of pediatric cancer treatment, and adequate pain and anxiety management during these treatments is of pivotal importance. In this context, it is widely recognized that a holistic approach, including pharmacological and non-pharmacological modalities, such as distraction techniques, should be the standard of care. Recent evidence suggested the use of virtual reality (VR) as an effective non-pharmacological intervention in pediatrics. Therefore, this systematic review aims to analyze previously published studies on the effectiveness of VR for the management of pain and/or anxiety in children and adolescents with hematological or solid cancer. Medline, SCOPUS, Web of Science, ProQuest, CINAHL, and The Cochrane Central Register of Controlled Trials were used to search for relevant studies in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. Randomized controlled trial, crossover trial, cluster randomized trial, and quasi-experimental studies were included. Thirteen studies, published between 1999 and 2022, that fulfilled the inclusion criteria were included. Regarding the primary outcomes measured, pain was considered in five studies, anxiety in three studies, and the remaining five studies analyzed the effectiveness of VR for both pain and anxiety reduction. Our findings suggested a beneficial effect of VR during painful vascular access procedures. Limited data are available on the reduction of anxiety in children with cancer.
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Affiliation(s)
- Dania Comparcini
- Degree Course in Nursing, Faculty of Medicine and Surgery, Politecnica delle Marche University, 60121 Ancona, Italy
| | - Valentina Simonetti
- Department of Medicine and Surgery, LUM University, 70010 Casamassima, Italy
| | - Francesco Galli
- Degree Course in Nursing, Faculty of Medicine and Surgery, Politecnica delle Marche University, 60121 Ancona, Italy
| | - Ilaria Saltarella
- Section of Pharmacology, Department of Precision and Regenerative Medicine and Ionian Area, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Interdepartmental Center for Research in Telemedicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Concetta Altamura
- Section of Pharmacology, Department of Precision and Regenerative Medicine and Ionian Area, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Interdepartmental Center for Research in Telemedicine, University of Bari Aldo Moro, 70124 Bari, Italy
| | - Marco Tomietto
- Department of Nursing, Midwifery and Health, Faculty of Health and Life Sciences, Northumbria University, Newcastle upon Tyne NE1 8ST, UK
| | - Jean-François Desaphy
- Section of Pharmacology, Department of Precision and Regenerative Medicine and Ionian Area, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Interdepartmental Center for Research in Telemedicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Correspondence: (J.-F.D.); (G.C.)
| | - Giancarlo Cicolini
- Interdepartmental Center for Research in Telemedicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Section of Nursing, Department of Precision and Regenerative Medicine and Ionian Area, School of Medicine, University of Bari Aldo Moro, 70124 Bari, Italy
- Correspondence: (J.-F.D.); (G.C.)
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18
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Guidelines for Wide-Awake Local Anesthesia Surgery with No Tourniquet in the Office Setting Using Field Preparation Sterility. Plast Reconstr Surg 2023; 151:267e-273e. [PMID: 36696323 DOI: 10.1097/prs.0000000000009850] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
SUMMARY Wide-awake local anesthesia surgery with no tourniquet, or WALANT, has become popular in surgery, especially among hand surgeons. With the increasing number of surgeons performing office-based procedures, this article provides guidelines that may be used in the office setting to help transition more traditional hospital operating room-based procedures to the office setting. This article outlines the benefits of performing office-based wide-awake local anesthesia surgery with no tourniquet and provides a step-by-step guide to performing procedures that can be easily incorporated into any hand surgeon's practice successfully and safely.
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Poot CC, Meijer E, Bruil A, Venema M, Vegt NJH, Donkel N, van Noort V, Chavannes NH, Roest AAW. How to use participatory design to develop an eHealth intervention to reduce preprocedural stress and anxiety among children visiting the hospital: The Hospital Hero app multi-study and pilot report. Front Pediatr 2023; 11:1132639. [PMID: 36865696 PMCID: PMC9971988 DOI: 10.3389/fped.2023.1132639] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2022] [Accepted: 01/24/2023] [Indexed: 02/18/2023] Open
Abstract
BACKGROUND Medical procedures can cause considerable stress and anxiety among children. Current interventions mainly diminish stress and anxiety during procedures, while stress and anxiety often build up at home. Moreover, interventions often focus on either distraction or preparation. eHealth can combine multiple strategies and provide a low-cost solution that can be used outside the hospital. OBJECTIVE To develop an eHealth solution to diminish preprocedural stress and anxiety, and to evaluate the app on use, usability and user experience in practice. We also aimed to gain in-depth insights in children's and caregivers' opinions and experiences to inform future improvements. METHODS This is a multi-study report on the development (Study 1) and evaluation (Study 2) of a first version of the developed app. In study 1 we adopted a participatory design approach in which children's experiences were central to the design process. We performed an experience journey session with stakeholders (n = 13) to map the child's outpatient journey, identify pains and gains, and formulate the desired experience journey. Iterative development and testing with children (n = 8) and caregivers (n = 6) resulted in a working prototype. The prototype was tested with children, resulting in a first version of the Hospital Hero app. The app was evaluated on use, user-experience and usability during an eight-week pilot study in practice (Study 2). We triangulated data from online interviews with children and caregivers (n = 21) and online questionnaires (n = 46). RESULTS Multiple stress and anxiety experience touchpoints were identified. The Hospital Hero app supports children in their hospital journey by facilitating preparation at home and providing distraction at the hospital. The pilot study showed that the app was evaluated positively on usability and user-experience and is considered feasible. Qualitative data showed five themes: (1) user-friendliness, (2) coherence and power of storytelling, (3) motivation and reward, (4) fit with real hospital journey, (5) procedural comfort. DISCUSSION Using participatory design, we developed a child-centered solution that supports children in the entire hospital journey and may diminish preprocedural stress and anxiety. Future efforts should create a more tailored journey, define an optimal engagement window and formulate implementation strategies.
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Affiliation(s)
- Charlotte C Poot
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands
| | - Eline Meijer
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands
| | | | - Melanie Venema
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Niko J H Vegt
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands.,Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands
| | - Nicole Donkel
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Veronique van Noort
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
| | - Niels H Chavannes
- Department of Public Health and Primary Care, Leiden University Medical Centre, Leiden, Netherlands.,National EHealth Living Lab (NeLL), Leiden University Medical Centre, Leiden, Netherlands
| | - Arno A W Roest
- The Willem-Alexander Pediatric Hospital, Leiden University Medical Centre, Leiden, Netherlands
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Virtual Reality Reduces Fear and Anxiety During Pediatric Orthopaedic Cast Room Procedures: A Randomized Controlled Trial. J Pediatr Orthop 2022; 42:600-607. [PMID: 36040069 DOI: 10.1097/bpo.0000000000002250] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND Virtual Reality (VR) has been used as a distraction tool in various medical settings to reduce pain and anxiety associated with procedures. This study evaluates the effectiveness of VR as a distraction tool for decreasing fear, anxiety, and pain in pediatric patients undergoing common outpatient orthopaedic procedures. METHODS A total of 210 patients were recruited from a single orthopaedic clinic between October 2017 and July 2019. Patients were randomized to the VR group or to the control group (standard of care). Outpatient procedures included cast and/or pin removals. Primary outcome measures were collected preprocedure and postprocedure using validated surveys, and included: fear (Children's Fear Scale), anxiety (Children's Anxiety Meter-State), and pain (Numerical Rating Scale). Patients and caregivers in the VR group completed a satisfaction survey at the end of their appointment. Fear, anxiety, and pain scores between the 2 groups were analyzed using multivariable linear regression models, and the satisfaction survey was analyzed using descriptive statistics. RESULTS One hundred twenty nine patients were included in the final analysis, with 85 patients in the VR group and 44 patients in the control group. During the procedure, patients in the VR group reported significantly lower average fear scores ( P <0.001) and anxiety scores ( P =0.003) as compared with controls. There were no differences between the groups in fear and anxiety scores before and after the procedure, or pain scores before, during, or after the procedure. Overall, patients and caregivers in the VR group reported high satisfaction scores, with 97% of patients and 95% of caregivers recommending this intervention to others. CONCLUSION VR technology was found to be an effective distraction tool to improve fear and anxiety during cast removal procedures. Findings build on a body of evidence that supports the use of distraction tools in clinics, specifically pediatric orthopaedics, to improve fear and anxiety. The distraction tools can be easily translated into current practices. LEVEL OF EVIDENCE Level I.
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21
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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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Kaya M, Karaman Özlü Z. The effect of virtual reality on pain, anxiety, and fear during burn dressing in children: A randomized controlled study. Burns 2022; 49:788-796. [PMID: 35753857 DOI: 10.1016/j.burns.2022.06.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2022] [Revised: 05/18/2022] [Accepted: 06/01/2022] [Indexed: 11/02/2022]
Abstract
AIM AND OBJECTIVES Virtual Reality (VR) can be used during painful procedures in children. This research was conducted to determine the effect of VR on the pain, anxiety, and fear levels experienced by patients during burn dressing. METHODS A randomized between groups study design was used to test whether VR reduced pain, fear, and anxiety during burn wound cleaning. The experimental (VR group) (n = 33) and the control group (n = 32) were determined using the simple randomization method for the children participating in the study (n = 65). The data were collected using the Wong-Baker FACES Pain Rating Scale, Children's Fear Scale, and State- Trait Anxiety Inventory for Children. In addition, oxygen saturation and heart rate measurements were recorded before and after the procedure. RESULTS Using a between groups t-test, burn injured children in the group that received virtual reality (M = 2.6, SD = 1.9, SE= 0.21) showed significantly less pain intensity during burn wound care than the No VR control group (M = 4.2, SD =1.0, SE= 0.19, t = -5.89, p < 0.005). Similarly, the VR group reported significantly lower fear during wound care (M= 2.24, SD = 1.1, SE=0.19) than the No VR control group (M=3.72, SD = 0.6, SE=0.10, t = 6.70, p < 0.005), and on a scale from 0 to 100, patients in the VR group showed significantly less anxiety (36.46, SD = 8.1, SE=1.40) than patients in the No VR group (M= 53.16, SD = 7.4, SE=1.35, t = 8.52, p < 0.005). Heart rate during wound care was significantly lower in the VR group (M=119.60, SD = 8.1, SE=1.40) than in the No VR control group (M=129.56, SD = 10.64, SE=1.88, t = -4.25, p < 0.005). However, no significant difference in Oxygen saturation was found, (VR = 97.03, SD = 0.90, SE= 0.17, vs. No VR = 96.94, SD = 0.29, SE=0.23, t = 0.326, p > 0.05). CONCLUSIONS VR is an effective method in reducing pain, fear, and anxiety caused by burn dressing in children aged 7-12. The use of VR during burn dressing was determined to have positive results on some physical and psychological parameters.
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Affiliation(s)
- Merve Kaya
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey.
| | - Zeynep Karaman Özlü
- Department of Surgical Nursing, Faculty of Nursing, Ataturk University, Erzurum, Turkey
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Fuller C, Huang H, Thienprayoon R. Managing Pain and Discomfort in Children with Cancer. Curr Oncol Rep 2022; 24:961-973. [PMID: 35353347 DOI: 10.1007/s11912-022-01277-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/01/2022] [Indexed: 12/12/2022]
Abstract
PURPOSE OF REVIEW Approximately 15,600 children are diagnosed with cancer annually. Many of these children have cancer-related pain that improves with cancer treatment, but some develop intractable pain from cancer progression or sequelae from treatment modalities. The purpose of this paper is to provide a critical evaluation of the literature relevant to pain management in children with cancer. We intend to emphasize important and up-to-date findings in pharmacology, interventional pain management, and complementary and alternative medicine. RECENT FINDINGS Alternative medications and routes of administration, complementary and alternative medicine techniques, and interventional pain procedures offer possible routes for a multi-pronged pediatric cancer pain management plan, although high-level data is often lacking. To improve pediatric cancer pain management, a multifaceted approach embracing the biopsychosocial model of pain is recommended, incorporating evidence-based pharmacology, complementary and alternative medicine techniques, and if needed, interventional pain procedures.
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Affiliation(s)
- Clinton Fuller
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Ste A3300, Houston, TX, USA.
| | - Henry Huang
- Department of Anesthesiology, Perioperative and Pain Medicine, Texas Children's Hospital, Baylor College of Medicine, 6621 Fannin St, Ste A3300, Houston, TX, USA
| | - Rachel Thienprayoon
- Departments of Pediatrics and Anesthesia, Division of Palliative Care, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
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Moriconi V, Maroto C, Cantero-García M. Efectividad de la Realidad Virtual (RV) en la disminución del distrés de niños y adolescentes con cáncer: Revisión sistemática. PSICOONCOLOGIA 2022. [DOI: 10.5209/psic.80797] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Introducción: Aunque se han publicado muchos estudios que han intentado demostrar la eficacia de diferentes tratamientos psicológicos en pacientes con cáncer; hasta la fecha no se ha revisado la evidencia disponible sobre la eficacia de la Realidad Virtual (RV) para disminuir el distrés en niños y adolescentes con cáncer. Objetivo: El objetivo principal es evaluar la efectividad de la intervención con Realidad virtual en la disminución del distrés que padecen los niños y adolescentes con cáncer ante los procedimientos médicos, la hospitalización, o la propia enfermedad. Resultados: De los 22 artículos encontrados, se han seleccionado para la revisión un total de 8, que seguían un diseño experimental o cuasiexperimental en pacientes niños y jóvenes diagnosticados de cáncer tratados con RV. Conclusiones: Los resultados, aunque heterogéneos, sugieren mejorías a medio–largo plazo en las variables de ansiedad, depresión, aceptación, calidad de vida, distrés y flexibilidad psicológica. Además, la RV ha resultado ser más eficaz que otras técnicas. De este modo, a pesar de las limitaciones encontradas en este estudio, se han obtenido resultados prometedores para futuras revisiones y/ o metaanálisis.
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Addab S, Hamdy R, Thorstad K, May S, Tsimicalis A. Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review. J Clin Nurs 2022; 31:3032-3059. [DOI: 10.1111/jocn.16217] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 11/23/2021] [Accepted: 12/16/2021] [Indexed: 01/06/2023]
Affiliation(s)
- Sofia Addab
- Experimental Surgery Faculty of Medicine McGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Reggie Hamdy
- Experimental Surgery Faculty of Medicine McGill University Montreal Quebec Canada
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Kelly Thorstad
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
| | - Sylvie May
- CHU Ste‐Justine Montreal Quebec Canada
- Faculty of Nursing Université de Montréal Montreal Quebec Canada
| | - Argerie Tsimicalis
- Shriners Hospitals for Children®‐Canada Montreal Quebec Canada
- Ingram School of Nursing McGill University Montreal Quebec Canada
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Tran Thi TH, Konara Mudiyanselage SP, Huang MC. Effects of Distraction on Reducing Pain During Invasive Procedures in Children with Cancer: A Systematic Review and Meta-Analysis. Pain Manag Nurs 2022; 23:281-292. [PMID: 35031216 DOI: 10.1016/j.pmn.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 11/24/2021] [Accepted: 12/08/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Distraction is a known behavioral intervention that is widely used for pain management in the pediatric population. However, there is a shortage of reviews reporting the efficacy of distraction for procedural pain reduction in pediatric oncology settings. AIM To determine the current evidence on the effects of distraction on procedural pain in children with cancer. DESIGN This systematic review and meta-analysis was undertaken according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines SETTINGS: Six different databases from 1990 to June 2019. METHOD A literature search was conducted to identify the effects of distraction on procedural pain reduction in children with cancer. A meta-analysis was undertaken along with applying a mixed effect model to quantify the standardized mean difference in the 95% confidence interval (CI) as the overall effects. RESULTS Ten randomized controlled trials were included. Distraction during an invasive procedure had a large effect on pain intensity (-0.92, 95% CI -1.48 to -0.36, p = .001) and on needle insertion as well (-1.12, 95% CI -1.52 to -0.72, p = .000), but only a moderate effect on lumbar puncture procedures (-0.57, 95% CI -1.02 to -0.12, p = .012). Uncertain effects on pain relief showed up in a virtual reality (VR) distraction (-0.93, 95% CI -2.63 to 0.76, p = .28) and during active distraction (-0.72, 95% CI -1.48 to 0.03, p = .06). CONCLUSIONS Distraction is an efficacious intervention to reduce procedural pain during needle insertion or lumbar puncture procedures in children with cancer. However, the efficacy of active distraction and VR remain uncertain. Future research should focus on specific comparisons of different forms of distractions with larger sample sizes.
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Affiliation(s)
- Thu Hang Tran Thi
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; Department of Nursing and Medical Technology, Pham Ngoc Thach University of Medicine, Vietnam
| | | | - Mei-Chih Huang
- Department of Nursing, College of Medicine, National Cheng Kung University, Taiwan; Deaprtment of Nursing, National Tainan Junior College of Nursing, Taiwan.
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Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis. Br J Anaesth 2021; 127:608-619. [PMID: 34340838 DOI: 10.1016/j.bja.2021.06.039] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/19/2021] [Accepted: 06/09/2021] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND Procedural pain and anxiety in children can be poorly controlled, leading to significant short- and long-term sequelae, such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children's procedural pain and anxiety, including the effect of different types of video games on those outcomes. METHODS We conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared with standard care in children (0-18 yr) undergoing painful procedures. We searched the databases MEDLINE, Embase, and PsycINFO. We conducted random-effects meta-analysis using 'R' of children's procedural pain and anxiety and caregivers' anxiety. RESULTS Of 2185 studies screened, 36 were eligible (n=3406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children's procedural pain (standardised mean difference [SMD]=-0.43; 95% confidence interval [CI]: -0.67 to -0.20), anxiety (SMD=0.61; 95% CI: -0.88 to -0.34), and caregivers' procedural anxiety (SMD=-0.31; 95% CI: -0.58 to -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared with standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. CONCLUSIONS Our findings support introducing easily available video games, such as distraction-based conventional video games, into routine practice to minimise paediatric procedural pain and child/caregiver anxiety.
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Fu H, Garrett B, Tao G, Cordingley E, Ofoghi Z, Taverner T, Sun C, Cheung T. Virtual Reality-Guided Meditation for Chronic Pain in Patients With Cancer: Exploratory Analysis of Electroencephalograph Activity. JMIR BIOMEDICAL ENGINEERING 2021; 6:e26332. [PMID: 38907380 PMCID: PMC11135186 DOI: 10.2196/26332] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 04/23/2021] [Accepted: 04/29/2021] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Mindfulness-based stress reduction has demonstrated some efficacy for chronic pain management. More recently, virtual reality (VR)-guided meditation has been used to assist mindfulness-based stress reduction. Although studies have also found electroencephalograph (EEG) changes in the brain during mindfulness meditation practices, such changes have not been demonstrated during VR-guided meditation. OBJECTIVE This exploratory study is designed to explore the potential for recording and analyzing EEG during VR experiences in terms of the power of EEG waveforms, topographic mapping, and coherence. We examine how these measures changed during a VR-guided meditation experience in participants with cancer-related chronic pain. METHODS A total of 10 adult patients with chronic cancer pain underwent a VR-guided meditation experience while EEG signals were recorded during the session using a BioSemi ActiveTwo system (64 channels, standard 10-20 configuration). The EEG recording session consisted of an 8-minute resting condition (pre), a 30-minute sequence of 3 VR-guided meditation conditions (med), and a final rest condition (post). Power spectral density (PSD) was compared between each condition using a cluster-based permutation test and across conditions using multivariate analysis of variance. A topographic analysis, including coherence exploration, was performed. In addition, an exploratory repeated measures correlation was used to examine possible associations between pain scores and EEG signal power. RESULTS The predominant pattern was for increased β and γ bandwidth power in the meditation condition (P<.025), compared with both the baseline and postexperience conditions. Increased power in the δ bandwidth was evident, although not statistically significant. The pre versus post comparison also showed changes in the θ and α bands (P=.02) located around the frontal, central, and parietal cortices. Across conditions, multivariate analysis of variance tests identified 4 clusters with significant (P<.05) PSD differences in the δ, θ, β, and γ bands located around the frontal, central, and parietal cortices. Topographically, 5 peak channels were identified: AF7, FP2, FC1, CP5, and P5, and verified the changes in power in the different brain regions. Coherence changes were observed primarily between the frontal, parietal, and occipital regions in the θ, α, and γ bands (P<.0025). No significant associations were observed between pain scores and EEG PSD. CONCLUSIONS This study demonstrates the feasibility of EEG recording in exploring neurophysiological changes in brain activity during VR-guided meditation and its effect on pain reduction. These findings suggest that distinct altered neurophysiological brain signals are detectable during VR-guided meditation. However, these changes were not necessarily associated with pain. These exploratory findings may guide further studies to investigate the highlighted regions and EEG bands with respect to VR-guided meditation. TRIAL REGISTRATION ClinicalTrials.gov NCT00102401; http://clinicaltrials.gov/ct2/show/NCT00102401.
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Affiliation(s)
- Henry Fu
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
| | - Bernie Garrett
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Gordon Tao
- School of Rehabilitation Sciences, University of British Columbia, Vancouver, BC, Canada
| | - Elliott Cordingley
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Zahra Ofoghi
- School of Interactive Arts and Technology, Simon Fraser University, Surrey, BC, Canada
| | - Tarnia Taverner
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Crystal Sun
- School of Nursing, University of British Columbia, Vancouver, BC, Canada
| | - Teresa Cheung
- School of Engineering Science, Simon Fraser University, Burnaby, BC, Canada
- Surrey Memorial Hospital, Fraser Health Authority, Surrey, BC, Canada
- Behavioural and Cognitive Neuroscience Institute, Simon Fraser University, Burnaby, BC, Canada
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Lewandowski K, Kaniewska M, Rosołowski M, Kucha P, Rydzewska G. The Use of Virtual Reality to Reduce Stress among Inflammatory Bowel Disease Patients Treated with Vedolizumab. J Clin Med 2021; 10:jcm10122709. [PMID: 34205323 PMCID: PMC8235083 DOI: 10.3390/jcm10122709] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Revised: 06/15/2021] [Accepted: 06/17/2021] [Indexed: 11/26/2022] Open
Abstract
(1) Background: The use of virtual reality (VR) in improving patient comfort related to medical procedures in oncology patients raised the question of whether similar benefits could be obtained by patients with inflammatory bowel disease (IBD). (2) Methods: In this prospective, randomized, controlled, single-center clinical trial, a total of 90 patients with IBD treated with vedolizumab were enrolled and randomized in a 1:1 allocation to either the VR immersion group or the routine-treated group. The primary outcome was to evaluate whether VR could decrease stress and anxiety related to a medical procedure. The secondary outcome was to assess the safety of the VR. (3) Results: A statistically significant improvement in well-being and psychological comfort (p = 0.046), feeling of relaxation (p = 0.046), sense of influence on the treatment process (p < 0.001), improved perception of the way the drug works (p < 0.001), improved positive attitude while waiting for the next administration of the drug (p = 0.026), and increased motivation for treatment (p = 0.026) was noticed in the intervention group. There were no statistically significant differences in the incidence of complications in the intervention and control groups. (4) Conclusions: The use of VR had a positive effect on the reduction of stress associated with vedolizumab treatment and could improve compliance.
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Affiliation(s)
- Konrad Lewandowski
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Inferior and Administration, 02-507 Warsaw, Poland; (K.L.); (P.K.); (G.R.)
| | - Magdalena Kaniewska
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Inferior and Administration, 02-507 Warsaw, Poland; (K.L.); (P.K.); (G.R.)
- Correspondence: ; Tel.: +48-477-22-1242
| | - Mariusz Rosołowski
- Department of Internal Medicine and Hypertension, Medical University of Bialystok, 15-276 Białystok, Poland;
- Department of Hypertension, Gastroenterology and Internal Medicine, Medical University of Bialystok Clinical Hospital, 15-276 Białystok, Poland
| | - Piotr Kucha
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Inferior and Administration, 02-507 Warsaw, Poland; (K.L.); (P.K.); (G.R.)
| | - Grażyna Rydzewska
- Clinical Department of Internal Medicine and Gastroenterology with Inflammatory Bowel Disease Unit, Central Clinical Hospital of the Ministry of the Inferior and Administration, 02-507 Warsaw, Poland; (K.L.); (P.K.); (G.R.)
- Collegium Medicum, Jan Kochanowski University, 25-317 Kielce, Poland
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30
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Buche H, Michel A, Piccoli C, Blanc N. Contemplating or Acting? Which Immersive Modes Should Be Favored in Virtual Reality During Physiotherapy for Breast Cancer Rehabilitation. Front Psychol 2021; 12:631186. [PMID: 33897539 PMCID: PMC8060650 DOI: 10.3389/fpsyg.2021.631186] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Background Even though virtual reality (VR) is more and more considered for its power of distraction in different medical contexts, the optimal conditions for its use still have to be determined in order to design interfaces adapted to therapeutic support in oncology. Objective The objective of this study was to examine the benefits of VR using two immersion methods (i.e., one participatory, one contemplative) and comparing them with each other in a population of women with breast cancer who have undergone breast surgery, during scar massage sessions. Methods In a physiotherapy center, each patient participated in four experimental conditions in a random order: two sessions used virtual immersion (i.e., one participatory and one contemplative), one session proposed musical listening and the fourth one was a standard session care. The impact of the level of patient involvement in the virtual world was apprehended through the evaluation of the feeling of presence; the estimation of elapsed time of the physiotherapy sessions and particular attention was paid to the evaluation of patient emotional state. Results Our study showed an increase in positive emotions (i.e., joy and happiness) and a decrease in anxiety regardless which support methods were offered. Participatory VR created a feeling of more intense spatial presence. Conclusion Our results highlight the importance of the context in which VR should be offered. The presence of the practitioner and his interactions with the patient can provide a context just as favorable in reducing anxiety as the emotional regulation tools used (VR, music). The use of technological tools should be favored when the practitioner is unavailable during the treatment phase or, even, in order to reduce the monotonous nature of repetitive therapeutic sessions.
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Affiliation(s)
- Hélène Buche
- Laboratoire Epsylon EA 4556, Université Paul Valéry, Montpellier III, Montpellier, France
| | - Aude Michel
- Laboratoire Epsylon EA 4556, Université Paul Valéry, Montpellier III, Montpellier, France.,Montpellier Institut du Sein, Clinique Clémentville, Montpellier, France
| | - Christina Piccoli
- Kinesitherapeute, Montpellier Institut du Sein, Clinique Clémentville, Montpellier, France
| | - Nathalie Blanc
- Laboratoire Epsylon EA 4556, Université Paul Valéry, Montpellier III, Montpellier, France
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Frasier K, Burker E, Chan DV. Tablet therapy as an assistive technology-based treatment for anxiety in pediatric oncology. Assist Technol 2021; 34:533-542. [PMID: 33544063 DOI: 10.1080/10400435.2021.1884919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The painful interventions and invasive procedures associated with pediatric cancer treatment can result in anxiety. Anxiety can be reduced or better controlled through distraction and thought retraining. Although art therapy, non-electronic play therapy, music therapy, and traditional counseling are often used to alleviate stress and anxiety, new technology innovations are proving to be additional options to decrease stress and anxiety through distraction and attention shifting. Tablet-based interventions are emerging as an easily available and effective means of reducing stress and fear prior to operations, and have potential applications to reduce anxiety for patients before receiving chemotherapy, during time spent in hospital rooms, and while experiencing distressing physiological symptoms. This paper reviews the research on tablet therapy and discusses the application of assistive technologies in clinical oncology settings to reduce pediatric anxiety throughout the treatment process.
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Affiliation(s)
- Kelly Frasier
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Eileen Burker
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
| | - Dara V Chan
- Division of Clinical Rehabilitation and Mental Health Counseling, Department of Allied Health Sciences, School of Medicine, The University of North Carolina at Chapel Hill, Chapel Hill, North Carolina, USA
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Chow H, Hon J, Chua W, Chuan A. Effect of Virtual Reality Therapy in Reducing Pain and Anxiety for Cancer-Related Medical Procedures: A Systematic Narrative Review. J Pain Symptom Manage 2021; 61:384-394. [PMID: 32822755 DOI: 10.1016/j.jpainsymman.2020.08.016] [Citation(s) in RCA: 21] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/13/2020] [Accepted: 08/14/2020] [Indexed: 12/19/2022]
Abstract
CONTEXT Virtual reality (VR) has emerged as a novel form of nonpharmacological analgesia therapy. We wished to review the use of VR to treat pain and anxiety in cancer-related medical procedures and chemotherapy. OBJECTIVES To determine if immersive VR influences pain and/or anxiety outcomes in patients with cancer undergoing medical interventions. To discuss critical limitations in the current evidence base and provide suggestions for future areas of research. METHODS A systematic review was performed on Ovid MEDLINE, PubMed, and Google Scholar from 1999 to December 2019. The following search terms were run in each of the databases: Virtual Reality and pain or anxiety. Articles were assessed by two independent authors for inclusion. RESULTS From 999 retrieved citations, nine studies met inclusion criteria for review. Methodological limitations and small sample sizes preclude strong guidance for clinical applications. Although studies demonstrated a trend toward improvement in pain and anxiety, only two studies reached statistical significance. CONCLUSION There is inconclusive evidence on the significance of immersive VR in reducing pain (five studies) or anxiety (six studies) for patients with cancer undergoing medical interventions or receiving chemotherapy. Further research on the effect of immersive VR as a tool for medical procedures and/or patients with cancer undergoing treatment is required.
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Affiliation(s)
- Howard Chow
- UNSW Sydney and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia.
| | - Joshua Hon
- UNSW Sydney and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia
| | - Wei Chua
- UNSW Sydney and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Sydney, New South Wales, Australia; Department of Medical Oncology, Liverpool Hospital, Liverpool, New South Wales, Australia
| | - Alwin Chuan
- UNSW Sydney and Ingham Institute of Applied Medical Research, Liverpool, New South Wales, Australia; Western Sydney University, Sydney, New South Wales, Australia; Department of Anaesthesia, Liverpool Hospital, Liverpool, New South Wales, Australia
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Virtual Reality Technology for Pain and Anxiety Management among Patients with Cancer: A Systematic Review. Pain Manag Nurs 2020; 21:601-607. [DOI: 10.1016/j.pmn.2020.04.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2018] [Revised: 03/12/2020] [Accepted: 04/15/2020] [Indexed: 11/17/2022]
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Gerçeker GÖ, Bektaş M, Aydınok Y, Ören H, Ellidokuz H, Olgun N. The effect of virtual reality on pain, fear, and anxiety during access of a port with huber needle in pediatric hematology-oncology patients: Randomized controlled trial. Eur J Oncol Nurs 2020; 50:101886. [PMID: 33321461 DOI: 10.1016/j.ejon.2020.101886] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 11/24/2020] [Accepted: 11/26/2020] [Indexed: 11/16/2022]
Abstract
PURPOSE Port needle insertions are painful and distressing for Pediatric Hematology-Oncology patients. Virtual Reality (VR) can be used during needle-related procedures in these patients. This study aimed to investigate the effect of VR distraction during access to the venous port with a Huber needle in reducing needle-related pain, fear, and anxiety of children and adolescents with cancer. METHODS This randomized controlled study used a parallel trial design guided by the CONSORT checklist. The sample of children (n = 42) was allocated to the VR group (n = 21) and the control group (n = 21). Port needle-related pain was assessed using the Wong-Baker Faces Pain Rating Scale after the procedure. Before and after the port needle insertion procedure, anxiety and fear assessed using self- and parent-report using the Children's Anxiety Meter and Child Fear Scale. The primary outcome was the patient-reported pain scores after the procedure and fear and anxiety scores before and after the procedure. Pain, anxiety, and fear scores of the two groups and within groups were analyzed and also Spearman correlation analysis was used. RESULTS Self-reported pain scores of patients in the VR and control group were 2.4 ± 1.8 and 5.3 ± 1.8, respectively. This study found a statistically significant difference between groups in pain scores (p < .001). A statistically significant difference was found between groups according to the self- and parent-reported fear and anxiety scores after the procedure. Self-reported fear scores in the VR and control group were 0.8 ± 0.9, 2.0 ± 1.0, self-reported anxiety scores were 2.9 ± 2.0, 5.4 ± 2.0, respectively (p < .001). CONCLUSION Virtual reality is an effective distraction method in reducing port needle-related pain, fear, and anxiety in Pediatric Hematology-Oncology patients. ClinicalTrials.gov NCT04093154.
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Affiliation(s)
- Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, 35340, Turkey.
| | - Murat Bektaş
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, 35340, Turkey.
| | - Yeşim Aydınok
- Ege University Hospital, Department of Paediatric Hematology-Oncology, Izmir, Turkey.
| | - Hale Ören
- Dokuz Eylül University Hospital, Department of Paediatric Hematology, Izmir, Turkey.
| | - Hülya Ellidokuz
- Dokuz Eylül University Hospital, Institue of Oncology, Izmir, Turkey.
| | - Nur Olgun
- Dokuz Eylül University Hospital, Department of Paediatric Oncology, Izmir, Turkey.
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Won AS, Pandita S, Kruzan KP. Social Interaction and Pain Threshold in Virtual Reality. CYBERPSYCHOLOGY, BEHAVIOR AND SOCIAL NETWORKING 2020; 23:829-845. [PMID: 33179974 PMCID: PMC7757604 DOI: 10.1089/cyber.2020.0055] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
This experiment examined the effects of social presence and perceived location of a virtual environment on participants' pain thresholds in a preregistered, within-subjects experiment. First, we examined the effects of social interaction versus being alone in a virtual environment. Second, we compared a virtual environment representing a remote location to a replication of the laboratory environment. Social interaction predicted increased pain tolerance, but there was no effect of the "location" of the virtual environment. To our knowledge, this research project is the first to use real-time social interaction in virtual reality as a distractor for experimental thermal pain, and the first to examine the potential interaction between social interaction and transportation to different virtual locations. While this task is not directly analogous to the experience of pain in a medical setting, this preliminary study indicates future avenues for patient treatment. Clinical Trial Registration number: 1701006910.
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Affiliation(s)
| | - Swati Pandita
- Department of Communication, Cornell University, Ithaca, New York, USA
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Yap KYL, Koh DWH, Lee VSJ, Wong LL. Use of virtual reality in the supportive care management of paediatric patients with cancer. THE LANCET CHILD & ADOLESCENT HEALTH 2020; 4:899-908. [DOI: 10.1016/s2352-4642(20)30240-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Revised: 05/24/2020] [Accepted: 06/10/2020] [Indexed: 12/20/2022]
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Lambert V, Boylan P, Boran L, Hicks P, Kirubakaran R, Devane D, Matthews A. Virtual reality distraction for acute pain in children. Cochrane Database Syst Rev 2020; 10:CD010686. [PMID: 33089901 PMCID: PMC8094164 DOI: 10.1002/14651858.cd010686.pub2] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
BACKGROUND Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The effectiveness of VR distraction on acute pain intensity in children is uncertain. OBJECTIVES To assess the effectiveness and adverse effects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors. SELECTION CRITERIA Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. DATA COLLECTION AND ANALYSIS We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse effects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. MAIN RESULTS We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their different perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision. 1: VR distraction versus no distraction Acute pain intensity: during procedure Self-report: one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Observer-report: no data. Behavioural measurements (observer-report): two studies, 62 participants; low-certainty evidence. One study (n = 42) found no beneficial effect of non-immersive VR. One study (n = 20) found a beneficial effect favouring immersive VR. Acute pain intensity: post-procedure Self-report: 10 studies, 461 participants; very low-certainty evidence. Four studies (n = 95) found no beneficial effect of immersive and semi-immersive or non-immersive VR. Five studies (n = 357) found a beneficial effect favouring immersive VR. Another study (n = 9) reported less pain in the VR group. Observer-report: two studies (216 participants; low-certainty evidence) found a beneficial effect of immersive VR, as reported by primary caregiver/parents or nurses. One study (n = 80) found a beneficial effect of immersive VR, as reported by researchers. Behavioural measurements (observer-report): one study (42 participants) found no beneficial effect of non-immersive VR (very low-certainty evidence). Adverse effects: five studies, 154 participants; very low-certainty evidence. Three studies (n = 53) reported no adverse effects. Two studies (n = 101) reported mild adverse effects (e.g. nausea) in the VR group. 2: VR distraction versus other non-VR distraction Acute pain intensity: during procedure Self-report, observer-report and behavioural measurements (observer-report): two studies, 106 participants: Self-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (very low-certainty evidence). Observer-report: one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) found no evidence of a difference in mean pain change scores (low-certainty evidence). Behavioural measurements (observer-report): one study (n = 65) found a beneficial effect favouring immersive VR and one (n = 41) reported a difference in mean pain change scores with fewer pain behaviours in VR group (low-certainty evidence). Acute pain intensity: post-procedure Self-report: eight studies, 575 participants; very low-certainty evidence. Two studies (n = 146) found a beneficial effect favouring immersive VR. Two studies (n = 252) reported a between-group difference favouring immersive VR. One study (n = 59) found no beneficial effect of immersive VR versus television and Child Life non-VR distraction. One study (n = 18) found no beneficial effect of semi-immersive VR. Two studies (n = 100) reported no between-group difference. Observer-report: three studies, 187 participants; low-certainty evidence. One study (n = 81) found a beneficial effect favouring immersive VR for parent, nurse and researcher reports. One study (n = 65) found a beneficial effect favouring immersive VR for caregiver reports. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Behavioural measurements (observer-report): two studies, 106 participants; low-certainty evidence. One study (n = 65) found a beneficial effect favouring immersive VR. Another study (n = 41) reported no evidence of a difference in mean pain change scores. Adverse effects: six studies, 429 participants; very low-certainty evidence. Three studies (n = 229) found no evidence of a difference between groups. Two studies (n = 141) reported no adverse effects in VR group. One study (n = 59) reported no beneficial effect in reducing estimated cyber-sickness before and after VR immersion. 3: VR distraction versus other VR distraction We did not identify any studies for this comparison. AUTHORS' CONCLUSIONS We found low-certainty and very low-certainty evidence of the effectiveness of VR distraction compared to no distraction or other non-VR distraction in reducing acute pain intensity in children in any healthcare setting. This level of uncertainty makes it difficult to interpret the benefits or lack of benefits of VR distraction for acute pain in children. Most of the review primary outcomes were assessed by only two or three small studies. We found limited data for adverse effects and other secondary outcomes. Future well-designed, large, high-quality trials may have an important impact on our confidence in the results.
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Affiliation(s)
- Veronica Lambert
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
| | - Patrick Boylan
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Lorraine Boran
- School of Psychology, Dublin City University, Dublin, Ireland
| | - Paula Hicks
- Centre for Innovative Human Systems, School of Psychology, Trinity College Dublin, Dublin, Ireland
| | - Richard Kirubakaran
- Cochrane South Asia, Prof. BV Moses Centre for Evidence-Informed Healthcare and Health Policy, Christian Medical College, Vellore, India
| | - Declan Devane
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Anne Matthews
- School of Nursing, Psychotherapy and Community Health, Dublin City University, Dublin, Ireland
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Liu KY, Ninan SJ, Laitman BM, Goldrich DY, Iloreta AM, Londino AV. Virtual Reality as Distraction Analgesia and Anxiolysis for Pediatric Otolaryngology Procedures. Laryngoscope 2020; 131:E1714-E1721. [PMID: 33017065 DOI: 10.1002/lary.29148] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/04/2020] [Accepted: 09/13/2020] [Indexed: 01/26/2023]
Abstract
OBJECTIVES/HYPOTHESIS While virtual reality (VR) has been used as analgesia and anxiolysis for invasive procedures, no literature exists on the use of VR in the pediatric otolaryngology setting. The purpose of this study was to determine the efficacy of VR in reducing pain and anxiety for pediatric otolaryngology patients. STUDY DESIGN Randomized controlled trial. METHODS A total of 53 patients aged 7-17 undergoing in-office nasal endoscopies were included. Patients were randomized to receive VR or standard of care. Procedural pain, anxiety, and satisfaction scores were recorded from patients and caregivers. The physician filled out a childhood emotional manifestation scale (CEMS). RESULTS Patients in VR group reported a significant decrease in pain (0.80 ± 1.06 vs. 2.26 ± 2.38, P = .018) and anxiety (9.50 ± 12.48 vs. 38.48 ± 29.83, P = .0002) and increase in procedural satisfaction (6.40 ± 0.77 vs. 4.74 ± 1.74, P = .0002) compared to patients in control group. CEMS scores were significantly reduced in VR group (5.15 ± 0.46 vs. 9.64 ± 5.66, P = .0001) and caregiver anxiety levels were significantly reduced in VR group (11.50 ± 17.67 vs. 27.39 ± 30.48, P = .041) compared to control group. There were no reported side effects. Procedural time did not significantly differ between groups. CONCLUSIONS For pediatric otolaryngology patients undergoing in-office nasal endoscopies, VR is a safe and effective form of distraction analgesia and anxiolysis, significantly reducing pain and increasing procedural satisfaction for patients. In addition, VR significantly reduces anxiety for both patients and caregivers without disrupting procedural efficiency and workflow. LEVEL OF EVIDENCE 2. Laryngoscope, 131:E1714-E1721, 2021.
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Affiliation(s)
- Katherine Y Liu
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Sen J Ninan
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Benjamin M Laitman
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - David Y Goldrich
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Alfred M Iloreta
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
| | - Aldo V Londino
- Department of Otolaryngology - Head and Neck Surgery, Icahn School of Medicine at Mount Sinai, New York, New York, U.S.A
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Georgescu R, Fodor LA, Dobrean A, Cristea IA. Psychological interventions using virtual reality for pain associated with medical procedures: a systematic review and meta-analysis. Psychol Med 2020; 50:1795-1807. [PMID: 31456530 DOI: 10.1017/s0033291719001855] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Virtual reality (VR) may enhance the effectiveness of psychological interventions for acute pain. We conducted a meta-analysis to assess the efficacy and safety of VR-based interventions for pain associated with medical procedures. METHODS We searched PubMed, EMBASE, the Cochrane Library, and PsycINFO until June 17th 2018. We identified randomized controlled trials (RCTs), comparing VR-based psychological interventions to usual care, for pain intensity (primary outcome) or affective and cognitive components of pain (secondary outcomes), assessed real-time or retrospectively. Two independent reviewers performed study selection and data extraction. Risk of bias was independently evaluated by three raters using the revised Cochrane Collaboration tool. A random-effects model using the Paule and Mandel estimator was used for pooling effect sizes. RESULTS 27 RCTs (1452 patients) provided enough data for meta-analysis. Compared to usual care, VR-based interventions reduced pain intensity both real-time (9 RCTs, Hedges' g = 0.95, 95% CI 0.32-1.57) and retrospectively (22 RCTs, g = 0.87, 95% CI 0.54-1.21). Results were similar for cognitive (8 RCTs, g = 0.82, 95% CI 0.39-1.26) and affective pain components (14 RCTs, g = 0.55, 95% CI 0.34-0.77). There was marked heterogeneity, which remained similarly high in sensitivity analyses. Across domains, few trials were rated as low risk of bias and there was evidence of publication bias. Adverse events were rare. CONCLUSIONS Though VR-based interventions reduced pain for patients undergoing medical procedures, inferring clinical effectiveness is precluded by the predominance of small trials, with substantial risk of bias, and by incomplete reporting.
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Affiliation(s)
- Raluca Georgescu
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Liviu A Fodor
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Evidence Based Psychological Assessment and Interventions Doctoral School, Babeș-Bolyai University, Cluj-Napoca, Romania
| | - Anca Dobrean
- International Institute for The Advanced Studies of Psychotherapy and Applied Mental Health, Babeș-Bolyai University, Cluj-Napoca, Romania
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
| | - Ioana A Cristea
- Department of Clinical Psychology and Psychotherapy, Babeş-Bolyai University, Republicii Street 37, 400015, Cluj-Napoca, Romania
- Department of Clinical, Neuro and Developmental Psychology, Vrije Universiteit, Amsterdam, The Netherlands
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İnangil D, Şendir M, Büyükyılmaz F. Efficacy of Cartoon Viewing Devices During Phlebotomy in Children: A Randomized Controlled Trial. J Perianesth Nurs 2020; 35:407-412. [DOI: 10.1016/j.jopan.2020.01.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2019] [Revised: 01/12/2020] [Accepted: 01/18/2020] [Indexed: 10/24/2022]
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Tennant M, Youssef GJ, McGillivray J, Clark TJ, McMillan L, McCarthy MC. Exploring the use of Immersive Virtual Reality to enhance Psychological Well-Being in Pediatric Oncology: A pilot randomized controlled trial. Eur J Oncol Nurs 2020; 48:101804. [PMID: 32949941 DOI: 10.1016/j.ejon.2020.101804] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Revised: 06/16/2020] [Accepted: 07/14/2020] [Indexed: 01/21/2023]
Abstract
PURPOSE To investigate whether Immersive Virtual Reality (VR) has a greater positive influence on oncology patients' physical and emotional mood states when compared to an iPad attentional control condition. Our secondary objective was to understand what factors influenced VR effectiveness. METHOD Participants were 90 oncology inpatients, aged 7-19 years, and their primary parent caregiver. Using a randomized controlled study design patients were allocated to VR (three content groups) or an iPad control condition. Pre-post-intervention self-report state measures were collected using visual analogue scales and an objective measure of physiological arousal (pulse rate). Post-intervention, patients reported on level of immersion, enjoyment and simulator sickness. RESULTS Patients benefited from both Immersive VR and novel iPad intervention with no statistically significant differences found between conditions on child outcomes. However, patients accessing Immersive VR consistently reported greater positive shifts in mood state and reductions in negative symptoms when compared with iPad. No change was observed in physiological arousal levels (pulse rate) in either condition before, during or immediately after intervention. Moderation analysis showed that the degree of child illness (PedsQL), sex, age, and level of immersion were important in influencing the magnitude of differences between the VR and iPad conditions on mood, anxiety and pain. CONCLUSIONS These preliminary findings support the use of Immersive VR in clinical oncology settings to improve patient well-being. Further studies examining the application of Immersive VR in supporting children adjusting to hospitalization and cancer treatment are therefore warranted. Factors found to moderate VR effectiveness provide important clinical implications.
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Affiliation(s)
- Michelle Tennant
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia; Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia; Children's Cancer Centre, The Royal Children's Hospital, Parkville, Victoria, 3052, Australia.
| | - George J Youssef
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Jane McGillivray
- School of Psychology, Faculty of Health, Deakin University, Geelong, Victoria, 3220, Australia; Deakin Child Study Centre, School of Psychology, Deakin University, Burwood, Victoria, 3125, Australia
| | - Tara-Jane Clark
- Children's Cancer Centre, The Royal Children's Hospital, Parkville, Victoria, 3052, Australia
| | - Laura McMillan
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
| | - Maria C McCarthy
- Clinical Sciences, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia; Children's Cancer Centre, The Royal Children's Hospital, Parkville, Victoria, 3052, Australia; Department of Paediatrics, University of Melbourne, Parkville, Victoria, 3052, Australia
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Wong J, Ghiasuddin A, Tamaye H, Siu A. Effectiveness of Virtual Reality Gaming on Pain Reduction in Children during PIV/PICC Placement. ACTA ACUST UNITED AC 2020. [DOI: 10.1007/s41347-020-00146-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Schlechter AK, Whitaker W, Iyer S, Gabriele G, Wilkinson M. Virtual reality distraction during pediatric intravenous line placement in the emergency department: A prospective randomized comparison study. Am J Emerg Med 2020; 44:296-299. [PMID: 32307295 DOI: 10.1016/j.ajem.2020.04.009] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 04/04/2020] [Accepted: 04/06/2020] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To evaluate the efficacy of virtual reality distraction (VR) during intravenous line (IV) placement in a pediatric emergency department to increase first-attempt IV success. Secondary endpoints included median time to successful IV placement, patient pain and anxiety scores, and an evaluation of characteristics of patients in whom VR is well tolerated. STUDY DESIGN This was a randomized controlled trial at a tertiary pediatric emergency department, enrolling patients aged 4-17 years who required IV placement. Patients were enrolled only when child life specialists were unavailable. The primary endpoint was first attempt IV success. RESULTS A total of 116 subjects were enrolled, 58 were randomly assigned to the VR group and 58 were assigned to the standard of care (SOC) group. 115 subjects completed the trial and were analyzed. First attempt IV success rates were similar between the groups (VR = 81%, standard = 84.2%, p = .65). Number of IV attempts and changes in pain and anxiety scores were also similar between the groups. The median time to successful IV placement was shorter in the VR group (78 vs 104 seconds) but this difference was not statistically significant (p = .21). Overall the VR headset was tolerated by 79% of subjects assigned to that group. The only significant predictor of headset tolerance was older age (P = .02). CONCLUSIONS VR distraction for IV placement in the Pediatric Emergency Department shows similar efficacy to standard distraction techniques and appears to be well tolerated.
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Affiliation(s)
- Anna K Schlechter
- The University of Texas at Austin, Dell Medical School, Department of Pediatrics, Division of Pediatric Emergency Medicine, United States of America.
| | - Winnie Whitaker
- The University of Texas at Austin, Dell Medical School, Department of Pediatrics, Division of Pediatric Emergency Medicine, United States of America
| | - Sujit Iyer
- The University of Texas at Austin, Dell Medical School, Department of Pediatrics, Division of Pediatric Emergency Medicine, United States of America
| | - Giovanni Gabriele
- The University of Texas at Austin, Dell Medical School, Department of Pediatrics, Division of Pediatric Emergency Medicine, United States of America
| | - Matthew Wilkinson
- The University of Texas at Austin, Dell Medical School, Department of Pediatrics, Division of Pediatric Emergency Medicine, United States of America
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Finkelstein JB, Cahill D, Graber K, Tulley K, O'Connell B, Mednick L, Rosoff JS, Bauer SB, Weinstock P, Estrada CR. Anxiety, distress, and pain in pediatric urodynamics. Neurourol Urodyn 2020; 39:1178-1184. [PMID: 32203630 DOI: 10.1002/nau.24339] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2020] [Accepted: 03/12/2020] [Indexed: 11/07/2022]
Abstract
AIMS No one has assessed urodynamic studies (UDS) to determine those steps that elicit the greatest anxiety, distress, and pain in children. We sought to systematically evaluate a child's UDS experience to mollify these reactions. METHODS Prospective study involving children aged ≥5 undergoing UDS over a 6-month period (from 10 December 2018 to 22 May 2019). Upon arrival, patients completed a visual analog scale for anxiety (VAS-A, 0-10) about the upcoming procedure. A research assistant assessed the patient's behavior during each major step of UDS using a validated brief behavioral distress scale. Nursing staff also obtained patients' pain ratings (0-10) for these key elements. Immediately after UDS, each child completed a posttest VAS-A along with a survey about the UDS experience. RESULTS A total of 76 UDS were observed; almost half included sphincter needle electromyography (EMG). Mean patient VAS-A scores were 2.3 before UDS, compared to 0.8 afterward (P < .001). The highest proportion of distressful behaviors were observed during EMG needle (31%) and urethral catheter (29%) insertion, in agreement with the highest mean pain scores of 3.2 and 2.7, respectively. Fifty-four percent of children reported not being completely aware of what was going to happen before the procedure and 50% of those patients exhibited at least one interfering or potentially interfering behavior. Similarly, 60% of children with no prior history of UDS exhibited at least one interfering or potentially interfering behavior. CONCLUSIONS EMG needle and urethral catheter placement, initial urodynamic testing and not knowing what to expect were associated with greater pain and distress during pediatric UDS.
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Affiliation(s)
| | - Dylan Cahill
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
| | - Kelsey Graber
- Simulator Program, Boston Children's Hospital, Boston, Massachusetts
| | - Kelsey Tulley
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts
| | - Brianna O'Connell
- Simulator Program, Boston Children's Hospital, Boston, Massachusetts.,Child Life Services, Boston Children's Hospital, Boston, Massachusetts
| | - Lauren Mednick
- Simulator Program, Boston Children's Hospital, Boston, Massachusetts.,Department of Psychiatry, Boston Children's Hospital, Boston, Massachusetts
| | - James S Rosoff
- Department of Urology, Yale School of Medicine, New Haven, Connecticut
| | - Stuart B Bauer
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
| | - Peter Weinstock
- Child Life Services, Boston Children's Hospital, Boston, Massachusetts.,Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, Connecticut
| | - Carlos R Estrada
- Department of Urology, Boston Children's Hospital, Boston, Massachusetts
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Jiang S. Positive Distractions and Play in the Public Spaces of Pediatric Healthcare Environments: A Literature Review. HERD-HEALTH ENVIRONMENTS RESEARCH & DESIGN JOURNAL 2020; 13:171-197. [DOI: 10.1177/1937586720901707] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: A positive distraction is a significant environmental feature that introduces positive feelings by diverting attention from stress or anxious thoughts. Existing research has deemed the application of positive distractions in pediatric environments to be significant. This study investigated the essential positive distractions and the associated health benefits. Aims: The aims of this study were to validate and extend evidence on positive distractions and play opportunities in the design of the public spaces in pediatric healthcare environments, translate existing evidence into design suggestions, and identify research gaps in this realm. Methods: A four-phased literature review method was employed in the study, including literature search, literature screening and selection, literature appraisal, and thematic analysis and in-depth discussion. Eventually, 27 peer-reviewed publications were reviewed and discussed in detail. Results/Conclusions: The gathered materials were grouped into six themes of positive distractions: (1) art and environmental aesthetics, (2) spatial arrangement and atrium, (3) considerations of socialization patterns, (4) play and interactive technologies, (5) sound and lighting interventions, and (6) access to nature. The research indicated that positive distractions in the pediatric healthcare environment provide a series of health benefits for patients, including improved behavioral and emotional well-being, reduced stress and anxiety, enhanced healthcare experience and satisfaction, and facilitated medical procedures and recovery. Yet significant research gaps emerged between positive distractions and play in garden spaces and spatial design to accommodate interactive technology and socialization in the public areas of pediatric healthcare environments. This study organized the understanding on the components of supportive environments and its outcomes for pediatric healthcare design.
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Affiliation(s)
- Shan Jiang
- School of Design and Community Development, West Virginia University, Morgantown, WV, USA
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Gates M, Hartling L, Shulhan-Kilroy J, MacGregor T, Guitard S, Wingert A, Featherstone R, Vandermeer B, Poonai N, Kircher J, Perry S, Graham TAD, Scott SD, Ali S. Digital Technology Distraction for Acute Pain in Children: A Meta-analysis. Pediatrics 2020; 145:peds.2019-1139. [PMID: 31969473 DOI: 10.1542/peds.2019-1139] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/04/2019] [Indexed: 12/14/2022] Open
Abstract
CONTEXT Digital distraction is being integrated into pediatric pain care, but its efficacy is currently unknown. OBJECTIVE To determine the effect of digital technology distraction on pain and distress in children experiencing acutely painful conditions or procedures. DATA SOURCES Medline, Embase, Cochrane Library, Cumulative Index to Nursing and Allied Health Literature, PsycINFO, Institute of Electrical and Electronics Engineers Xplore, Ei Compendex, Web of Science, and gray literature sources. STUDY SELECTION Quantitative studies of digital technology distraction for acutely painful conditions or procedures in children. DATA EXTRACTION Performed by 1 reviewer with verification. Outcomes were child pain and distress. RESULTS There were 106 studies (n = 7820) that reported on digital technology distractors (eg, virtual reality and video games) used during common procedures (eg, venipuncture, dental, and burn treatments). No studies reported on painful conditions. For painful procedures, digital distraction resulted in a modest but clinically important reduction in self-reported pain (standardized mean difference [SMD] -0.48; 95% confidence interval [CI] -0.66 to -0.29; 46 randomized controlled trials [RCTs]; n = 3200), observer-reported pain (SMD -0.68; 95% CI -0.91 to -0.45; 17 RCTs; n = 1199), behavioral pain (SMD -0.57; 95% CI -0.94 to -0.19; 19 RCTs; n = 1173), self-reported distress (SMD -0.49; 95% CI -0.70 to -0.27; 19 RCTs; n = 1818), observer-reported distress (SMD -0.47; 95% CI -0.77 to -0.17; 10 RCTs; n = 826), and behavioral distress (SMD -0.35; 95% CI -0.59 to -0.12; 17 RCTs; n = 1264) compared with usual care. LIMITATIONS Few studies directly compared different distractors or provided subgroup data to inform applicability. CONCLUSIONS Digital distraction provides modest pain and distress reduction for children undergoing painful procedures; its superiority over nondigital distractors is not established. Context, preferences, and availability should inform the choice of distractor.
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Affiliation(s)
- Michelle Gates
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Lisa Hartling
- Department of Pediatrics and .,Alberta Research Centre for Health Evidence, and
| | | | - Tara MacGregor
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Samantha Guitard
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Aireen Wingert
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Robin Featherstone
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Ben Vandermeer
- Department of Pediatrics and.,Alberta Research Centre for Health Evidence, and
| | - Naveen Poonai
- Department of Pediatrics and Internal Medicine, Schulieh School of Medicine and Dentistry, Western University, London, Canada
| | - Janeva Kircher
- Department of Pediatrics and.,Emergency Medicine, Faculty of Medicine and Dentistry
| | - Shirley Perry
- Women and Children's Health Research Institute, University of Albert, Edmonton, Canada
| | - Timothy A D Graham
- Emergency Medicine, Faculty of Medicine and Dentistry.,Alberta Health Services Edmonton Zone, Edmonton, Canada; and
| | | | - Samina Ali
- Department of Pediatrics and.,Emergency Medicine, Faculty of Medicine and Dentistry.,Women and Children's Health Research Institute, University of Albert, Edmonton, Canada
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Patel P, Ivanov D, Bhatt S, Mastorakos G, Birckhead B, Khera N, Vittone J. Low-Cost Virtual Reality Headsets Reduce Perceived Pain in Healthy Adults: A Multicenter Randomized Crossover Trial. Games Health J 2019; 9:129-136. [PMID: 31804853 DOI: 10.1089/g4h.2019.0052] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
Objectives: Recent studies have established the usage of virtual reality (VR) to help alleviate acute and chronic pain. VR technology can be cost prohibitive and cheaper alternatives are desired. In this study, a Google Cardboard headset ($15) combined with a smartphone was used as a low-cost VR device to assess efficacy in altering the perception of pain. Materials and Methods: The cold pressor test, a minimal-risk method, was used to simulate pain. Participants immersed their hands into ice water, with and without VR, in a crossover manner, and their pain perception data were recorded. Results: Forty-eight healthy volunteer participants completed the study between 2017 and 2018. Participants were randomized to right hand control, left control, right experimental, and left experimental groups, respectively, before the crossover. Data collected included pain threshold (time at which participants first reported pain), pain tolerance (time at which participants removed their hand), and pain intensity (highest reported pain level on a [1-10] scale). Approximately two-thirds of participants had improvements in pain threshold and pain tolerance with a mean improvement of +13.0 seconds (P = 0.0045) for pain threshold and +29.8 seconds (P = 0.0003) for pain tolerance. Pain intensity had a reduction of 0.43 points (P = 0.0371). Conclusion: Our results demonstrate that inexpensive VR devices, such as the Google Cardboard headset used in this study, may be a safe, portable, and cost-effective way to alter the perception and improve tolerance of pain.
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Affiliation(s)
- Payal Patel
- Mayo Clinic School of Medicine, Rochester, Minnesota
| | - David Ivanov
- Mayo Clinic School of Medicine, Rochester, Minnesota
| | | | | | - Brandon Birckhead
- Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, California
| | - Nandita Khera
- Department of Hematology and Oncology, Mayo Clinic, Phoenix, Arizona
| | - Janet Vittone
- General Internal Medicine, Mayo Clinic, Rochester, Minnesota
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Chen YJ, Cheng SF, Lee PC, Lai CH, Hou IC, Chen CW. Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial. J Clin Nurs 2019; 29:503-510. [PMID: 31715039 DOI: 10.1111/jocn.15088] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 10/03/2019] [Accepted: 10/20/2019] [Indexed: 01/13/2023]
Abstract
AIM AND OBJECTIVES To determine whether the virtual reality as a distracting intervention could reduce pain and fear in school-age children receiving intravenous injections at an emergency department. BACKGROUND An intravenous injection is the most common invasive procedure that paediatric patients encounter in emergency department. School-age children seldom show their fear or discomfort during the procedure which may be ignored. DESIGN A randomised controlled trial was conducted from December 2017-May 2018 and performed according to the CONSORT guidelines. METHODS One hundred and thirty-six children aged 7-12 years were randomly allocated to receive either a routine intravenous injection procedure or one with an immersive virtual reality experience. Children were asked to rate their pain and fear along with their caregivers and nurses on the Wong-Baker FACES Pain Rating Scale and Children's Fear Scale, respectively. The time required for successful intravenous insertion was also assessed in the emergency department. Clinical trial registration was done (ClinicalTrials.gov.: NCT04081935). RESULTS Pain and fear scores were significantly lower in the virtual reality group, as were the children's ratings as perceived by their caregivers and nurses. The children's ratings of pain and fear were positively correlated with the caregivers' ratings and the nurses' ratings as well. The time required for successful intravenous insertion was significantly lower in the virtual reality group. CONCLUSION Visual reality intervention can effectively reduce the pain and fear during intravenous procedure in school-age children in emergency department. RELEVANCE TO CLINICAL PRACTICE The results of this study indicate the feasible clinical value of virtual reality interventions during the administration of intravenous injections in school-age children in emergency departments.
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Affiliation(s)
- Yen-Ju Chen
- Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan.,School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Su-Fen Cheng
- Department of Allied Health Education and Digital Learning, National Taipei University of Nursing and Health Sciences, Taipei, Taiwan
| | - Pi-Chang Lee
- Department of Pediatrics, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Chi-Hsiu Lai
- Department of Nursing, National Yang-Ming University Hospital, Yilan, Taiwan
| | - I-Ching Hou
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
| | - Chi-Wen Chen
- School of Nursing, National Yang-Ming University, Taipei, Taiwan
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Eijlers R, Utens EMWJ, Staals LM, de Nijs PFA, Berghmans JM, Wijnen RMH, Hillegers MHJ, Dierckx B, Legerstee JS. Systematic Review and Meta-analysis of Virtual Reality in Pediatrics: Effects on Pain and Anxiety. Anesth Analg 2019; 129:1344-1353. [PMID: 31136330 PMCID: PMC6791566 DOI: 10.1213/ane.0000000000004165] [Citation(s) in RCA: 230] [Impact Index Per Article: 46.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/27/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Medical procedures often evoke pain and anxiety in pediatric patients. Virtual reality (VR) is a relatively new intervention that can be used to provide distraction during, or to prepare patients for, medical procedures. This meta-analysis is the first to collate evidence on the effectiveness of VR on reducing pain and anxiety in pediatric patients undergoing medical procedures. METHODS On April 25, 2018, we searched EMBASE, MEDLINE, CENTRAL, PubMed, Web of Science, and PsycINFO with the keywords "VR," "children," and "adolescents." Studies that applied VR in a somatic setting with participants ≤21 years of age were included. VR was defined as a fully immersive 3-dimensional environment displayed in surround stereoscopic vision on a head-mounted display (HMD). We evaluated pain and anxiety outcomes during medical procedures in VR and standard care conditions. RESULTS We identified 2889 citations, of which 17 met our inclusion criteria. VR was applied as distraction (n = 16) during venous access, dental, burn, or oncological care or as exposure (n = 1) before elective surgery under general anesthesia. The effect of VR was mostly studied in patients receiving burn care (n = 6). The overall weighted standardized mean difference (SMD) for VR was 1.30 (95% CI, 0.68-1.91) on patient-reported pain (based on 14 studies) and 1.32 (95% CI, 0.21-2.44) on patient-reported anxiety (based on 7 studies). The effect of VR on pediatric pain was also significant when observed by caregivers (SMD = 2.08; 95% CI, 0.55-3.61) or professionals (SMD = 3.02; 95% CI, 0.79-2.25). For anxiety, limited observer data were available. CONCLUSIONS VR research in pediatrics has mainly focused on distraction. Large effect sizes indicate that VR is an effective distraction intervention to reduce pain and anxiety in pediatric patients undergoing a wide variety of medical procedures. However, further research on the effect of VR exposure as a preparation tool for medical procedures is needed because of the paucity of research into this field.
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Affiliation(s)
- Robin Eijlers
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Elisabeth M. W. J. Utens
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
- Research Institute of Child Development and Education, University of Amsterdam, Amsterdam, the Netherlands
- Academic Center for Child Psychiatry, The Bascule/Department of Child and Adolescent Psychiatry, Academic Medical Center, Amsterdam, the Netherlands
| | - Lonneke M. Staals
- Department of Anesthesiology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Pieter F. A. de Nijs
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Johan M. Berghmans
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
- Department of Anesthesia, ZNA Middelheim, Queen Paola Children’s Hospital, Antwerp, Belgium
| | - René M. H. Wijnen
- Intensive Care and Department of Pediatric Surgery, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Manon H. J. Hillegers
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Bram Dierckx
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
| | - Jeroen S. Legerstee
- From the Department of Child and Adolescent Psychiatry/Psychology, Erasmus Medical Center-Sophia Children’s Hospital, Rotterdam, the Netherlands
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Dumoulin S, Bouchard S, Ellis J, Lavoie KL, Vézina MP, Charbonneau P, Tardif J, Hajjar A. A Randomized Controlled Trial on the Use of Virtual Reality for Needle-Related Procedures in Children and Adolescents in the Emergency Department. Games Health J 2019; 8:285-293. [DOI: 10.1089/g4h.2018.0111] [Citation(s) in RCA: 54] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stéphanie Dumoulin
- Université du Québec à Montréal, Department of Psychology, Montréal, Canada
- Université du Québec en Outaouais, Department de Psychoéducation et de Psychologie, Gatineau, Québec, Canada
| | - Stéphane Bouchard
- Université du Québec en Outaouais, Department de Psychoéducation et de Psychologie, Gatineau, Québec, Canada
- Centre Intégré de Santé et de Services Sociaux de l'Outaouais, Gatineau, Québec, Canada
- University of Ottawa, Department of Psychology/School of Nursing, Ottawa, Canada
| | - Jacqueline Ellis
- University of Ottawa, Department of Psychology/School of Nursing, Ottawa, Canada
| | - Kim L. Lavoie
- Université du Québec à Montréal, Department of Psychology, Montréal, Canada
- Research Center, CIUSSS-NIM Hôpital du Sacré-Coeur de Montréal, Montreal Behavioral Medicine Center, Montreal, Canada
| | - Marie-Pier Vézina
- Université du Québec à Montréal, Department of Psychology, Montréal, Canada
- Université du Québec en Outaouais, Department de Psychoéducation et de Psychologie, Gatineau, Québec, Canada
| | - Priscilla Charbonneau
- Université du Québec en Outaouais, Department de Psychoéducation et de Psychologie, Gatineau, Québec, Canada
| | - Jessica Tardif
- Université du Québec en Outaouais, Department de Psychoéducation et de Psychologie, Gatineau, Québec, Canada
| | - Alain Hajjar
- Université du Québec en Outaouais, Department de Psychoéducation et de Psychologie, Gatineau, Québec, Canada
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