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Massov L, Robinson B, Rodriguez-Ramirez E, Maude R. 'Giving birth on a beach': Women's experiences of using virtual reality in labour. PLoS One 2024; 19:e0304349. [PMID: 38865321 PMCID: PMC11168694 DOI: 10.1371/journal.pone.0304349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 05/10/2024] [Indexed: 06/14/2024] Open
Abstract
INTRODUCTION Birth is a normal physiological process, and many women want a natural birth. Women use a range of non-pharmacological pain relief methods to reduce labour pain intensity, to help manage labour pain and to induce relaxation. The purpose of this study was to explore the experiences of women using Virtual Reality as a non-pharmacological method of pain relief in labour. Virtual Reality has been shown to be an effective distraction technique in other acute pain settings which also reduces anxiety. METHODS This study conducted qualitative in-depth interviews postnatally with women who used Virtual Reality in labour. Thematic analysis was used to analyse the qualitative data. RESULTS Nineteen women used Virtual Reality in labour. Results from interviews with nineteen women in the postnatal period identified three main themes: impact of virtual reality on experience of labour, managing the pain of labour and challenges of using virtual reality in labour. CONCLUSION This study identified that Virtual Reality was effective as a relaxation technique and helped in pain management by the use of self-efficacy techniques. Women in this study also identified preferred virtual environments specifically to use during labour and birth. This study provides a unique and original contribution to the field of Virtual Reality in labour and birth. It also identifies Virtual Reality as an acceptable and positive experience in the management of anxiety and labour pain.
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Affiliation(s)
- Lorna Massov
- School of Nursing, Midwifery and Health Practice, Victoria University Wellington, Wellington, New Zealand
| | - Brian Robinson
- School of Nursing, Midwifery and Health Practice, Victoria University Wellington, Wellington, New Zealand
| | | | - Robyn Maude
- School of Nursing, Midwifery and Health Practice, Victoria University Wellington, Wellington, New Zealand
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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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Zavlanou C, Savary V, Mermet S, Sander D, Corradi-Dell’Acqua C, Rudrauf D, Tisserand Y, Sahyoun C. Virtual reality vs. tablet for procedural comfort using an identical game in children undergoing venipuncture: a randomized clinical trial. Front Pediatr 2024; 12:1378459. [PMID: 38803637 PMCID: PMC11128582 DOI: 10.3389/fped.2024.1378459] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2024] [Accepted: 04/30/2024] [Indexed: 05/29/2024] Open
Abstract
Introduction Recent research has explored the effectiveness of interactive virtual experiences in managing pain and anxiety in children during routine medical procedures, compared to conventional care methods. However, the influence of the specific technology used as an interface, 3-dimensions (D) immersive virtual reality (VR) vs. 2D touch screens, during pediatric venipuncture, remains unexamined. This study aimed to determine if immersive VR is more effective than a tablet in reducing pain and anxiety during short procedures. Methods An interactive game was designed by clinicians and psychologists, expert in pain theory, hypnosis, and procedural pain and anxiety relief, and was tailored for both VR and tablet use. Fifty patients were randomly assigned to either the Tablet or VR group. The primary outcome measures were pain and anxiety levels during the procedure. Secondary outcome measures included the need for physical restraint, duration of the procedure, enjoyment levels, and satisfaction ratings from both parents and nurses. Results Participants, in both groups, had low levels of pain and anxiety. Physical restraint was infrequently used, procedures were brief, and high satisfaction levels were reported by patients, parents, and nurses. Discussion This study suggests that the type of technology used as a support for the game has a minimal effect on the child's experience, with both groups reporting low pain and anxiety levels, minimal physical restraint, and high enjoyment. Despite immersive VR's technological advancements, this study underscores the value of traditional tablets with well-designed interactive games in enhancing children's wellbeing during medical procedures. Clinical Trial Registration [ClinicalTrials.gov], identifier [NCT05065307].
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Affiliation(s)
- Christina Zavlanou
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Valentine Savary
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Stephanie Mermet
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Geneva, Switzerland
| | - David Sander
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | | | - David Rudrauf
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Yvain Tisserand
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Cyril Sahyoun
- Division of Pediatric Emergency Medicine, Children’s Hospital of Geneva, Geneva University Hospitals, Geneva, Switzerland
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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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Gruber N, Shemesh-Iron M, Kraft E, Mitelberg K, Mauda E, Ben-Ami M, Mazor-Aronovitch K, Levy-Shraga Y, Levran N, Levek N, Zimlichman E, Pinhas-Hamiel O. Virtual reality's impact on children with type 1 diabetes: a proof-of-concept randomized cross-over trial on anxiety, pain, adherence, and glycemic control. Acta Diabetol 2024; 61:215-224. [PMID: 37845502 DOI: 10.1007/s00592-023-02195-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/15/2023] [Accepted: 09/26/2023] [Indexed: 10/18/2023]
Abstract
AIMS Assess the effectiveness of virtual reality (VR) technology, in reducing pain and anxiety, and improving adherence and glycemic control among children with type 1 diabetes (T1D). METHODS Children with T1D, managed with continuous glucose monitoring and insulin pumps, were recruited for a randomized cross-over trial. Children were randomized to one of two interventions for diabetes management: group 1 used VR glasses first and group 2 listened to vocal-guided affective imagery first (audio). After 1 month, the interventions were crossed over. The outcome measures included pain and anxiety assessment, adherence, glycemic control, and patient-reported outcome measures (PROMs) of VR satisfaction and effectiveness. RESULTS Forty children, mean age 11.4 ± 1.8 years, were participated. During the VR part, the monthly mean pain score compared to the baseline improved in both groups by 30% (p = 0.03). A 14% reduction in the state anxiety score was observed from baseline to 1 month in both groups (p = 0.009). Glycemic control measures including time in range, time above range, and glucose management indicator improved in both groups during VR part (p < 0.004 for all), compared to audio part. After one month, the patient-reported outcome measure (PROM) of satisfaction and effectiveness was sixfold higher after 1 month in group 1 compared to group 2 (p = 0.002). Adherence improved for both groups. CONCLUSIONS VR was shown to be effective in reducing pain and anxiety, improving adherence, PROM, and glycemic control among children with T1D. We suggest incorporating VR technology in pediatric diabetes clinics to facilitate and improve coping and management of diabetes. TRIAL REGISTRATION Trial registration number and date of registration for prospectively registered trials:ClinicalTrials.gov Identifier: NCT05883267, May 10th, 2023.
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Affiliation(s)
- Noah Gruber
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel.
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel.
| | - Moran Shemesh-Iron
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Ethel Kraft
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Karen Mitelberg
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Elinor Mauda
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Michal Ben-Ami
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Kineret Mazor-Aronovitch
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Yael Levy-Shraga
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Neriya Levran
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
| | - Noah Levek
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
| | - Eyal Zimlichman
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
- Innovation and Transformation Management, Sheba Medical Center, Ramat Gan, Israel
| | - Orit Pinhas-Hamiel
- Pediatric Endocrine and Diabetes Unit, The Edmond and Lily Safra Children's Hospital, Sheba Medical Center, 5265601, Ramat Gan, Israel
- Sackler School of Medicine, Tel-Aviv University, Tel Aviv-Yafo, Israel
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Yang X, Zhong S, Yang S, He M, Xu X, He S, Fan G, Liu L. Global Scientific Trends in Virtual Reality for Pain Treatment From 2000 to 2022: Bibliometric Analysis. JMIR Serious Games 2023; 11:e48354. [PMID: 37991981 PMCID: PMC10686536 DOI: 10.2196/48354] [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: 04/20/2023] [Revised: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/24/2023] Open
Abstract
Background Virtual reality (VR) is a computer simulation technique that has been increasingly applied in pain management over the past 2 decades. Objective In this study, we used bibliometrics to explore the literature on VR and pain control, with the aim of identifying research progress and predicting future research hot spots. Methods We extracted literature on VR and pain control published between 2000 and 2022 from the Web of Science Core Collections and conducted bibliometric analyses. We analyzed the publication and citation trends in the past 2 decades, as well as publication and citation analyses of different countries, institutions, journals, and authors. For references, we conducted cocitation and burst analyses. For keywords, we conducted co-occurrence, clustering, timeline view, and citation burst analyses. Results Based on 1176 publications, we found that there was a continuous increase in publication and citation volumes, especially in the last 5 years. The United States was the most representative country, and the University of Washington was the most representative institution, with both having the most publications and citations. The most popular journal in this field was Burns, and Hoffman HG was the most productive author, leading many studies on patients with burn pain. The reference with the most citation burst was a study on the verification of new hardware in pain control. The keywords with the highest citation bursts related to various situations of pain such as "burn pain," "wound care," "low back pain," and "phantom limb." Conclusions VR has been applied in various clinical situations for pain management, among which burns and pediatric surgery have achieved satisfactory results. We infer that VR will be extended to more clinical pain situations in the future, such as pain control in wound care, low back pain, and phantom limb pain. New research hot spots will include the development of software and hardware to improve the immersive experience of VR for pain control. However, our work was based solely on English literature from the Web of Science database. For future studies, we recommend that researchers explore literature from multiple databases to enhance the scope of their research.
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Affiliation(s)
- Xun Yang
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
| | - Sen Zhong
- Department of Orthopedic, School of Medicine, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Sheng Yang
- Department of Orthopedic, School of Medicine, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Meng He
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
| | - Xu Xu
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
| | - Shisheng He
- Department of Orthopedic, School of Medicine, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Guoxin Fan
- Department of Pain Medicine, National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Lijun Liu
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
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Plummer K, McCarthy M, Newall F, Manias E. The management of pain during pediatric hematopoietic stem cell transplantation: A qualitative study of contextual factors that influenced pain management practices. Pediatr Blood Cancer 2023; 70:e30614. [PMID: 37548486 DOI: 10.1002/pbc.30614] [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: 02/02/2023] [Revised: 06/29/2023] [Accepted: 07/26/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND Children hospitalized following hematopoietic stem cell transplantation (HSCT) experience complex and prolonged pain in response to the intensity of this treatment. OBJECTIVES To describe how pain was managed for children during HSCT therapy and how contextual factors related to the clinical environment influenced healthcare providers' and parents' pain management practices. METHODS A qualitative case study was conducted and involved semi-structured interviews at two time points following transplantation (30 and 90 days) with parents (n = 10) and naturalistic observations of pain-related care provided to children (n = 29) during HSCT therapy by their healthcare providers (n = 10). Semi-structured interviews were also conducted with healthcare providers (n = 14). RESULTS The effectiveness of pain management interventions was hindered by the multifactorial nature of pain children experienced, a gap in the provision of psychosocial interventions for pain and a lack of evidence-based guidelines for the sustained, and often long-term, administration of opioids and adjuvant medications. Misconceptions were demonstrated by healthcare providers about escalating pain management according to pain severity and differentiating between opioid tolerance and addiction. Parents were active in the management of pain for children, especially the provision of nonpharmacological interventions. Collaboration with external pain services and the impact of caring for children in protective isolation delayed timely management of pain. CONCLUSIONS There is a pressing need to create evidence-based supportive care guidelines for managing pain post transplantation to optimize children's relief from pain. If parents and children are to be involved in managing pain, greater efforts must be directed toward building their capacity to make informed decisions.
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Affiliation(s)
- Karin Plummer
- Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
- Department of Anaesthesia and Pain, Queensland Children's Hospital, South Brisbane, Australia
| | - Maria McCarthy
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
| | - Fiona Newall
- Department of Nursing, University of Melbourne, Carlton, Melbourne, Victoria, Australia
- Children's Cancer Centre, Royal Children's Hospital, Melbourne, Victoria, Australia
- Clinical Sciences, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Nursing Research, Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Elizabeth Manias
- School of Nursing and Midwifery, Monash University, Melbourne, Victoria, Australia
- School of Nursing and Midwifery, Centre for Quality and Patient Safety Research, Institute for Health Transformation, Deakin University, Melbourne, Victoria, Australia
- Department of Medicine, Royal Melbourne Hospital, University of Melbourne, Melbourne, Victoria, Australia
- Melbourne School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
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Gerlach C, Greinacher A, Alt-Epping B, Wrzus C. My virtual home: needs of patients in palliative cancer care and content effects of individualized virtual reality - a mixed methods study protocol. BMC Palliat Care 2023; 22:167. [PMID: 37904162 PMCID: PMC10617036 DOI: 10.1186/s12904-023-01297-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2023] [Accepted: 10/23/2023] [Indexed: 11/01/2023] Open
Abstract
BACKGROUND The desire to be at home is one of the most important needs of patients with advanced, incurable cancers. However, palliative cancer patients may require inpatient hospital care for medical reasons. Virtual reality (VR) could provide an approximation to the individuals' home environment. METHODS The project consists of 3 parts. All parts are supported by the patient advisory board. In the 1st part of the project, we interview patients, relatives, and the patient advisory board about their wishes and concerns regarding the project. In the 2nd part of the project, patients are offered to view 360° VR videos of their choice (their home, relatives, others if applicable). Effects and side-effects of the intervention are assessed with validated instruments (MIDOS, MDBF, SSQ, SPES). Diagnosis, treatment adherence, medication, and vegetative functionality is determined from the medical records of the patients. In the 3rd part of the project, the results of the study will be discussed with patients, relatives, health care professionals and the patient advisory board regarding implementation. DISCUSSION This study is the first to investigate whether individualized VR videos have additional benefits over generic VR nature videos on symptom relief, well-being, treatment satisfaction, and adherence in patients with palliative cancer care. A strength of the study is that we can incorporate the results of each part of the project into the subsequent project parts. However, the generalizability might be limited as this is a single-centred study. TRIAL REGISTRATION Registered at German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS); registration number: DRKS00032172; registration date: 11/07/2023 https://drks.de/search/de/trial/DRKS00032172 .
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Affiliation(s)
- Christina Gerlach
- Department of Palliative Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany.
| | - Anja Greinacher
- Department of Palliative Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
- Institute of Medical Psychology, Heidelberg University Hospital, Bergheimer Straße 20, 69115, Heidelberg, Germany
| | - Bernd Alt-Epping
- Department of Palliative Medicine, Heidelberg University Hospital, Im Neuenheimer Feld 305, 69120, Heidelberg, Germany
| | - Cornelia Wrzus
- Psychological Institute and Network Aging Research, Ruprecht Karls University of Heidelberg, Bergheimer Str. 20, 69115, Heidelberg, Germany
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Camacho-Cruz J, Palacios-Ariza MA, Orrego-Celestino L, Valbuena-Velandia N, Paez-Castellanos L, Bolaños JM, Pradilla I. Effectiveness of non-immersive virtual reality in the management of procedure-related pain in preschool children: a randomized clinical trial. Eur J Pediatr 2023; 182:4103-4112. [PMID: 37407711 DOI: 10.1007/s00431-023-05070-5] [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: 04/14/2023] [Revised: 06/14/2023] [Accepted: 06/16/2023] [Indexed: 07/07/2023]
Abstract
The objective of this study is to assess the effectiveness of non-immersive virtual reality as a pain-distraction measure in children between the ages of 3 and 5 years undergoing painful injection procedures in an outpatient setting. We carried out a randomized, unmasked clinical trial in children undergoing venipuncture or intramuscular injection procedures. Patients were randomized to a distraction virtual reality video or standard care. After the procedure, three independent observers (parents, researchers, nursing staff) rated pain on the LLANTO pain scale. We recruited 122 subjects, half of which were randomized to virtual reality. The median age was of approximately 60 months (IQR: 15 months), and the sample was balanced with regard to sex. There were significant differences in LLANTO scales scores between the VR subjects and controls of - 3.34 (95% CI - 4.15; - 2.54), - 3.02 (95% CI - 3.90; - 2.14), and - 2.98 (95% CI - 3.87; - 2.09), as rated by parents, researchers, and nursing staff, respectively. Agreement between raters was high for all three types of observers, with Cohen Kappas over 0.79 in all cases. Bivariate analysis showed reductions in the risk of obtaining higher scores in the LLANTO scale. Linear regression models showed a reduction of approximately 3 points in the scale, regardless of the type of observer. These models were adjusted for sex, age, kind of procedure, use of prior analgesia, and recruitment center. CONCLUSIONS Non-immersive virtual reality is an effective adjunctive therapy for the reduction of pain in children undergoing painful injection procedures in an outpatient setting. This strategy may be used to improve the quality of care in pediatric outpatient services. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03985930 (Registered June 14, 2019). WHAT IS KNOWN •The use of immersive virtual reality (VR) has been described as an effective adjunctive distraction method during painful procedures in children over 5 years. WHAT IS NEW •The utility of non-immersive VR in children below that age is not yet clear. This randomized clinical trial comparing non-immersive VR vs. standard care showed an average reduction of three points in the LLANTO pain scale favoring non-immersive VR. Non-immersive VR is an effective and inexpensive non-pharmacological technique that reduces fear and pain in pediatric patients.
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Affiliation(s)
- Jhon Camacho-Cruz
- School of Medicine, Salud de la Infancia Research Group, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
| | - María A Palacios-Ariza
- Research Unit, Fundación Universitaria Sanitas, Sede Salitre, Ninth Floor, Bogotá, D.C., 111321, Colombia.
| | | | | | | | - Johanna M Bolaños
- School of Medicine, Salud de la Infancia Research Group, Fundación Universitaria Sanitas, Bogotá, D.C., Colombia
| | - Iván Pradilla
- Neuroscience Research Group (NeURos), School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, D.C., Colombia
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10
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Whu YW, Hsu MF, Lin IC, Chou CC, Lin HW, Chen CW. Children's perceptions of interactive virtual-reality interventions implemented before and after intravenous cannulation. Scand J Caring Sci 2023; 37:434-443. [PMID: 36314196 DOI: 10.1111/scs.13128] [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: 04/26/2022] [Revised: 10/02/2022] [Accepted: 10/15/2022] [Indexed: 05/18/2023]
Abstract
BACKGROUND Although some studies have reported evidence of the effectiveness of virtual-reality interventions implemented for children undergoing intravenous (IV) cannulation, children's perceptions of virtual-reality interventions implemented during IV cannulation warrant further exploration. AIMS To explore the school-aged children's perceptions of interactive virtual-reality interventions implemented before and after IV cannulation. METHODS A qualitative descriptive study was adopted. Sixty-nine children aged 6-12 years from two medical centers were recruited and interviewed from June to September 2020. After the completion of the immersive virtual-reality scene of IV cannulation before undergoing actual IV cannulation and the emotionally cathartic virtual-reality play after the placement process, individual interviews were conducted with the children in the paediatric wards. Inductive content analysis was performed to analyse children's perceptions. The study complied with the Consolidated Criteria for Reporting Qualitative Research. RESULTS Three categories related to children's perception of interactive virtual-reality interventions implemented before and after IV cannulation were identified: (1) feelings towards and coping strategies employed during IV cannulation; (2) mental preparation through immersion in the virtual-reality scene; and (3) healing effects of immersive cathartic play. CONCLUSIONS The findings indicate that interactive virtual-reality interventions can help hospitalised children mentally prepare for medical procedures, obtain knowledge regarding such procedures, and overcome their fear of needles. The children's reported perceptions of the virtual-reality interventions indicated that the interventions were age-appropriate, safe and fun. The results of this study highlight the need to more thoroughly understand the perceptions of hospitalised children and may serve as a reference for designing child-friendly care interventions for nursing practice.
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Affiliation(s)
- Yew-Wha Whu
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan
| | - Mei-Feng Hsu
- Department of Nursing, Da-Yeh University, Changhua, Taiwan
| | - I-Chen Lin
- College of Computer Science, National Yang Ming Chiao Tung University, Hsinchu, Taiwan
| | - Cheng-Chen Chou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Wen Lin
- Department of Nursing, Changhua Christian Children's Hospital, Changhua, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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11
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Hoffman HG, Fontenot MR, Garcia-Palacios A, Greenleaf WJ, Alhalabi W, Curatolo M, Flor H. Adding tactile feedback increases avatar ownership and makes virtual reality more effective at reducing pain in a randomized crossover study. Sci Rep 2023; 13:7915. [PMID: 37217536 DOI: 10.1038/s41598-023-31038-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 03/06/2023] [Indexed: 05/24/2023] Open
Abstract
Severe pain is a widespread health problem in need of novel treatment approaches. In the current study we used real water to give virtual objects (i.e., animated virtual water) more realistic physical properties (wet liquid qualities). Healthy volunteers aged 18-34 participated in a within-subject randomized study comparing participants' worst pain during brief thermal stimuli with (1) No Immersive Virtual Reality (VR), versus (2) during VR + no tactile feedback versus (3) VR + real water (with tactile feedback from co-located real objects). Tactile feedback significantly decreased pain intensity (VR analgesia, p < 0.01), compared to VR with no tactile feedback, and compared to No VR (baseline). Tactile feedback made the virtual water feel significantly more real, increased participant's sense of presence, and both VR conditions were distracting (significantly reduced accuracy on an attention demanding task). As a non-pharmacologic analgesic, mixed reality reduced pain by 35% in the current study, comparable to the analgesia from a moderate dose of hydromorphone in previous published experimental studies. Tactile feedback also significantly increased avatar embodiment, the participants illusion of ownership of the virtual hands, which has potential to improve the effectiveness of avatar therapy for chronic pain in future studies. Mixed reality should be tested as treatment in pain patients.
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Affiliation(s)
- Hunter G Hoffman
- Virtual Reality Research Center, Mechanical Engineering, University of Washington, Seattle, 98195, USA.
- Virtual Human Interaction Lab, Stanford University, Stanford, 94305, USA.
| | - Miles R Fontenot
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, 98195, USA
| | - Azucena Garcia-Palacios
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, 12071, Castellón de La Plana, Spain
| | - Walter J Greenleaf
- Virtual Human Interaction Lab, Stanford University, Stanford, 94305, USA
| | - Wadee Alhalabi
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, 21589, Saudi Arabia
| | - Michele Curatolo
- Department of Anesthesiology and Pain Medicine, University of Washington, Seattle, 98195, USA
| | - Herta Flor
- Department of Cognitive and Clinical Neuroscience, Central Institute of Mental Health, Medical Faculty Mannheim, Heidelberg University, 68159, Mannheim, Germany
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12
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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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13
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The Emerging Role of Virtual Reality as an Adjunct to Procedural Sedation and Anesthesia: A Narrative Review. J Clin Med 2023; 12:jcm12030843. [PMID: 36769490 PMCID: PMC9917582 DOI: 10.3390/jcm12030843] [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: 12/19/2022] [Revised: 01/03/2023] [Accepted: 01/08/2023] [Indexed: 01/24/2023] Open
Abstract
Over the past 20 years, there has been a significant reduction in the incidence of adverse events associated with sedation outside of the operating room. Non-pharmacologic techniques are increasingly being used as peri-operative adjuncts to facilitate and promote anxiolysis, analgesia and sedation, and to reduce adverse events. This narrative review will briefly explore the emerging role of immersive reality in the peri-procedural care of surgical patients. Immersive virtual reality (VR) is intended to distract patients with the illusion of "being present" inside the computer-generated world, drawing attention away from their anxiety, pain, and discomfort. VR has been described for a variety of procedures that include colonoscopies, venipuncture, dental procedures, and burn wound care. As VR technology develops and the production costs decrease, the role and application of VR in clinical practice will expand. It is important for medical professionals to understand that VR is now available for prime-time use and to be aware of the growing body in the literature that supports VR.
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14
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Gao Y, Xu Y, Liu N, Fan L. Effectiveness of virtual reality intervention on reducing the pain, anxiety and fear of needle-related procedures in paediatric patients: A systematic review and meta-analysis. J Adv Nurs 2023; 79:15-30. [PMID: 36330583 DOI: 10.1111/jan.15473] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 08/08/2022] [Accepted: 10/06/2022] [Indexed: 11/06/2022]
Abstract
AIMS To evaluate the effectiveness of virtual reality (VR) intervention in the management of pain, anxiety and fear in paediatric patients undergoing needle-related procedures. DESIGN A systematic review and meta-analysis of randomized controlled trials (RCTs). DATA SOURCES A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI, and Wanfang databases was conducted to identify research articles in English or Chinese on RCTs up to February 28, 2022. REVIEW METHODS Two researchers independently screened eligible articles. The Cochrane Handbook for Systematic Reviews was used to assess the risk of bias in the included studies. A fixed- or random-effects meta-analysis model was used to determine the pooled mean difference based on the results of the heterogeneity test. RESULTS A total of 2269 articles were initially screened. The meta-analysis included data from 27 studies representing 2224 participants. Compared with the non-VR group, the VR intervention group significantly reduced pain, anxiety, and fear in paediatric patients who underwent puncture-related procedures. Subgroup analysis showed that VR has advantages over conventional and other distraction methods. CONCLUSION Paediatric patients undergoing needle-related procedures would benefit from VR interventions for pain, anxiety and fear management. IMPACT VR intervention has the potential to reduce pain, anxiety and fear in paediatric patients undergoing puncture-related procedures. Future clinical interventions could incorporate VR into puncture procedures as an effective method to reduce negative emotions in children eligible for VR distractions. PATIENT OR PUBLIC CONTRIBUTION Our paper is a systematic review and meta-analysis and such details don't apply to our work.
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Affiliation(s)
- Yan Gao
- Department of Rehabilitation, Shengjing Hospital of China Medical University, Shenyang, China
| | - Yiwei Xu
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
| | - Naiquan Liu
- Department of Nephrology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Ling Fan
- Department of Nursing, Shengjing Hospital of China Medical University, Shenyang, China
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15
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Tas FQ, van Eijk CAM, Staals LM, Legerstee JS, Dierckx B. Virtual reality in pediatrics, effects on pain and anxiety: A systematic review and meta-analysis update. Paediatr Anaesth 2022; 32:1292-1304. [PMID: 35993398 PMCID: PMC9804813 DOI: 10.1111/pan.14546] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 07/23/2022] [Accepted: 08/16/2022] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Medical procedures are often accompanied by pain and anxiety in pediatric patients. A relatively new technique to reduce pediatric pain and anxiety is virtual reality. Virtual reality is both applied as a distraction tool and as an exposure tool to prepare patients for medical procedures. Research into the application of virtual reality in medical settings is rapidly evolving. This meta-analysis is an update of the meta-analysis of Eijlers et al. investigating the effectiveness of virtual reality as an intervention tool on pain and anxiety in pediatric patients undergoing medical procedures. METHODS We searched the databases Embase, Medline, Web of Science Core Collection, Cochrane Central Register of Controlled Trials and PsycINFO. For each of these databases, different search strategies were developed. The search period from the meta-analysis from Eijlers et al., reaching until April 2018, was extended to December 2020. Pain and anxiety outcomes during medical procedures were compared for virtual reality and standard care conditions for various medical procedures. RESULTS The search yielded 1824 articles, of which 13 met our inclusion criteria. Combined with 13 articles of Eijlers' review study, this resulted in 26 articles. Virtual reality was applied as distraction (n = 23) during medical procedures or as exposure (n = 4) before medical procedures. The effect of virtual reality distraction was mostly studied in patients during venous access (n = 10). The overall weighted standardized mean difference for virtual reality distraction was -0.67 (95% CI, -0.89 to -0.45; p < .001) on patient-reported pain (based on 21 studies) and -0.74 (95% CI, -1.00 to -0.48; p < .001) on patient-reported anxiety (based on 10 studies). The effect of virtual reality as an exposure tool on patient-reported anxiety was significant too (standardized mean difference = -0.58; 95% CI, -1.15 to -0.01; p < .05). DISCUSSION The current updated systematic review and meta-analysis indicates that virtual reality is a useful tool to reduce pain and anxiety in pediatric patients undergoing a range of medical procedures as it significantly decreases pain and anxiety outcomes when compared to care as usual.
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Affiliation(s)
- Floris Q. Tas
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Cynthia A. M. van Eijk
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Lonneke M. Staals
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Jeroen S. Legerstee
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
| | - Bram Dierckx
- Child‐ and Youth psychiatrySophia Children's Hospital – Erasmus MCRotterdamThe Netherlands
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16
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Effectiveness of Virtual Reality-Based Interventions for Managing Chronic Pain on Pain Reduction, Anxiety, Depression and Mood: A Systematic Review. Healthcare (Basel) 2022; 10:healthcare10102047. [PMID: 36292493 PMCID: PMC9602273 DOI: 10.3390/healthcare10102047] [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: 09/20/2022] [Revised: 10/09/2022] [Accepted: 10/12/2022] [Indexed: 11/23/2022] Open
Abstract
(1) Background: Patients diagnosed with chronic pain suffer from long-term pain, which negatively affects their daily lives and mental health. Virtual reality (VR) technologies are considered a therapeutic tool to manage pain perception and mental health conditions. This systematic review aimed to appraise the efficacy of VR in improving pain intensity, anxiety, depression and mood among patients with chronic pain; (2) Methods: Five electronic databases were systematically searched using the terms representing VR and chronic pain. Quality assessment was conducted using Cochrane Collaboration’s tool and Newcastle-Ottawa scale; (3) Results: Seventeen peer-reviewed articles were included in this review. It was found that VR was able to reduce pain intensity in patients with phantom limb pain, chronic headache, chronic neck pain and chronic low-back pain. The effects of VR on the improvement of anxiety, depression and mood were not determined due to the inadequate amount of clinical evidence; (4) Conclusions: VR, especially immersive VR, improves pain outcomes and its effects may vary depending on the approach and study design. More research is still needed to investigate the clinical use of VR in patients with chronic pain.
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17
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Fitzpatrick R, McGuire BE, Lydon HK. Student Commentary: Targeting the Right Supports to Reduce Pediatric Procedural Pain and Distress. J Pediatr Psychol 2022; 48:120-122. [PMID: 36063410 PMCID: PMC9941802 DOI: 10.1093/jpepsy/jsac069] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 08/18/2022] [Accepted: 08/18/2022] [Indexed: 11/12/2022] Open
Affiliation(s)
- Rachel Fitzpatrick
- All correspondence concerning this article should be addressed to Rachel Fitzpatrick, MSc, School of Psychology, National University of Ireland, Galway, Ireland. E-mail: ;
| | - Brian E McGuire
- School of Psychology and Centre for Pain Research and Applied Behaviour Research Clinic, National University of Ireland, Ireland
| | - Helena K Lydon
- School of Psychology and Centre for Pain Research and Applied Behaviour Research Clinic, National University of Ireland, Ireland
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18
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Thybo KH, Friis SM, Aagaard G, Jensen CS, Dyekjaer CD, Jørgensen CH, Walther-Larsen S. A randomized controlled trial on virtual reality distraction during venous cannulation in young children. Acta Anaesthesiol Scand 2022; 66:1077-1082. [PMID: 35898121 PMCID: PMC9545199 DOI: 10.1111/aas.14120] [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: 05/02/2022] [Revised: 06/24/2022] [Accepted: 07/15/2022] [Indexed: 12/03/2022]
Abstract
Background and Objectives Pain management in children is often inadequate, and the single most common painful procedure in children who are hospitalized is needle procedures. Virtual reality (VR) has been shown to decrease anxiety and pain in children undergoing painful procedures primarily in children from the age of 7 years. Our aim for this study is to investigate patient satisfaction and pain reduction by using a three‐dimensional VR interactive game as a distraction in 4–7 years old children during venous cannulation. Methods In this randomized clinical trial, we enrolled 106 children aged 4–7 years who were scheduled for venous cannulation. Patients assigned to the control group were adherent to standard of care, including topical numbing cream, positioning, and distraction in this group by games of choice on a tablet/smartphone. In the study group, children were adherent to standard of care and were distracted by an interactive VR game. Primary outcomes were patient satisfaction and the procedural pain assessed by using Wong–Baker Faces Pain Rating Scale; secondary outcomes were the procedural time and any adverse events. Results We found an overall high level of patient satisfaction with our regime of topical numbing cream, positioning, and distraction. The primary outcome of pain during the procedure was median 20 mm (IQR 0–40) and 20 mm (IQR 0–55) (Wong–Baker 0–100 mm) in the VR group and the control group, respectively (difference: 0 mm, 95%CI: 0–20, p = .19). No significant difference was found in procedural times. The number of adverse effects was low, with no significant difference between the two groups. Conclusions VR distraction is an acceptable form of distraction for children 4–7 years old when combined with topical numbing cream and positioning during preoperative venous cannulation. No difference was found between VR‐ and smartphone/tablet distraction.
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Affiliation(s)
- Kasper H Thybo
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Susanne M Friis
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Gitte Aagaard
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
| | - Claus S Jensen
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark.,Research Center for Emergency Medicine and Department of Clinical Medicine, Aarhus University Hospital and Aarhus University, Aarhus, Denmark
| | - Charlotte D Dyekjaer
- Department of Paediatrics and Adolescent Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Søren Walther-Larsen
- Department of Anaesthesiology and The Paediatric Pain Clinic, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark
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Baker NA, Polhemus AH, Haan Ospina E, Feller H, Zenni M, Deacon M, DeGrado G, Basnet S, Driscoll M. The State of Science in the Use of Virtual Reality in the Treatment of Acute and Chronic Pain: A Systematic Scoping Review. Clin J Pain 2022; 38:424-441. [PMID: 35537072 DOI: 10.1097/ajp.0000000000001029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022]
Abstract
Previous reviews have reported virtual reality (VR) to be an effective method to treat pain. This scoping review examines the state of the science for VR and pain both generally and by pain type (acute and chronic) related to types of mechanisms, dosage, effectiveness, and adverse events (AEs). We searched online databases PubMed, Web of Science, PsychInfo, and CINAHL from 2010 to 2020 and included studies from peer reviewed journals that examined people with pain, (excluding pain-free participants) with a primary outcome measuring pain. We assessed studies for risk of bias using PEDro criteria. We described data through counts and percentages. Significant results were determined through P-values. We found 70 studies representing 4105 people; 46 acute pain studies (65.7%), 22 chronic pain studies (31.4%), and 2 (2.9%) "both." The most common VR mechanism was distraction (78.6%) then embodiment (17.1%). However, distraction was the mechanism for 97.8% acute pain studies while embodiment was more common for chronic pain (54.5%). Dosage of VR was inconsistently reported and varied considerably. VR treatment groups showed significant improvements in pain, particularly for intensity of pain (72.1%) and quality of pain (75.0%). Few studies examined AEs. Limitations of this review include only examining last 10 years of articles and that many studies were missing data. VR appears to be an effective intervention to address both acute and chronic pain. Research evaluating VR mechanisms, dosage, and AEs is warranted, as is further work in under-served populations (children for chronic pain and older adults) as the current evidence is largely limited to adult populations with pain.
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Affiliation(s)
- Nancy A Baker
- Department of Occupational Therapy, Tufts University, Medford MA
| | | | - Emma Haan Ospina
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Haley Feller
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Miranda Zenni
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Megan Deacon
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Grace DeGrado
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Sami Basnet
- Department of Occupational Therapy, Tufts University, Medford MA
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Garcia L, Birckhead B, Krishnamurthy P, Mackey I, Sackman J, Salmasi V, Louis R, Castro C, Maddox R, Maddox T, Darnall BD. Durability of the Treatment Effects of an 8-Week Self-administered Home-Based Virtual Reality Program for Chronic Low Back Pain: Follow-up Study of a Randomized Clinical Trial. J Med Internet Res 2022; 24:e37480. [PMID: 35612905 PMCID: PMC9177046 DOI: 10.2196/37480] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Revised: 03/22/2022] [Accepted: 04/26/2022] [Indexed: 12/19/2022] Open
Abstract
Background We previously reported the efficacy of an 8-week home-based therapeutic immersive virtual reality (VR) program in a double-blind randomized placebo-controlled study. Community-based adults with self-reported chronic low back pain were randomized 1:1 to receive either (1) a 56-day immersive therapeutic pain relief skills VR program (EaseVRx) or (2) a 56-day sham VR program. Immediate posttreatment results revealed the superiority of therapeutic VR over sham VR for reducing pain intensity; pain-related interference with activity, mood, and stress (but not sleep); physical function; and sleep disturbance. At 3 months posttreatment, therapeutic VR maintained superiority for reducing pain intensity and pain-related interference with activity, stress, and sleep (new finding). Objective This study assessed between-group and within-group treatment effects 6 months posttreatment to determine the extended efficacy, magnitude of efficacy, and clinical importance of home-based therapeutic VR. Methods E-surveys were deployed at pretreatment, end-of-treatment, and posttreatment months 1, 2, 3, and 6. Self-reported data for 188 participants were analyzed in a mixed-model framework using a marginal model to allow for correlated responses across the repeated measures. Primary outcomes were pain intensity and pain-related interference with activity, mood, stress, and sleep at 6 months posttreatment. Secondary outcomes were Patient-Reported Outcome Measurement Information System (PROMIS) sleep disturbance and physical function. Results Therapeutic VR maintained significant and clinically meaningful effects 6 months posttreatment and remained superior to sham VR for reducing pain intensity and pain-related interference with activity, stress, and sleep (ds=0.44-0.54; P<.003). Between-group comparisons for physical function and sleep disturbance showed superiority of EaseVRx over sham VR (ds=0.34; P=.02 and ds=0.46; P<.001, respectively). Participants were encouraged to contact study staff with any problems experienced during treatment; however, no participants contacted study staff to report adverse events of any type, including nausea and motion sickness. Conclusions Our 8-week home-based VR pain management program caused important reductions in pain intensity and interference up to 6 months after treatment. Additional studies are needed in diverse samples. Trial Registration ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID) RR2-10.2196/25291
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Affiliation(s)
| | | | | | | | | | - Vafi Salmasi
- Stanford University School of Medicine, Palo Alto, CA, United States
| | - Robert Louis
- Hoag Memorial Hospital, Newport Beach, CA, United States
| | | | | | | | - Beth D Darnall
- Stanford School of Medicine, Palo Alto, CA, United States
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21
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Wang Y, Guo L, Xiong X. Effects of Virtual Reality-Based Distraction of Pain, Fear, and Anxiety During Needle-Related Procedures in Children and Adolescents. Front Psychol 2022; 13:842847. [PMID: 35519646 PMCID: PMC9063726 DOI: 10.3389/fpsyg.2022.842847] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Accepted: 03/14/2022] [Indexed: 12/31/2022] Open
Abstract
Background Needle-related pain, fear, and anxiety can be a deterrent to treatments in children and adolescents. Virtual reality (VR) can be used to manage the poor experience of needle procedures. Objective This meta-analysis aimed to examine the effects of VR on pain, fear, and anxiety related to needle procedures in children and adolescents. Methods PubMed, EMBASE, and the Cochrane Library were searched for potentially eligible studies published up to June 2021. The outcomes were pain assessed by the Wong-Baker Faces Pain Scale (WBS) or Faces Pain Scale-Revised (FPS-R), and Visual Analog Scale (VAS), fear assessed by Children's Fear Scale (CFS), and anxiety assessed by Children's Anxiety Meter (CAM), VAS, or CFS. Because of expected heterogeneity among studies, all analyses were conducted using the random-effects model. Results Ten studies were included (571 children in the VR group and 575 in the control group). Based on the WBS, VR reduced pain, either self-reported (WMD = −2.17, 95%CI: −3.37, −0.97), parent-reported (WMD = −3.52, 95%CI: −4.62, −2.42), nurse-reported (WMD = −3.29, 95%CI: −5.59, −0.99), and physician/investigator-reported (WMD = −3.48, 95%CI: −5.93, −1.04). Using the FPS-R, VR reduced needle-related pain compared with controls (WMD = −0.85, 95%CI: −1.64, −0.06). Similar results were observed for fear (children/adolescents: WMD = −1.52, 95%CI: −2.18, −0.86; parents: WMD = −1.71, 95%CI: −2.30, −1.13; nurses: WMD = −1.55, 95%CI: −2.47, −0.63; physicians/investigators: WMD = −0.59, 95%CI: −1.00, −0.18) and anxiety (self-reported: WMD = −2.79, 95%CI: −4.07, −1.54; parent-reported: WMD = −3.87, 95%CI: −5.58, −2.15; nurse-reported: WMD = −4.64, 95%CI: −6.56, −2.71; physician/investigator-reported: WMD = −2.06, 95%CI: −4.13, −0.00). Conclusion A VR-based intervention could reduce needle-related pain, fear, and anxiety in children and adolescents.
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Affiliation(s)
- Yan Wang
- Emergency Department, General Hospital of Xinjiang Military Region of People's Liberation Army, Ürümqi, China
| | - Liangmei Guo
- Neurology Department, The Second Medical Center & National Clinical Research Center for Geriatric Diseases, Chinese People's Liberation Army (PLA) General Hospital, Beijing, China
| | - Xinjuan Xiong
- Department of Burns and Plastic Surgery, The 960th Hospital of the Chinese People's Liberation Army, Jinan, China
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22
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Ghasemi M, Hoseinialiabadi P, Yazdanpanah F, Mahani MA, Malekyan L, Najafi K, Arab M, Arab M, Ranjbar H. Comparison of music and vapocoolant spray in reducing the pain of venous cannulation in children age 6-12: a randomized clinical trial. BMC Pediatr 2022; 22:237. [PMID: 35488225 PMCID: PMC9052614 DOI: 10.1186/s12887-022-03271-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Accepted: 04/06/2022] [Indexed: 12/24/2022] Open
Abstract
Background Venous cannulation is among the most stressful and painful experiences of children hospitalization. Children with thalassemia need regular blood transfusion which needs venous access each time. The quality of care and quality of life of children will be improved if appropriate methods are used to reduce pain. This study aimed to compare vapocoolant spray and music in the reduction of pain of Venous cannulation in children with thalassemia. Methods The study was a randomized controlled clinical trial with a cross-over design. Thirty-six children with thalassemia from Thalassemia Patients of Pasteur Hospital in Bam from October to December 2020 and were recruited and randomly allocated to two arms. The pain of venous cannulation (no treatment) was measured in the first blood transfusion session as control. In the second and third sessions, two arms received music and vapocoolant spray before the venous cannulation with a cross-over design. The intensity of pain was measured by a Visual Analogue Scale (VAS). The change in pain scores was tested by ANOVA and Tukey post-hoc test between three measurements. Results During and after the cannulation, the pain was significantly lower in the vapocoolant measurement than in control and music (p < 0.05). There was a significant effect of vapocoolant spray during the procedure F (2, 90) = 25.604, p = 0.001. Also, there was a significant effect of vapocoolant spray after the procedure F (2, 90) = 10.087, p = 0.004). Music did not reduce the pain during cannulation (p = 0.413) and after that (p = 0.807) significantly when compared with control. Conclusions Vapocoolant was an effective method of pain reduction in the reduction of venous cannulation pain. Music was not effective in the reduction of venous cannulation pain when we compared it with controls. The pain of venous cannulation is rated as high and it can have negative effects on the children. There is a need to do more research on the methods of pain reduction of venous cannulation. Trial registration The trial is registered: IRCT20111019007844N13, 13/03/2020. Available at: https://en.irct.ir/trial/42904.
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Affiliation(s)
| | - Poria Hoseinialiabadi
- Student Research Committee of School of Medicine, Bam University of Medical Sciences, Bam, Iran
| | | | - Maryam Askaryzadeh Mahani
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Leila Malekyan
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | - Kazem Najafi
- Department of Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran.,Department of Medical-Surgical Nursing, School of Nursing and Midwifery, Bam University of Medical Sciences, Bam, Iran
| | | | - Mansour Arab
- Kerman University of Medical Sciences, Kerman, Iran
| | - Hadi Ranjbar
- Mental Health Research Center, Psychosocial Health Research Institute, Iran University of Medical Sciences, Tehran, Iran.
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23
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Belsky JA, Stanek JR, Rose MJ. Investigating the safety and feasibility of osteopathic medicine in the pediatric oncology outpatient setting. J Osteopath Med 2022; 122:423-429. [PMID: 35421288 DOI: 10.1515/jom-2021-0246] [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: 10/07/2021] [Accepted: 03/22/2022] [Indexed: 11/15/2022]
Abstract
CONTEXT Pediatric patients receiving chemotherapy experience unwanted therapy-induced side effects, commonly constipation and pain that diminish quality of life. To date, few studies have investigated the safety and feasibility of osteopathic manipulative treatment (OMT) in pediatric oncology. OBJECTIVES The primary objective of this study is to investigate the safety and feasibility of OMT in pediatric oncology outpatient clinics. METHODS This is a single institutional pilot study evaluating children aged ≥2-21 years receiving chemotherapy for an oncological diagnosis at Nationwide Children's Hospital (NCH). Permission was obtained from the NCH Institutional Review Board. Participants were enrolled for 8 weeks and received weekly OMT. OMT was deemed feasible by participating in six out of eight weekly treatments, and safety was assessed through adverse event grading per Common Terminology Criteria for Adverse Events (CTCAE). During the clinic visit, patients answered validated surveys on constipation (Bristol Stool Scale) and pain (FACES Scale) pre/post-OMT. Feasibility was analyzed utilizing a one-sided exact binomial test while validated tools and adverse events were summarized descriptively. RESULTS A total of 23 patients were enrolled, with 21 included in feasibility analyses. The majority of the patients were female (n=13, 61.9%), with a median age of 12 years at enrollment (range, 2.7-20.8 years). There were no serious adverse events attributed to OMT intervention, and among the patients assessed for feasibility, 100% of them participated in at least two-thirds of their weekly OMT treatments, meeting our defined feasibility criteria. The intervention lasted an average of 14.2 min (range, 7.2-19.2 min). There were no FACES or Bristol Stool Scale scores that correlated with worsening pain on constipation post-OMT intervention. CONCLUSIONS Pediatric oncology patients were feasibly and safely able to receive OMT during a regularly scheduled chemotherapy visit. The limitations include the small sample size. These findings support the need to further investigate the safety and feasibility, as well as efficacy, of OMT in the pediatric oncology clinical setting.
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Affiliation(s)
- Jennifer A Belsky
- Division of Pediatric Hematology/Oncology/BMT, Riley Hospital for Children, Indianapolis, IN, USA.,Department of Pediatrics, Indiana University, Indianapolis, IN, USA
| | - Joseph R Stanek
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa J Rose
- Division of Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University, Columbus, OH, USA
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24
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Ryu JH, Han SH, Hwang SM, Lee J, Do SH, Kim JH, Park JW. Effects of Virtual Reality Education on Procedural Pain and Anxiety During Venipuncture in Children: A Randomized Clinical Trial. Front Med (Lausanne) 2022; 9:849541. [PMID: 35463010 PMCID: PMC9022029 DOI: 10.3389/fmed.2022.849541] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2022] [Accepted: 03/16/2022] [Indexed: 11/13/2022] Open
Abstract
Background Venipuncture is one of the most frequent and frightening medical procedures for children. This randomized clinical trial aimed to evaluate whether pre-procedural immersive virtual reality (VR) education could decrease pain and anxiety during venipuncture procedure of children. Methods Sixty children scheduled for venipuncture at the phlebotomy unit were randomized into either the control or VR group. Before the procedure, children of the control group received conventional simple verbal instructions, whereas those of the VR group experienced a 4-min VR education regarding venipuncture. The primary outcome was the pain and anxiety of pediatric patients assessed with the children’s hospital of eastern ontario pain scale. Secondary outcomes were parental satisfaction, venipuncture time, repeated procedure and procedural difficulty rated by phlebotomists. Results The pain and anxiety score during the procedure was significantly lower in the VR group than in the control group (median [IQR], 6.0 [5.0–7.0] vs. 8.0 [6.0–9.8], P = 0.001). Parental satisfaction about the procedural process were higher in the VR group than in the control group (P = 0.029), and the degree of procedural difficulty was lower in the VR group, compared to the control group (P = 0.026). Conclusion The preprocedural VR education significantly reduced pain and anxiety of children and decreased the procedural difficulty of phlebotomists during venipuncture procedure. Clinical Trial Registration University hospital Medical Information Network Clinical Trials Registry (registration number: UMIN000042968, date of registration: January 9, 2021, URL: https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000049043).
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Affiliation(s)
- Jung-Hee Ryu
- Medical Virtual Reality Research Group, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sung-Hee Han
- Medical Virtual Reality Research Group, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Sang Mee Hwang
- Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Jiyoun Lee
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Sang-Hwan Do
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Hee Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, South Korea
| | - Jin-Woo Park
- Medical Virtual Reality Research Group, Seoul National University College of Medicine, Seoul, South Korea
- Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Seongnam, South Korea
- *Correspondence: Jin-Woo Park,
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25
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Seiler A, Schettle M, Amann M, Gaertner S, Wicki S, Christ SM, Theile G, Feuz M, Hertler C, Blum D. Virtual Reality Therapy in Palliative Care: A Case Series. J Palliat Care 2022:8258597221086767. [PMID: 35293818 DOI: 10.1177/08258597221086767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Virtual reality (VR) opens a variety of therapeutic options to improve symptom burden in patients with advanced disease. Until to date, only few studies have evaluated the use of VR therapy in the context of palliative care. This case series aims to evaluate the feasibility and acceptability of VR therapy in a population of palliative care patients. METHODS In this single-site case series, we report on six palliative care patients undergoing VR therapy. The VR therapy consisted of a one-time session ranging between 20 to 60 minutes depending on the patient's needs and the content chosen for the VR sessions. A semi-structured survey was conducted and the Edmonton Symptom Assessment System (ESAS) and the Distress Thermometer were performed pre- and post-intervention. RESULTS Overall, VR therapy was well accepted by all patients. Five out of six patients reported having appreciated VR therapy. There were individual differences of perceived effects using VR therapy. The semi-structured survey revealed that some patients felt a temporary detachment from their body and that patients were able to experience the VR session as a break from omnipresent worries and the hospital environment ("I completely forgot where I am"). There was a considerable reduction in the total ESAS score post-treatment (T0 ESASTot = 27.2; T1 ESASTot = 18.8) and a slightly reduction in distress (T0 DTTot = 4.4; T1 DTTot = 3.8). However, two patients were more tired after the intervention.Significance of Results: Our preliminary results demonstrate that VR therapy is acceptable, feasible and safe for use within a palliative care population and appears to be a viable treatment option. Clinical trials are both warranted and necessary to confirm any therapeutic effects of VR therapy, as is the need to tailor VR systems better for use in palliative care settings.
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Affiliation(s)
- A Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - M Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Gaertner
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Internal Medicine Centre, Hirslanden Klinik Aarau, Switzerland
| | - S M Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - G Theile
- Clinic Susenberg, Zurich, Switzerland
| | - M Feuz
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - C Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - D Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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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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Hsu MF, Whu YW, Lin IC, Liu CY, Lai FC, Liu PC, Chen CW. Effectiveness of Virtual Reality Interactive Play for Children during Intravenous Placement: A Randomized Controlled Trial. Asian Nurs Res (Korean Soc Nurs Sci) 2022; 16:87-93. [DOI: 10.1016/j.anr.2022.03.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 03/06/2022] [Accepted: 03/07/2022] [Indexed: 11/30/2022] Open
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An Exploratory Study on the Effectiveness of Virtual Reality Analgesia for Children and Adolescents with Kidney Diseases Undergoing Venipuncture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19042291. [PMID: 35206481 PMCID: PMC8872518 DOI: 10.3390/ijerph19042291] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 02/02/2022] [Accepted: 02/10/2022] [Indexed: 02/01/2023]
Abstract
The current study evaluated the effectiveness of VR analgesia among pediatric and adolescent patients with kidney disease undergoing venipuncture. Patients at an Italian Children’s hospital (N = 82, age range 7–17 years) undergoing venipuncture were randomly assigned to a No VR group (non-medical conversation) vs. a Yes VR group (VR analgesia). After the procedure, patients gave 0–10 Verbal Numeric Pain Scale ratings. Compared with patients in the No VR Group, patients in the Yes VR group reported significantly lower “Pain intensity”(No VR mean = 2.74, SD = 2.76 vs. Yes VR mean = 1.56, SD = 1.83) and the VR group also rated “Pain unpleasantness” significantly lower than the No VR group (No VR mean = 2.41, SD = 0.94 vs. Yes VR mean = 1.17, SD = 1.80). Patients distracted with VR also reported having significantly more fun during the venipuncture procedure. No side effects emerged. In addition to reducing pain intensity, VR has the potential to make venipuncture a more fun and less unpleasant experience for children with CKD, as measured in the present study for the first time. Finally, in exploratory analyses, children aged 7–11 in the VR group reported 55% lower worst pain than control subjects in the same age range, whereas children aged 12 to 17 in the VR group only reported 35% lower worst pain than control subjects. Additional research and development using more immersive VR is recommended.
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Yang DJ, Lu MY, Chen CW, Liu PC, Hou IC. Developing the Therapeutic Video Game with MDA Framework to Decrease Anxiety for Pre-school Children with Acute Lymphoblastic Leukemia: Mix-method Approaches (Preprint). JMIR Serious Games 2022; 10:e37079. [PMID: 35994340 PMCID: PMC9446132 DOI: 10.2196/37079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 05/01/2022] [Accepted: 06/12/2022] [Indexed: 11/25/2022] Open
Abstract
Background Preschool-aged children with acute lymphoblastic leukemia (ALL) receive long-term treatment according to the Taiwan Pediatric Oncology Group (TPOG)–ALL 2013 protocol. Severe anxiety and noncompliance ahead of frequent invasive therapies leads to an increase in health care costs. Previous studies have shown that therapeutic video games (TVGs) can decrease the anxiety experienced by children who are ill. To our knowledge, no existing TVG has been designed specifically for preschool-aged children with ALL in Taiwan. Objective The purpose of this study was to develop a TVG using the popular Mechanics, Dynamics, and Aesthetics (MDA) framework for game design and to investigate the effect of this TVG on the reduction of therapy-related anxiety among preschool-aged children with ALL. Methods This study used a mixed methods approach over three phases: (1) develop a TVG using the MDA framework, (2) test the reliability of the TVG among three certified children’s art therapists, and (3) evaluate the reduction of therapy-related anxiety among participants after using the TVG for 6 weeks, using a two-group, stratified randomized controlled trial at a medical center in northern Taiwan. Eligible preschool-aged children with ALL were randomly assigned 1:1 into an experimental group or a control group. The two groups of subjects received the same usual care, and only the experimental group had access to and used the TVG. The children’s anxiety responses were reported by their family caregivers using the face rating scale (FRS). Descriptive analyses, the Fisher exact test, the Pearson chi-square test, and the Mann-Whitney U test were used to statistically analyze the variables. Results Six mechanics rules supported the dynamics of the TVG using four main features—character, nursery, tasks, and market—in order to complete all of the therapy-related anxiety reduction scenarios and to achieve eight aesthetics goals. The results of reliability test showed that participants found the TVG to be useful and trustworthy for preschool-aged children with ALL (Cronbach α=.98). A total of 15 participants were enrolled and randomly allocated to the experimental group (n=7) or the control group (n=8). The average number of TVG log-ins was 37.9 (SD 15.30, range 14-62) in the experimental group. The demographic data showed homogeneity across the two groups regarding age (3 to 5 years), sex (male), risk classification (standard risk), and treatment status (continuation therapy). The mean FRS score was 6.16 (SD 3.31) for the experimental group as compared to 7.45 (SD 2.71) for the control group (P=.04), which represented a significant difference between the groups at the 6-week follow-up. Conclusions This research provides evidence that using a TVG can decrease anxiety in preschool-aged children with ALL in Taiwan. The TVG could be used to support clinical professionals before they perform invasive therapies. However, it is recommended to increase the statistical power for inference. Trial Registration ClinicalTrials.gov NCT04199637; https://www.clinicaltrials.gov/ct2/show/NCT04199637
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Affiliation(s)
- Dai-Jie Yang
- College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Department of Nursing, National Taiwan University Hospital, Taipei City, Taiwan
| | - Meng-Yao Lu
- Department of Pediatrics, National Taiwan University Hospital, Taipei City, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - Pei-Ching Liu
- College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
| | - I-Ching Hou
- College of Nursing, National Yang Ming Chiao Tung University, Taipei City, Taiwan
- Efficient Smart Care Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
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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 TP, Hollinger T, Dolby T, Sherman JM. Development and Considerations for Virtual Reality Simulations for Resuscitation Training and Stress Inoculation. Simul Healthc 2021; 16:e219-e226. [PMID: 33273419 DOI: 10.1097/sih.0000000000000521] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Resuscitation simulations immerse learners into the complexity of emergency patient management. Head-Mounted Display Virtual Reality (VR) has been used for stress inoculation therapy for phobias and posttraumatic stress disorder. However, VR for stress inoculation in resuscitation leadership training has not been studied. We sought to develop VR simulation for stress inoculation, as exposure therapy training, for resuscitations. METHODS We explain the conceptual design, development, production, and initial evaluation process for 2 VR simulations in infant status epilepticus and pediatric anaphylactic shock. We further describe deliberate game mechanic choices to maximize psychological fidelity. In-virtual reality performance data for time-to-critical actions and stress physiology markers (heart rate, salivary cortisol) were collected from expert pediatric emergency physicians and novice pediatric residents. Data were analyzed to examine differences between the 2 groups for both outcome types to determine the extent of stress response or performance deficit the VR induced. RESULTS Multiple difficulties and distractions were designed for the 2 scenarios; we evaluated the highest difficulty and environmental distraction versions. Between 19 expert physicians and 15 novice physicians, no performance differences were found in typical airway, breathing, and circulation actions. Residents preferred more lorazepam first-line antiepileptics than attendings (P = 0.003) and performed a cricothyrotomy later than attendings (P = 0.02). Residents, however, manifested higher salivary cortisol levels than attendings (+0.07 μg/dL, 95% confidence interval = 0.03-0.12, P = 0.001). CONCLUSIONS A VR resuscitation simulation manifested expected stress physiology changes in physicians. Further evaluation is needed to determine the effect of VR simulation as longitudinal stress inoculation for healthcare providers.
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Affiliation(s)
- Todd P Chang
- From the Division of Emergency Medicine, Keck School of Medicine, University of Southern California (T.P.C.), and Division of Emergency and Transport Medicine (T.H.), Children's Hospital Los Angeles, Los Angeles, CA; A.i.Solve, Ltd (T.D.), Luton, United Kingdom; and PM Pediatrics (J.M.S.), Los Angeles, CA
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Althumairi A, Sahwan M, Alsaleh S, Alabduljobar Z, Aljabri D. Virtual Reality: Is It Helping Children Cope with Fear and Pain During Vaccination? J Multidiscip Healthc 2021; 14:2625-2632. [PMID: 34584419 PMCID: PMC8464586 DOI: 10.2147/jmdh.s327349] [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: 07/01/2021] [Accepted: 08/06/2021] [Indexed: 11/23/2022] Open
Abstract
Background Virtual reality (VR) is an innovative distraction technology in health care, but little is known about this topic in Saudi Arabia. The aim of this study was to assess the effectiveness of using VR to reduce pain and fear among children during vaccination. Methods It is a cross-sectional study design. A total of 104 children (ages 4–6 years) receiving routine vaccinations in a single primary health care in Eastern Region, Saudi Arabia, participated in the study and grouped to a VR technology intervention group or vaccination as usual without VR distraction. The primary outcome is the difference in the child’s self-rated fear and pain scores between those who have been vaccinated with or without VR distraction, measured by the two validated international facial expressions scales Wong–Baker FACES Pain Scale and Children’s Fear Scale. Results In the two-month study period, 53 children were vaccinated using the VR technology and 50 children were vaccinated without VR. Bivariate analysis showed a significantly lower pain score among the VR group (\documentclass[12pt]{minimal}
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\end{document}=1.36, SD 2.06) compared with the group without VR (\documentclass[12pt]{minimal}
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\end{document}=0.64, SD 0.92) compared with the group without VR (\documentclass[12pt]{minimal}
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\end{document}=2.88, SD1.55) (P < 0.001). In multivariable regression models adjusted for age and gender, children vaccinated using the VR technology had significantly lower pain and fear scores compared with those who were vaccinated as usual without VR distraction. Conclusion VR technology showed a positive impact on reducing pain and fear among children aged 4–6 years during vaccination. Policymakers are encouraged to expand the use of this distraction tool in primary health centers to improve the vaccination experience among children.
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Affiliation(s)
- Arwa Althumairi
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Maryam Sahwan
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Sawsan Alsaleh
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Zinab Alabduljobar
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Duaa Aljabri
- Department of Health Information Management and Technology, College of Public Health, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
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Lee HN, Bae W, Park JW, Jung JY, Hwang S, Kim DK, Kwak YH. Virtual reality environment using a dome screen for procedural pain in young children during intravenous placement: A pilot randomized controlled trial. PLoS One 2021; 16:e0256489. [PMID: 34464411 PMCID: PMC8407539 DOI: 10.1371/journal.pone.0256489] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Accepted: 08/03/2021] [Indexed: 12/05/2022] Open
Abstract
We assessed the feasibility and potential efficacy of a virtual reality (VR) environment using a dome screen as a distraction method in young children during intravenous (IV) placement in the pediatric emergency department. This randomized controlled pilot study enrolled children aged 2 to 6 years who underwent IV placement into either the intervention group or the control group. Children in the intervention group experienced VR using a dome screen during IV placement. The child’s pain intensity was measured using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale at four time points of IV placement: immediately after arrival to the blood collection room (base); immediately after the child laid down on the bed (preparation); when the tourniquet was applied (tourniquet); and the moment at which the needle penetrated the skin (venipuncture). The guardian’s satisfaction and rating of the child’s distress were assessed using a 5-point Likert-type questionnaire. We recruited 19 children (9 in the intervention group and 10 in the control group). Five children in the control group were excluded from the analysis because of missing video recordings (n = 3), failed first attempt at IV placement (n = 1), and the child’s refusal to lie on the bed during the procedure (n = 1). No side effects of VR were reported during the study period. Although the average FLACC scale score at each time point (preparation, tourniquet, venipuncture) was lower in the intervention group than the control group, the difference was not statistically significant (2.3, interquartile range [IQR]: 2.0–3.0; vs. 3.3, IQR: 2.7–6.7, P = 0.255). There were no statistically significant differences between the groups in the guardian’s satisfaction and anxiety or his/her rating of the child’s pain and anxiety. The guardians and emergency medical technicians reported satisfaction with the use of VR with a dome screen and considered it a useful distraction during the procedure. VR using a dome screen is a feasible distraction method for young children during IV placement. A larger clinical trial with further development of the VR environment and study process is required to adequately evaluate the efficacy of VR using a dome screen.
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Affiliation(s)
- Ha Ni Lee
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woori Bae
- Department of Emergency Medicine, Seoul St. Mary Hospital, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joong Wan Park
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
- * E-mail:
| | - Jae Yun Jung
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Soyun Hwang
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Do Kyun Kim
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Young Ho Kwak
- Department of Emergency Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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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: 17] [Impact Index Per Article: 5.7] [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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Canares T, Parrish C, Santos C, Badawi A, Stewart A, Kleinman K, Psoter K, McGuire J. Pediatric Coping During Venipuncture With Virtual Reality: Pilot Randomized Controlled Trial. JMIR Pediatr Parent 2021; 4:e26040. [PMID: 34319249 PMCID: PMC8367183 DOI: 10.2196/26040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 05/16/2021] [Accepted: 05/16/2021] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND Virtual reality (VR) has shown promise in reducing children's pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. OBJECTIVE The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. METHODS This stratified, randomized, controlled pilot trial compared coping and distress between child life-supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. RESULTS Overall recruitment was 93% (66/71), VR withdrawal rate was 27% (4/15), and of the completed procedures, 100% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). CONCLUSIONS Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children's coping during venipuncture or other related procedures. TRIAL REGISTRATION ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176.
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Affiliation(s)
- Therese Canares
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Carisa Parrish
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Christine Santos
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alia Badawi
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Alyssa Stewart
- Department of Child Life, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Keith Kleinman
- Division of Pediatric Emergency Medicine, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Kevin Psoter
- Division of General Pediatrics, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Joseph McGuire
- Division of Child and Adolescent Psychiatry, Johns Hopkins University School of Medicine, Baltimore, MD, United States
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Colombo D, Díaz-García A, Fernandez-Álvarez J, Botella C. Virtual reality for the enhancement of emotion regulation. Clin Psychol Psychother 2021; 28:519-537. [PMID: 34048621 DOI: 10.1002/cpp.2618] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 04/22/2021] [Accepted: 05/21/2021] [Indexed: 01/21/2023]
Abstract
In recent decades, a growing body of literature has focused on emotion regulation (ER), which refers to the ability to implement strategies in order to modulate emotional responses and reach desirable goals. To date, impaired ER (i.e., emotion dysregulation) has been identified as a transdiagnostic factor across a wide range of psychopathological conditions, which shows the importance of improving patients' ability to regulate negative and positive emotions in clinical practice. In addition to the increasing evidence showing its efficacy in the treatment of several clinical conditions, virtual reality (VR) has recently emerged as a potentially powerful tool for enhancing ER, thus breaking new ground in the development of cutting-edge transdiagnostic interventions. In the present narrative review, we will provide an overview of the existing evidence about VR-based interventions in the field of ER, emphasizing the promising findings and the barriers that still have to be addressed. To this aim, the available VR-based literature will be analysed in relation to four categories of ER strategies: situational strategies, attentional strategies, cognitive strategies, and response modulation strategies. Furthermore, new emerging fields of research targeting innovative aspects of ER will be highlighted, including the use of VR to promote positive emotions and interpersonal ER skills. Besides, its cost-effectiveness will be discussed, taking into account the costs for both developers (e.g., clinicians and researchers) and end-users. Finally, future directions in this promising field of research will be outlined.
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Affiliation(s)
- Desirée Colombo
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain
| | - Amanda Díaz-García
- Department of Psychology and Sociology, Universidad de Zaragoza, Zaragoza, Spain
| | | | - Cristina Botella
- Department of Basic Psychology, Clinic and Psychobiology, Jaume I University, Castellón de la Plana, Spain.,CIBER Fisiopatología Obesidad y Nutrición (CIBERobn), Instituto Salud Carlos III, Madrid, Spain
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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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Garcia LM, Birckhead BJ, Krishnamurthy P, Sackman J, Mackey IG, Louis RG, Salmasi V, Maddox T, Darnall BD. An 8-Week Self-Administered At-Home Behavioral Skills-Based Virtual Reality Program for Chronic Low Back Pain: Double-Blind, Randomized, Placebo-Controlled Trial Conducted During COVID-19. J Med Internet Res 2021; 23:e26292. [PMID: 33484240 PMCID: PMC7939946 DOI: 10.2196/26292] [Citation(s) in RCA: 78] [Impact Index Per Article: 26.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/11/2021] [Accepted: 01/13/2021] [Indexed: 01/22/2023] Open
Abstract
Background Chronic low back pain is the most prevalent chronic pain condition worldwide and access to behavioral pain treatment is limited. Virtual reality (VR) is an immersive technology that may provide effective behavioral therapeutics for chronic pain. Objective We aimed to conduct a double-blind, parallel-arm, single-cohort, remote, randomized placebo-controlled trial for a self-administered behavioral skills-based VR program in community-based individuals with self-reported chronic low back pain during the COVID-19 pandemic. Methods A national online convenience sample of individuals with self-reported nonmalignant low back pain with duration of 6 months or more and with average pain intensity of 4 or more/10 was enrolled and randomized 1:1 to 1 of 2 daily (56-day) VR programs: (1) EaseVRx (immersive pain relief skills VR program); or (2) Sham VR (2D nature content delivered in a VR headset). Objective device use data and self-reported data were collected. The primary outcomes were the between-group effect of EaseVRx versus Sham VR across time points, and the between–within interaction effect representing the change in average pain intensity and pain-related interference with activity, stress, mood, and sleep over time (baseline to end-of-treatment at day 56). Secondary outcomes were global impression of change and change in physical function, sleep disturbance, pain self-efficacy, pain catastrophizing, pain acceptance, pain medication use, and user satisfaction. Analytic methods included intention-to-treat and a mixed-model framework. Results The study sample was 179 adults (female: 76.5%, 137/179; Caucasian: 90.5%, 162/179; at least some college education: 91.1%, 163/179; mean age: 51.5 years [SD 13.1]; average pain intensity: 5/10 [SD 1.2]; back pain duration ≥5 years: 67%, 120/179). No group differences were found for any baseline variable or treatment engagement. User satisfaction ratings were higher for EaseVRx versus Sham VR (P<.001). For the between-groups factor, EaseVRx was superior to Sham VR for all primary outcomes (highest P value=.009), and between-groups Cohen d effect sizes ranged from 0.40 to 0.49, indicating superiority was moderately clinically meaningful. For EaseVRx, large pre–post effect sizes ranged from 1.17 to 1.3 and met moderate to substantial clinical importance for reduced pain intensity and pain-related interference with activity, mood, and stress. Between-group comparisons for Physical Function and Sleep Disturbance showed superiority for the EaseVRx group versus the Sham VR group (P=.022 and .013, respectively). Pain catastrophizing, pain self-efficacy, pain acceptance, prescription opioid use (morphine milligram equivalent) did not reach statistical significance for either group. Use of over-the-counter analgesic use was reduced for EaseVRx (P<.01) but not for Sham VR. Conclusions EaseVRx had high user satisfaction and superior and clinically meaningful symptom reduction for average pain intensity and pain-related interference with activity, mood, and stress compared to sham VR. Additional research is needed to determine durability of treatment effects and to characterize mechanisms of treatment effects. Home-based VR may expand access to effective and on-demand nonpharmacologic treatment for chronic low back pain. Trial Registration ClinicalTrials.gov NCT04415177; https://clinicaltrials.gov/ct2/show/NCT04415177 International Registered Report Identifier (IRRID) RR2-10.2196/25291
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Affiliation(s)
| | | | | | | | | | - Robert G Louis
- Division of Neurosurgery, Pickup Family Neurosciences Institute, Hoag Memorial Hospital, Newport Beach, CA, United States
| | - Vafi Salmasi
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Todd Maddox
- AppliedVR, Inc, Los Angeles, CA, United States
| | - Beth D Darnall
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
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Belsky JA, Stanek J, Skeens MA, Gerhardt CA, Rose MJ. Supportive care and osteopathic medicine in pediatric oncology: perspectives of current oncology clinicians, caregivers, and patients. Support Care Cancer 2021; 29:1121-1128. [PMID: 32647995 PMCID: PMC7767897 DOI: 10.1007/s00520-020-05612-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/26/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND OBJECTIVE Many children receiving chemotherapy struggle with therapy-induced side effects. To date, there has been no literature investigating the needs, knowledge, or implementation of osteopathic manipulative treatments (OMT) as a supportive care option in pediatric oncology. We hypothesized that pediatric oncology clinicians, caregivers, and patients have (a) limited knowledge of OMT and (b) dissatisfaction with current supportive care options and (c) would be interested in having OMT available during chemotherapy, once educated. METHODS Participants included three cohorts: (1) children aged ≥ 9 years, diagnosed with cancer and actively receiving chemotherapy; (2) their caregivers; and (3) oncology clinicians at Nationwide Children's Hospital. Participants completed 1:1 semi-structured interviews, which were audio-recorded, transcribed, and analyzed for thematic content regarding their perception of supportive care measures and views on OMT. Quantitative data was summarized descriptively. RESULTS A total of 60 participants completed the interview. Participants demonstrated limited awareness of osteopathic medicine; no participant had more than "some" knowledge of OMT. After education about OMT using a brief video, all clinicians, caregivers, and 95% of patients were receptive to OMT as a supportive care option. Major themes included the following: (a) patients have uncontrolled chemotherapy side effects, (b) improved supportive care options are desired, and (c) osteopathic medicine is a favorable supportive care adjunct. CONCLUSIONS Pediatric oncology clinicians, caregivers, and patients reported a need for better management of chemotherapy-associated side effects and an interest in utilizing OMT. These findings support further investigation into the safety, feasibility, and efficacy of implementing OMT in the pediatric oncology clinical setting.
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Affiliation(s)
- Jennifer A Belsky
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA.
| | - Joseph Stanek
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Micah A Skeens
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
| | - Cynthia A Gerhardt
- Departments of Pediatrics and Psychology, The Ohio State University, Columbus, OH, USA
- The Center for Biobehavioral Health, Nationwide Children's Hospital, Columbus, OH, USA
| | - Melissa J Rose
- Pediatric Hematology/Oncology/BMT, Nationwide Children's Hospital, 700 Children's Drive, Columbus, OH, 43205, USA
- Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, 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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Cozzi G, Valerio P, Kennedy R. A narrative review with practical advice on how to decrease pain and distress during venepuncture and peripheral intravenous cannulation. Acta Paediatr 2021; 110:423-432. [PMID: 32772423 DOI: 10.1111/apa.15526] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 08/04/2020] [Accepted: 08/05/2020] [Indexed: 01/08/2023]
Abstract
Venepuncture and peripheral intravenous cannulation are two of the most commonly paediatric performed medical procedures in many healthcare settings. These procedures can cause significant pain and distress at any age, during childhood, so appropriate management is strongly recommended. This review examines the evidence related to pain and distress management during venepuncture and peripheral intravenous cannulation, including preparing the environment, assessing and preparing patients, parental involvement and psychological and pharmacological interventions. It specifically refers to neonates, children with cognitive impairment and children with difficult intravenous access. We provide a brief management strategy, with easily implemented techniques to improve daily practice.
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Affiliation(s)
- Giorgio Cozzi
- Institute for Maternal and Child Health IRCCS Burlo Garofolo Trieste Italy
| | - Paolo Valerio
- Department of Pediatrics OLVG Hospital Amsterdam The Netherlands
| | - Robert Kennedy
- Washington University School of Medicine St Louis MO USA
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Trost Z, France C, Anam M, Shum C. Virtual reality approaches to pain: toward a state of the science. Pain 2021; 162:325-331. [PMID: 32868750 DOI: 10.1097/j.pain.0000000000002060] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Zina Trost
- Virginia Commonwealth University, Richmond, VA, United States
| | | | - Monima Anam
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Corey Shum
- Immersive Experience Labs, LLC, Birmingham, AL, United States
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Hoffman HG, Patterson DR, Rodriguez RA, Peña R, Beck W, Meyer WJ. Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement. FRONTIERS IN VIRTUAL REALITY 2020; 1:602299. [PMID: 33585833 PMCID: PMC7880045 DOI: 10.3389/frvir.2020.602299] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The objective of this study was to compare the effect of adjunctive virtual reality vs. standard analgesic pain medications during burn wound cleaning/debridement. Participants were predominantly Hispanic children aged 6-17 years of age, with large severe burn injuries (TBSA = 44%) reporting moderate or higher baseline pain during burn wound care. Using a randomized between-groups design, participants were randomly assigned to one of two groups, (a) the Control Group = pain medications only or (b) the VR Group = pain medications + virtual reality. A total of 50 children (88% Hispanic) with large severe burns (mean TBSA > 10%) received severe burn wound cleaning sessions. For the primary outcome measure of worst pain (intensity) on Study Day 1, using a between groups ANOVA, burn injured children in the group that received virtual reality during wound care showed significantly less pain intensity than the No VR control group, [mean worst pain ratings for the No VR group = 7.46 (SD = 2.93) vs. 5.54 (SD = 3.56), F (1,48) = 4.29, <0.05, MSE = 46.00]. Similarly, one of the secondary pain measures, "lowest pain during wound care" was significantly lower in the VR group, No VR = 4.29 (SD = 3.75) vs. 1.68 (2.04) for the VR group, F(147) = 9.29, < 0.005, MSE = 83.52 for Study Day 1. The other secondary pain measures showed the predicted pattern on Study Day 1, but were non-significant. Regarding whether VR reduced pain beyond Study Day 1, absolute change in pain intensity (analgesia = baseline pain minus the mean of the worst pain scores on Study days 1-10) was significantly greater for the VR group, F (148) = 4.88, p < 0.05, MSE = 34.26, partial eta squared = 0.09, but contrary to predictions, absolute change scores were non-significant for all secondary measures.
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Affiliation(s)
- Hunter G. Hoffman
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
- Department of Psychology, University of Washington, Washington, ME, United States
- Department of Radiology, University of Washington, Seattle, WA, United States
| | - David R. Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Robert A. Rodriguez
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
| | - Raquel Peña
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
| | - Wanda Beck
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
| | - Walter J. Meyer
- Department of Radiology, University of Washington, Seattle, WA, United States
- University of Texas Medical Branch at Galveston, Galveston, TX, United States
- Shriners Hospitals for Children Galveston, Galveston, TX, United States
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Firoozabadi R, Elhaddad M, Drever S, Soltani M, Githens M, Kleweno CP, Sharar SR, Patterson DR, Hoffman HG. Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study. FRONTIERS IN VIRTUAL REALITY 2020; 1:553492. [PMID: 33585832 PMCID: PMC7877803 DOI: 10.3389/frvir.2020.553492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Immersive virtual reality is proving effective as a non-pharmacologic analgesic for a growing number of painful medical procedures. External fixator surgical pins provide adjunctive stability to a broken pelvic bone until the bones heal back together, then pins are removed. The purpose of the present case study was to measure for the first time, whether immersive virtual reality could be used to help reduce pain and anxiety during the orthopedic process of removing external fixator pins from a conscious patient in the orthopedic outpatient clinic, and whether it is feasible to use VR in this context. Using a within-subject within wound care design with treatment order randomized, the patient had his first ex-fix pin unscrewed and removed from his healing pelvic bone while he wore a VR helmet and explored an immersive snowy 3D computer generated world, adjunctive VR. He then had his second pin removed during no VR, standard of care pain medications. The patient reported having 43% less pain intensity, 67% less time spent thinking about pain, and 43% lower anxiety during VR vs. during No VR. In addition, the patient reported that his satisfaction with pain management was improved with the use of VR. Conducting simple orthopedic procedures using oral pain pills in an outpatient setting instead of anesthesia in the operating room greatly reduces the amount of opioids used, lowers medical costs and reduces rare but real risks of expensive complications from anesthesia including oversedation, death, and post-surgical dementia. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive non-pharmacologic form of treatment for acute pain and anxiety during medical procedures in the orthopedic outpatient clinic. Recent multi-billion dollar investments into R and D and mass production have made inexpensive immersive virtual reality products commercially available and cost effective for medical applications. We speculate that in the future, patients may be more willing to have minor surgery procedures in the outpatient clinic, with much lower opioid doses, while fully awake, if offered adjunctive virtual reality as a non-pharmacologic analgesic during the procedure. Additional research and development is recommended.
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Affiliation(s)
- Reza Firoozabadi
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Moamen Elhaddad
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Sydney Drever
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Maryam Soltani
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Michael Githens
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Conor P. Kleweno
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Sam R. Sharar
- Department of Anesthesiology & Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - David R. Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Hunter G. Hoffman
- Department of Radiology, University of Washington, Seattle, WA, United States
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
- Department of Psychology, University of Washington, Washington, ME, United States
- Correspondence: Hunter G. Hoffman,
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Effects of a projector-based hybrid virtual reality on pain in young children with burn injuries during hydrotherapy sessions: A within-subject randomized crossover trial. Burns 2020; 46:1571-1584. [DOI: 10.1016/j.burns.2020.04.006] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 04/01/2020] [Accepted: 04/07/2020] [Indexed: 12/13/2022]
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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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New Technologies to Improve Pain, Anxiety and Depression in Children and Adolescents with Cancer: A Systematic Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103563. [PMID: 32438762 PMCID: PMC7277488 DOI: 10.3390/ijerph17103563] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Revised: 05/10/2020] [Accepted: 05/15/2020] [Indexed: 12/25/2022]
Abstract
Pain, anxiety, or depression are very prevalent in children and adolescents with cancer, which is a great challenge for health professionals. Several studies pointing out the positive effect of technology on the management of symptoms have been published in recent years. Considering these studies is important in order to reduce the negative impact on the quality of life of this population. This study aimed to analyze the available evidence and to describe the benefits of the new technologies in the treatment of pain, anxiety, and depression in children and adolescents with cancer. A systematic search using six electronic databases was conducted to identify studies using technological interventions with a focus on pain, anxiety, and depression that were published from 2008 to 2018 including oncology patients from 0–18 years old. Out of the 1261 studies that were identified, five studies met the inclusion criteria for this systematic review. Robots were used in two studies, providing amusement and social interventions that showed significant improvements. Virtual reality, a mobile application, and a videogame were used in three studies and obtained beneficial results in pain and anxiety. The studies included in this review suggest that new technologies can be used as an innovative form of non-pharmacological intervention with therapeutic benefits.
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Abstract
As avid users of technology, adolescents are a key demographic to engage when designing and developing technology applications for health. There are multiple opportunities for improving adolescent health, from promoting preventive behaviors to providing guidance for adolescents with chronic illness in supporting treatment adherence and transition to adult health care systems. This article will provide a brief overview of current technologies and then highlight new technologies being used specifically for adolescent health, such as artificial intelligence, virtual and augmented reality, and machine learning. Because there is paucity of evidence in this field, we will make recommendations for future research.
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Affiliation(s)
- Ana Radovic
- Department of Pediatrics, School of Medicine, University of Pittsburgh and University of Pittsburgh Medical Center Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania;
| | - Sherif M Badawy
- Department of Pediatrics, Feinberg School of Medicine, Northwestern University, Chicago, Illinois; and.,Division of Hematology, Oncology, Neurooncology, and Stem Cell Transplantation, Ann & Robert H. Lurie Children's Hospital of Chicago, Chicago, Illinois
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Al-Ghamdi NA, Meyer WJ, Atzori B, Alhalabi W, Seibel CC, Ullman D, Hoffman HG. Virtual Reality Analgesia With Interactive Eye Tracking During Brief Thermal Pain Stimuli: A Randomized Controlled Trial (Crossover Design). Front Hum Neurosci 2020; 13:467. [PMID: 32038200 PMCID: PMC6990370 DOI: 10.3389/fnhum.2019.00467] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Accepted: 12/19/2019] [Indexed: 12/14/2022] Open
Abstract
In light of growing concerns about opioid analgesics, developing new non-pharmacologic pain control techniques has become a high priority. Adjunctive virtual reality can help reduce acute pain during painful medical procedures. However, for some especially painful medical procedures such as burn wound cleaning, clinical researchers recommend that more distracting versions of virtual reality are needed, to further amplify the potency of virtual reality analgesia. The current study with healthy volunteers explores for the first time whether interacting with virtual objects in Virtual Reality (VR) via "hands free" eye-tracking technology integrated into the VR helmet makes VR more effective/powerful than non-interactive/passive VR (no eye-tracking) for reducing pain during brief thermal pain stimuli. METHOD Forty eight healthy volunteers participated in the main study. Using a within-subject design, each participant received one brief thermal pain stimulus during interactive eye tracked virtual reality, and each participant received another thermal pain stimulus during non-interactive VR (treatment order randomized). After each pain stimulus, participants provided subjective 0-10 ratings of cognitive, sensory and affective components of pain, and rated the amount of fun they had during the pain stimulus. RESULTS As predicted, interactive eye tracking increased the analgesic effectiveness of immersive virtual reality. Compared to the passive non-interactive VR condition, during the interactive eye tracked VR condition, participants reported significant reductions in worst pain (p < 0.001) and pain unpleasantness (p < 0.001). Participants reported a significantly stronger illusion of presence (p < 0.001), and significantly more fun in VR (p < 0.001) during the interactive condition compared to during passive VR. In summary, as predicted by our primary hypothesis, in the current laboratory acute pain analog study with healthy volunteers, increasing the immersiveness of the VR system via interactive eye tracking significantly increased how effectively VR reduced worst pain during a brief thermal pain stimulus. Although attention was not directly measured, the pattern of pain ratings, presence ratings, and fun ratings are consistent with an attentional mechanism for how VR reduces pain. Whether the current results generalize to clinical patient populations is another important topic for future research. Additional research and development is recommended.
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Affiliation(s)
- Najood A. Al-Ghamdi
- Department of Computer Science, Faculty of Computing and Information Technology, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Walter J. Meyer
- Shriners Hospitals for Children, Galveston, TX, United States
- Department of Psychiatry, The University of Texas Medical Branch at Galveston, Galveston, TX, United States
| | - Barbara Atzori
- Department of Health Sciences, School of Psychology, University of Florence, Florence, Italy
| | - Wadee Alhalabi
- Department of Computer Science, College of Engineering, Effat University, Jeddah, Saudi Arabia
- The Virtual Reality Research Group, King Abdulaziz University, Jeddah, Saudi Arabia
- Department of Computer Science, Dar Al-Hekma University, Jeddah, Saudi Arabia
| | - Clayton C. Seibel
- Virtual Reality Research Center, Human Photonics Lab, University of Washington, Seattle, WA, United States
| | - David Ullman
- Virtual Reality Research Center, Human Photonics Lab, University of Washington, Seattle, WA, United States
| | - Hunter G. Hoffman
- Virtual Reality Research Center, Human Photonics Lab, University of Washington, Seattle, WA, United States
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
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Virtual reality hand therapy: A new tool for nonopioid analgesia for acute procedural pain, hand rehabilitation, and VR embodiment therapy for phantom limb pain. J Hand Ther 2020; 33:254-262. [PMID: 32482376 PMCID: PMC7719341 DOI: 10.1016/j.jht.2020.04.001] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2020] [Accepted: 04/09/2020] [Indexed: 02/03/2023]
Abstract
INTRODUCTION Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products. PURPOSE OF THE STUDY The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist. DISCUSSION The following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions-immersive VR embodiment therapy for phantom limb (chronic) pain. CONCLUSION VR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients' pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera-based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.
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