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Sánchez-López MI, Lluesma-Vidal M, Ruiz-Zaldibar C, Tomás-Saura I, Martínez-Fleta MI, Gutiérrez-Alonso G, García-Garcés L. The effect of virtual reality versus standard-of-care treatment on pain perception during paediatric vaccination: A randomised controlled trial. J Clin Nurs 2024. [PMID: 38873883 DOI: 10.1111/jocn.17287] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 03/27/2024] [Accepted: 05/14/2024] [Indexed: 06/15/2024]
Abstract
AIMS AND OBJECTIVES To determine the effect of immersive virtual reality (VR) on perceived pain and fear in children during vaccination and parental satisfaction with the procedure. BACKGROUND Virtual reality can reduce the perception of pain by children but only three studies have analysed its use during vaccination to date; these had small sample sizes and imperfect methodological designs. DESIGN A randomised controlled clinical trial. METHODS One hundred and sixty participants from the Tres Forques Health Center were randomly assigned to the intervention group (IG) (n = 82) in which distraction with immersive VR was used during the vaccination, while standard distraction techniques were used for the control group (n = 80). The primary outcome was pain (Wong-Baker FACES). Secondary outcomes included (Children's Fear Scale) and parental satisfaction with the vaccination procedure. Chi-squared tests were used for qualitative variables, relationships between quantitative variables were tested with Spearman correlations, and Mann-Whitney U- or Student t-tests were employed to assess the relationship between quantitative and qualitative variables. RESULTS Compared to the controls, the children in the IG reported significantly less pain and fear, while parental satisfaction was significantly higher. Reported pain and fear did not differ according to the sex of the patient. Child age was not linked to fear but was related to pain: the younger the patient, the greater the pain they described. CONCLUSIONS Immersive VR effectively controlled pain and fear in children during vaccination and increased parent satisfaction with the vaccination process. Patient sex did not influence the level of pain and fear but age did. RELEVANCE TO CLINICAL PRACTICE Improving vaccination experiences can reduce perceived pain and fear in children and increase parent satisfaction, thereby enhancing vaccination schedule adherence and improving group immunity. REPORTING METHOD The CONSORT Statement for non-pharmacological randomised clinical trials were followed.
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Affiliation(s)
- María Inmaculada Sánchez-López
- Department of Nursing and Phisiotherapy, Faculty of Health Sciencies, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | - Marta Lluesma-Vidal
- Department of Nursing and Phisiotherapy, Faculty of Health Sciencies, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
| | | | - Inmaculada Tomás-Saura
- Tres Forques Health Centre, General Hospital of Valencia Health Department, Valencia, Spain
| | | | - Gema Gutiérrez-Alonso
- Tres Forques Health Centre, General Hospital of Valencia Health Department, Valencia, Spain
| | - Laura García-Garcés
- Department of Nursing and Phisiotherapy, Faculty of Health Sciencies, Universidad Cardenal Herrera-CEU, CEU Universities, Valencia, Spain
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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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3
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Şen T, Çetinkaya B. The effect of virtual reality glasses used during intravenous catheter application on the Child's emotional responses. J Pediatr Nurs 2024:S0882-5963(24)00154-4. [PMID: 38692952 DOI: 10.1016/j.pedn.2024.04.036] [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: 01/08/2024] [Revised: 04/10/2024] [Accepted: 04/10/2024] [Indexed: 05/03/2024]
Abstract
PURPOSE This study was conducted to determine the effect of virtual reality glasses used during intravenous catheter insertion on the child's emotional responses. DESIGN AND METHODS The sample of the research, which was carried out as a randomized controlled experimental study, consisted of 102 children, including 51 in the control group and 51 in the study group, who were aged between 7 and 12 years and were on treatment in the pediatric emergency department(PED). Research data were collected using a Descriptive Data Form for Children and the Children's Emotional Manifestation Scale. No intervention was applied to the control group. After the tourniquet was tied in the study group, the children started watching a video of their choice through virtual reality glasses. When the process was completed, the video was stopped. During this period, the child was evaluated using the Children's Emotional Manifestation Scale. RESULTS A statistically significant difference was found between the Children's Emotional Manifestation Scale scores of the children in the study and control groups (p = 0.000). The scores of the children in the study group were statistically significantly lower than the scores of the children in the control group. CONCLUSION During the intravenous catheter insertion process, children who watched cartoons on virtual reality glasses showed less negative emotional behavior than those who did not. PRACTICE IMPLICATIONS The use of virtual reality glasses is a developing technology in child health services, and it is recommended to encourage their use in these services.
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Affiliation(s)
- Türkan Şen
- Pamukkale University Institue of Health Sciences, Nursing Department, Child Health and Diseases Nursing Graduate Program, Denizli, Türkiye.
| | - Bengü Çetinkaya
- Pamukkale University Faculty of Health Sciences, Department of Pediatric Nursing, Denizli, Türkiye
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Rosa A, Pujia AM, Docimo R, Arcuri C. Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1763. [PMID: 38002854 PMCID: PMC10670820 DOI: 10.3390/children10111763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments. METHODS The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations. RESULTS Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered. CONCLUSIONS this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.
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Affiliation(s)
- Alessio Rosa
- Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, 00133 Rome, Italy
| | - Alberto Maria Pujia
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Raffaella Docimo
- Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudio Arcuri
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Plechatá A, Vandeweerdt C, Atchapero M, Luong T, Holz C, Betsch C, Dietermann B, Schultka Y, Böhm R, Makransky G. Experiencing herd immunity in virtual reality increases COVID-19 vaccination intention: Evidence from a large-scale field intervention study. COMPUTERS IN HUMAN BEHAVIOR 2023; 139:107533. [PMID: 36277032 PMCID: PMC9576250 DOI: 10.1016/j.chb.2022.107533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 10/07/2022] [Accepted: 10/12/2022] [Indexed: 01/04/2023]
Abstract
This study investigates the impact of an immersive virtual reality (VR) simulation of herd immunity on vaccination intentions and its potential underlying mechanisms. In this preregistered field study, N = 654 participants were randomly assigned to one of the three VR conditions: (1) Gamified Herd Immunity; (2) Gamified Herd Immunity + Empathy (with additional narrative elements); (3) Control (gamified with no vaccination-related content). In the Gamified Herd Immunity simulation, participants embodied a vulnerable person and navigated a wedding venue trying to avoid getting infected. A total of 455 participants with below maximum intentions to take a novel vaccine and without severe cybersickness were analyzed. The Gamified Herd Immunity + Empathy and the Gamified Herd Immunity conditions increased vaccination intentions by 6.68 and 7.06 points on a 0-100 scale, respectively, compared to 1.91 for the Control condition. The Gamified Herd Immunity + Empathy condition enhanced empathy significantly more than the Gamified Herd Immunity condition but did not result in higher vaccination intentions. Experienced presence was related to the change in vaccination intentions. The results suggest that VR vaccination communication can effectively increase vaccination intentions; the effect is not solely due to the technological novelty and does not depend on empathy.
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Affiliation(s)
- Adéla Plechatá
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark,Corresponding author
| | - Clara Vandeweerdt
- Department of Political Science, University of Copenhagen, Øster Farimagsgade 5, 1353 Copenhagen, Denmark
| | - Michael Atchapero
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
| | - Tiffany Luong
- Department of Computer Science, ETH Zürich, Universitätstrasse 6, 8006 Zürich, Switzerland
| | - Christian Holz
- Department of Computer Science, ETH Zürich, Universitätstrasse 6, 8006 Zürich, Switzerland
| | - Cornelia Betsch
- Media and Communication Science, University of Erfurt, Nordhäuser Str. 63, 99089, Erfurt, Germany,Center for Empirical Research in Economics and Behavioral Sciences, University of Erfurt, Nordhäuser Str. 63, 99089, Erfurt, Germany,Health Communication, Bernhard Nocht Institute for Tropical Medicine, Bernhard Nocht Str. 74, 20359, Hamburg, Germany
| | - Bonnie Dietermann
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Invalidenstrasse 43, 10115, Berlin, Germany
| | - Yori Schultka
- Museum für Naturkunde - Leibniz Institute for Evolution and Biodiversity Science, Invalidenstrasse 43, 10115, Berlin, Germany
| | - Robert Böhm
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark,Department of Occupational, Economic, And Social Psychology, Faculty of Psychology, University of Vienna, Universitätsstrasse 7, 1010, Vienna, Austria,Copenhagen Center for Social Data Science (SODAS), University of Copenhagen, Copenhagen, Denmark
| | - Guido Makransky
- Department of Psychology, University of Copenhagen, Øster Farimagsgade 2A, 1353, Copenhagen, Denmark
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Yıldırım BG, Gerçeker GÖ. The Effect of Virtual Reality and Buzzy on First Insertion Success, Procedure-Related Fear, Anxiety, and Pain in Children during Intravenous Insertion in the Pediatric Emergency Unit: A Randomized Controlled Trial. J Emerg Nurs 2023; 49:62-74. [PMID: 36376127 DOI: 10.1016/j.jen.2022.09.018] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 09/28/2022] [Accepted: 09/30/2022] [Indexed: 11/13/2022]
Abstract
INTRODUCTION Distraction methods such as virtual reality and cold vibration device are recommended during intravenous interventions. Few studies have focused on the impact of nonpharmacological interventions on intravenous insertion success. METHODS A randomized controlled study evaluated effect of virtual reality and cold vibration device application on first-attempt intravenous insertion success and procedure-related pain, fear, and anxiety during intravenous insertion in children. Children aged 4 to 10 years (N = 150) undergoing peripheral intravenous catheterization insertion in the pediatric emergency department were randomized to 1 of 3 groups: virtual reality, cold vibration (Buzzy), and control group. Distraction technique of talking and asking questions of children was used in control group. Primary outcome was first-attempt intravenous insertion success; secondary outcomes were procedure-related pain, fear, and anxiety. Study data were collected using Difficult Intravenous Access score, Emotional Appearance Scale for Children, Wong-Baker Faces Pain Rating Scale, Color Analog Scale, Children's Anxiety Meter-State, and Child Fear Scale. Data were analyzed using chi-square test, Fisher exact test, and Kruskal-Wallis test. RESULTS There were no significant differences in first-attempt intravenous insertion success rates (virtual reality = 47.2%, Buzzy® = 50%, control = 46.9%), preprocedural emotional appearance scores, and procedure-related pain and anxiety scores. There was no difference between groups for vital signs before, during, and at fifth minute of procedure. DISCUSSION Virtual reality and Buzzy may decrease procedure-related fear in children during intravenous insertion. This research has shown that pediatric emergency nurses can reduce pain and anxiety by talking to children, and simple distractions such as asking questions are as effective as more technological ones.
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Wu Y, Zhao Y, Wu L, Zhang P, Yu G. Non-Pharmacological Management for Vaccine-Related Pain in Children in the Healthcare Setting: A Scoping Review. J Pain Res 2022; 15:2773-2782. [PMID: 36106315 PMCID: PMC9467445 DOI: 10.2147/jpr.s371797] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/05/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose To examine how research was conducted on non-pharmacological management in children with vaccine-related pain in the healthcare setting, so as to provide reference for the relief of vaccine-related pain in children. Methods This study conducted a scoping review guided by the methodological framework of Arksey and O’Malley. MEDLINE, Cochrane Library, EMBASE, CINAHL, PubMed databases were searched in detail, and search strategy included the keyword “vaccine”, the keyword “pain”, and the keyword “children”. Two researchers conducted literature screening and data extraction independently, and any disagreements were resolved through team consultation. Results This study retrieved 1017 literatures, of which 22 were finally included, including 18 randomized controlled studies, 3 quasi-experimental studies and 1 cohort study. Non-pharmacological management measures were summarized in the study, mainly involving taste, tactile, olfactory, visual, exercise, and postural interventions and injection technique. All the above non-pharmacological management were effective in mitigating vaccine-related pain in children. The study population in the included literatures was mainly neonates and infants. Regarding the analgesic effects of taste intervention, breastfeeding was better than sweeteners, and sweeteners were better than sterile water or non-nutritive sucking. However, there was a lack of comparative studies on the analgesic effects of other non-pharmacological management. Conclusion There are many non-pharmacological management measures with varying analgesic effects. Diversified non-pharmacological management measures can provide more analgesic choices for children. For reducing vaccine-related pain in newborns and infants, breastfeeding is recommended first, then sweeteners, and then non-nutritious sucking. In addition to the taste intervention, the analgesic effects of other non-pharmacological management measures need further comparative studies. Moreover, medical staff can use a combination of non-pharmacological analgesic measures to maximize the analgesic effect, and medical staff should also fully consider the analgesia willingness of children and parents.
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Affiliation(s)
- Yujie Wu
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Yong Zhao
- School of Public Health and Management, Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Liping Wu
- Department of Nursing, Children's Hospital of Chongqing Medical University, Chongqing, 400014, People's Republic of China
| | - Ping Zhang
- Department of Nursing, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430030, People's Republic of China
| | - Genzhen Yu
- Department of Pediatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, 430030, People's Republic of China
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8
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Virtual reality for pain and anxiety of pediatric oncology patients: A systematic review and meta-analysis. Asia Pac J Oncol Nurs 2022; 9:100152. [DOI: 10.1016/j.apjon.2022.100152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Accepted: 09/17/2022] [Indexed: 11/23/2022] Open
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9
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COVID-19 vaccine campaign has now opened up for children aged 5-11. How are kids going to live it? J Pediatr Nurs 2022; 65:e19. [PMID: 35012869 PMCID: PMC8739635 DOI: 10.1016/j.pedn.2021.12.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 12/22/2021] [Indexed: 11/22/2022]
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10
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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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Chang ZY, Kang GCY, Koh EYL, Fong RJK, Tang J, Goh CK, Tan NC. Immersive Virtual Reality in Alleviating Pain and Anxiety in Children During Immunization in Primary Care: A Pilot Randomized Controlled Trial. Front Pediatr 2022; 10:847257. [PMID: 35402359 PMCID: PMC8990251 DOI: 10.3389/fped.2022.847257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Accepted: 03/02/2022] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Pediatric immunization is often associated with significant fear and anxiety among the children and their parents. Their distress may potentially affect their adherence to the childhood immunization schedule and the acceptance of other recommended vaccines by physicians. OBJECTIVE The study primarily aimed to assess the feasibility of using immersive virtual reality (VR) during immunization in children in primary care. The secondary aim was to determine the effectiveness of immersive VR in alleviating pain and anxiety among children, reduction of anxiety of their parents and attending nurses during immunization compared to usual care without VR. METHODS A pilot open-label randomized control trial was conducted at a public primary care clinic in Singapore. Thirty children, aged 4-10 years were randomized to an intervention group (n = 15) using VR and a control group (n = 15) without VR during immunization. Feasibility was assessed by the response rate to the use of VR. The Faces Pain Scale-Revised (FPS-R) and the Children's Fear Scale (CFS) were used to determine their pain and anxiety, respectively. The anxiety level of their accompanying parents and attending nurses were evaluated using Visual Analog Scale (VAS) prior and post-immunization of these children. The FPS-R and CFS scores, and anxiety assessment for parents and nurses were assessed using Mann-Whitney U test. Wilcoxon signed rank test was used to assess the difference in the nurses' experience of using the VR application. RESULTS One child refused to use the VR equipment, constituting a rejection rate of 6.7% (1/15) but no adverse event occurred in the intervention arm. The overall response rate of 88% (30/34) when the parents were approached to participate in the study, indicating feasibility of using VR in childhood immunization. In the intervention group compared to the control group, the change in scores for CFS (median -1, IQR -2 to 0; P = 0.04), parental VAS (median -4, IQR -5 to -1; P = 0.04) were significantly decreased. After immunization, nurses scored favorably for VR, in terms of simplicity (median 9.5, IQR 5.72 to 10; P = 0.01), acceptability (median 10, IQR 5 to 10; P = 0.005) and willingness to use VR in the future (median 10, IQR 5 to 10; P = 0.02). CONCLUSION Immersive VR is feasible, safe and effective in alleviating anxiety among the children and parents. Nurses viewed the application of VR in childhood immunization favorably. CLINICAL TRIAL REGISTRATION [https://clinicaltrials.gov/ct2/show/NCT04748367], identifier [NCT04748367].
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Affiliation(s)
- Zi Ying Chang
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | - Gary Chun-Yun Kang
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | | | - Rodney Jin Kai Fong
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
| | | | | | - Ngiap Chuan Tan
- SingHealth Polyclinics, Singapore, Singapore.,SingHealth Duke-NUS Family Medicine Academic Clinical Program, Singapore, Singapore
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