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Su S, Wang R, Chen Z, Zhou F, Zhang Y. The effectiveness of extended reality on relieving pain after total knee arthroplasty: a systematic review and meta-analysis of randomized controlled trials. Arch Orthop Trauma Surg 2024; 144:3217-3226. [PMID: 38960934 DOI: 10.1007/s00402-024-05440-0] [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: 01/07/2024] [Accepted: 06/27/2024] [Indexed: 07/05/2024]
Abstract
PURPOSE Patients with total knee arthroplasty (TKA) often suffer from severe postoperative pain, which seriously hinders postoperative rehabilitation. Extended reality (XR), including virtual reality, augmented reality, and mixed reality, has been increasingly used to relieve pain after TKA. The purpose of this study was to evaluate the effectiveness of XR on relieving pain after TKA. METHODS The electronic databases including PubMed, Embase, Web of Science, Cochrane Central Register of Controlled Trials (CENTRAL), and clinicaltrials.gov were searched for studies from inception to July 20, 2023. The outcomes were pain score, anxiety score, and physiological parameters related to pain. Meta-analysis was performed using the Review Manager 5.4 software. RESULTS Overall, 11 randomized control trials (RCTs) with 887 patients were included. The pooled results showed XR had lower pain scores (SMD = - 0.31, 95% CI [- 0.46 to - 0.16], P < 0.0001) and anxiety scores (MD = - 3.95, 95% CI [- 7.76 to - 0.13], P = 0.04) than conventional methods. The subgroup analysis revealed XR had lower pain scores within 2 weeks postoperatively (SMD = - 0.49, 95% CI [- 0.76 to - 0.22], P = 0.0004) and XR had lower pain scores when applying XR combined with conventional methods (SMD = - 0.43, 95% CI [- 0.65 to - 0.20], P = 0.0002). CONCLUSION This systematic review and meta-analysis found applying XR could significantly reduce postoperative pain and anxiety after TKA. When XR was combined with conventional methods, postoperative pain can be effectively relieved, especially within 2 weeks after the operation. XR is an effective non-pharmacological analgesia scheme.
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Affiliation(s)
- Shilong Su
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Ruideng Wang
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Zhengyang Chen
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China
| | - Fang Zhou
- Department of Orthopedics, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Peking University Third Hospital, No.49 North Garden Road. Haidian, Beijing, 100191, China.
| | - Yunqing Zhang
- Department of Orthopedics, The First Hospital of Changsha, No.311 Yingpan Road, Changsha, Hunan Province, 410005, China.
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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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Guo L, Li S, Xie S, Bian L, Shaharudin S. The impact of digital healthcare systems on pain and body function in patients with knee joint pain: a systematic review and meta-analysis. Sci Rep 2024; 14:3310. [PMID: 38331984 PMCID: PMC10853270 DOI: 10.1038/s41598-024-53853-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 02/06/2024] [Indexed: 02/10/2024] Open
Abstract
The digital healthcare (DH) system has recently emerged as an advanced rehabilitation approach that promotes rehabilitation training based on virtual reality (VR) and augmented reality (AR). The purpose of this meta-analysis study is to review and assess the impact of DH systems on pain and physical function among patients diagnosed with knee joint pain. Between January 2003 and September 2023, studies that met the listed inclusion criteria were gathered from Scopus, PubMed, Web of Science, and EBSCO databases. The analysis of standardized mean difference (SMD) was carried out with 95% confidence interval (95% CI) (PROSPERO registration number: CRD42023462538). Eight research papers were selected, which collectively involved 194 males and 279 females. The meta-analysis outcomes revealed that DH intervention significantly improved balance (SMD, 0.41 [0.12, 0.69], p < 0.05) and pain level (SMD, - 1.10 [- 2.02, - 0.18], p < 0.05). The subgroup analysis of the pain level showed varied outcomes for the TKA (SMD, - 0.22 [- 0.49, 0.04], p = 0.10) or OA patients (SMD, - 2.80 [- 3.83, - 1.78], p < 0.05) Next, this study found no significant effect of DH intervention on knee joint range of motion (ROM) (SMD, 0.00 [- 0.76, 0.76], p = 1.00) and walking velocity (SMD, 0.04 [- 0.22, 0.29], p = 0.77) in patients with knee joint pain. The meta-analysis review conducted in this study revealed that DH intervention may potentially improve balance among the patients with knee joint pain. It may also alleviate the pain level particularly among OA patients.
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Affiliation(s)
- Longfei Guo
- School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Shuoqi Li
- School of Sports Science, Nantong University, Nantong, Jiangsu, China
| | - Shihao Xie
- School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia
| | - Lin Bian
- School of Physical Education, Woosuk University, Jeonju, Korea
| | - Shazlin Shaharudin
- School of Health Sciences, Universiti Sains Malaysia, Kota Bharu, Kelantan, Malaysia.
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Andrade G, Abdelmonem KYA, Alqaderi N, Teir HJ, Elamin ABA, Bedewy D. Fear of Needles and Seasonal Influenza Vaccine Acceptance Amongst Adults in the United Arab Emirates: A Cross-Sectional Study and Implications for Nursing. SAGE Open Nurs 2024; 10:23779608241261622. [PMID: 38881678 PMCID: PMC11177738 DOI: 10.1177/23779608241261622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Revised: 05/13/2024] [Accepted: 05/27/2024] [Indexed: 06/18/2024] Open
Abstract
Introduction Seasonal influenza remains a challenge in the United Arab Emirates, and vaccination is an important preventive measure. However, fear of needles may be an obstacle in vaccination efforts. Objective The purpose of this study was to determine, in a non-clinical sample obtained from the UAE, how much of an impact fear of needles has on the decision to receive the seasonal influenza vaccine. Methods In the period September-December 2022, 372 participants were surveyed on their willingness to be vaccinated, their level of vaccine knowledge, and their level of fear of needles. Logistic regression models were used to assess the impact of fear of needles and vaccine knowledge on the decision to accept the seasonal influenza vaccine. Results Fear of needles and vaccine knowledge are significant predictors in the decision to receive the vaccine. There were no gender or ethnic differences in fear of needles, but there were differences in the decision to receive the vaccines, with women and non-Arabs being more hesitant. Conclusion Fear of needles may be an important variable to account for in public policies designed to improve vaccination rates in the UAE. For public health policy in the UAE, this implies that authorities must dedicate efforts to manage fear of needles in the general population. Efforts to address fear of vaccines in the general population must be made with proper training of nurses. Alternatively, authorities may need to seek oral alternatives for the administration of the seasonal influenza vaccine.
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Affiliation(s)
| | | | | | | | | | - Dalia Bedewy
- Ajman University, Ajman, UAE
- Tanta University, Tanta, Egypt
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Hu Y, Yuan X, Ye P, Chang C, Hu YH, Zhang W, Li K. Virtual Reality in Clinical Nursing Practice Over the Past 10 Years: Umbrella Review of Meta-Analyses. JMIR Serious Games 2023; 11:e52022. [PMID: 37997773 PMCID: PMC10690102 DOI: 10.2196/52022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2023] [Revised: 10/07/2023] [Accepted: 10/09/2023] [Indexed: 11/25/2023] Open
Abstract
Background Virtual reality (VR) has shown promising levels of effectiveness in nursing education, pain management, and rehabilitation. However, meta-analyses have discussed the effects of VR usage in nursing unilaterally and inconsistently, and the evidence base is diffuse and varied. Objective We aimed to synthesize the combined evidence from meta-analyses that assessed the effects of nurses using VR technology on nursing education or patient health outcomes. Methods We conducted an umbrella review by searching for meta-analyses about VR intervention in clinical nursing practice on Web of Science, Embase, Cochrane, and PubMed, and in reference lists. Eligible studies were published in English between December 1, 2012, and September 20, 2023. Meta-analyses of ≤2 intervention studies and meta-analyses without 95% CI or heterogeneity data were excluded. Characteristic indicators, population information, VR intervention information, and 95% CIs were extracted. A descriptive analysis of research results was conducted to discern relationships between VR interventions and outcomes. I2 and P values were used to evaluate publication bias. AMSTAR (A Measurement Tool to Assess Systematic Reviews) 2 and the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) checklist were used to appraise literature quality. Results In total, 768 records were identified; 74 meta-analyses were included for review. The most reported VR study conditions were neuronursing (25/74, 34%), pediatric nursing (13/74, 18%), surgical and wound care (11/74, 15%), oncological nursing (11/74, 15%), and older adult nursing (10/74, 14%). Further, 30% (22/74) of meta-analyses reported publication bias, and 15% (11/74) and 8% (6/74) were rated as "high" based on AMSTAR 2 and the GRADE checklist, respectively. The main outcome indicators among all included meta-analyses were pain (37/214, 17.3%), anxiety (36/214, 16.8%), cognitive function (17/214, 7.9%), balance (16/214, 7.5%), depression (16/214, 7.5%), motor function (12/214, 5.6%), and participation in life (12/214, 5.6%). VR treatment for cognition, pain, anxiety, and depression was effective (all P values were <.05), while the utility of VR for improving motor function, balance, memory, and attention was controversial. Adverse effects included nausea, vomiting, and dizziness (incidence: range 4.76%-50%). The most common VR platforms were Pico VR glasses, head-mounted displays, the Nintendo Wii, and the Xbox Kinect. VR intervention duration ranged from 2 weeks to 12 months (typically ≥4 wk). VR session length and frequency ranged from 5 to 100 minutes and from 1 to 10 times per week, respectively. Conclusions VR in nursing has positive effects-relieving patients' pain, anxiety, and depression and improving cognitive function-despite the included studies' limited quality. However, applying VR in nursing to improve patients' motor function, balance, memory, and attention remains controversial. Nursing researchers need to further explore the effects and standard operation protocols of VR in clinical practice, and more high-quality research on VR in nursing is needed.
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Affiliation(s)
- Yanjie Hu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Xingzhu Yuan
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Peiling Ye
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Chengting Chang
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Yue Han Hu
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
| | - Weihua Zhang
- School of Computer Science, Sichuan University, Chengdu, China
| | - Ka Li
- West China Hospital/West China School of Nursing, Sichuan University, Chengdu, China
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Goktas N, Avci D. The effect of visual and/or auditory distraction techniques on children's pain, anxiety and medical fear in invasive procedures: A randomized controlled trial. J Pediatr Nurs 2023; 73:e27-e35. [PMID: 37455147 DOI: 10.1016/j.pedn.2023.07.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 07/05/2023] [Accepted: 07/05/2023] [Indexed: 07/18/2023]
Abstract
PURPOSE This study was conducted to determine the effects of visual and/or auditory distraction techniques applied to children aged 7-12 during invasive procedures on pain, anxiety, and medical fear. METHODS This single-blinded, randomized controlled trial was carried out in the pediatric emergency department of a public hospital between November 2021 and March 2022. In the study, 144 children were assigned to three different intervention groups, in which a kaleidoscope, music, and virtual reality were applied during invasive procedures, and the control group in which the standard invasive procedure was applied, by using the stratified block randomization method. The data were collected using a Personal Information Form, Wong-Baker Faces Pain Rating Scale, Children's Anxiety Meter-State, and Child Medical Fear Scale. RESULTS In the study, the levels of pain, anxiety, and medical fear after the invasive procedure were lower in the intervention groups than in the control group. In addition, there was no difference between the three different distraction techniques in terms of reducing pain and medical fear, but the virtual reality application was more effective in reducing the level of anxiety. CONCLUSION Visual and/or auditory distraction techniques are effective methods that can be used by nurses in pediatric healthcare to reduce invasive procedure-related pain, anxiety, and medical fear. IMPLICATIONS FOR PRACTICE This study provides evidence that can guide the use of non-pharmacological methods such as distraction to prevent the traumatic effects of invasive procedures in children.
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Affiliation(s)
- Nursen Goktas
- Mehmet Akif Ersoy State Hospital, Child Monitoring Center, Canakkale, Turkey
| | - Dilek Avci
- Bandirma Onyedi Eylul University, Faculty of Health Sciences, Balikesir, Turkey.
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Oh N, Parrish N, Lee IW, Temple S, Perkins O, Kokkinakis M. Using Virtual Reality to Reduce Anxiety and Improve Hospital Experience in Paediatric Orthopaedic Patients and Their Parents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1409. [PMID: 37628408 PMCID: PMC10453231 DOI: 10.3390/children10081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
The hospital environment can be a stressful environment for paediatric patients and their parents, which is often characterised by heightened levels of pain and anxiety. To address these challenges, many innovative intervention methods has been explored. For example, immersive virtual reality (VR) headsets as a distraction method has become an increasingly popular intervention in recent years. This study aimed to evaluate the effectiveness of VR using 'Rescape DR.VR Junior' in reducing pain, anxiety, and enhancing the overall hospital experience for paediatric orthopaedic patients and their parents. A total of 64 patients aged 4-18 years were included in this study, which utilised a control group (interacting with a play specialist) and a VR intervention group (including pre-operative patients and fracture clinic patients). Anxiety and pain levels were measured using a 10-point Likert scale before and after the intervention, and validated questionnaires were used to assess parental anxiety and overall hospital experience. The results indicated that VR intervention significantly reduced patient and parental anxiety both before surgery and in the fracture clinic setting (p < 0.5). However, no significant reduction in pain scores was observed in either environments. Comparatively, VR intervention was found to be comparable to traditional play methods in terms of reducing anxiety in the pre-operative environment. All patients and parents agreed that the use of VR distraction methods significantly improved their hospital experience. In conclusion, VR is an effective method for reducing child and parental anxiety and enhancing the hospital experience and can be used alone or in conjunction with a play specialist.
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Affiliation(s)
- Natasha Oh
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - Nina Parrish
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - In Woo Lee
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - Sasha Temple
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
| | - Oliver Perkins
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
| | - Michail Kokkinakis
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
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Kim HY, Kim EY. Effects of Medical Education Program Using Virtual Reality: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3895. [PMID: 36900904 PMCID: PMC10001289 DOI: 10.3390/ijerph20053895] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 02/16/2023] [Accepted: 02/20/2023] [Indexed: 06/18/2023]
Abstract
Several studies have examined the effect of virtual reality (VR) education. However, they are mostly systematic reviews or meta-analyses focusing on doctors and residents; they fail to consider VR medical education for a broader range of learners. We evaluated the effectiveness of VR education for health professionals and identified the essential features of education. Randomized controlled trials published from January 2000 to April 2020 were identified from PubMed, Embase, CINAHL, and the Cochrane Library (n = 299). The randomized studies' bias risk was evaluated using Cochrane's Risk of Bias tool. Meta- and subgroup-analyses were conducted using Review Manager 5.4.1. The overall effect was measured using Hedges' g and determined using Z-statistics (p < 0.05). Heterogeneity was assessed using X2 and I2 statistics. Among the identified records, 25 studies were selected through systematic review, and 18 studies were included in the meta-analysis. We identified a significant improvement in the VR group's skill and satisfaction levels, and that less immersive VR was more efficacious for knowledge outcomes than fully immersive VR. Maximizing the advantages of VR will increase learning opportunities and complement the limited clinical experience, thus improving medical services. A systematic and efficient VR medical education program will greatly enhance learners' core competencies.
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Affiliation(s)
- Hyeon-Young Kim
- College of Nursing, Sahmyook University, Seoul 01795, Republic of Korea
- VR Healthcare Content Lab, Seoul 01795, Republic of Korea
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Wong CL, Choi KC. Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e230001. [PMID: 36795410 PMCID: PMC9936341 DOI: 10.1001/jamanetworkopen.2023.0001] [Citation(s) in RCA: 12] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2023] Open
Abstract
IMPORTANCE Venipuncture is one of the most painful and distressing procedures experienced by pediatric patients. Emerging evidence suggests that providing procedural information and distraction using immersive virtual reality (IVR) may reduce pain and anxiety among children undergoing needle-related procedures. OBJECTIVES To examine the effects of IVR on reducing the pain, anxiety, and stress experienced by pediatric patients undergoing venipuncture. DESIGN, SETTING, AND PARTICIPANTS This 2-group randomized clinical trial recruited pediatric patients aged 4 to 12 years undergoing venipuncture from a public hospital in Hong Kong between January 2019 and January 2020. Data were analyzed from March to May 2022. INTERVENTIONS Participants were randomly allocated to an intervention (an age-appropriate IVR intervention offering distraction and procedural information) or a control (standard care only) group. MAIN OUTCOMES AND MEASURES The primary outcome was child-reported pain. Secondary outcomes included child-reported anxiety, heart rate, salivary cortisol, length of procedure, and satisfaction of health care professionals with the procedure (rated on a 40 point scale, with higher scores indicating greater satisfaction). Outcomes were assessed 10 minutes before, during, immediately after, and 30 minutes after the procedure. RESULTS A total of 149 pediatric patients were recruited, with 86 female patients (57.7%) and 66 patients (44.3%) diagnosed with fever. Compared with the 74 participants in the control group (mean [SD] age, 7.21 [2.49] years), the 75 participants in the IVR group (mean [SD] age, 7.21 [2.43] years) reported significantly less pain (β = -0.78; 95% CI, -1.21 to -0.35; P < .001) and anxiety (β = -0.41; 95% CI, -0.76 to -0.05; P = .03) immediately after the intervention. Health care professional satisfaction in the IVR group (mean [SD] score, 34.5 [4.5]) was significantly higher than that in the control group (mean [SD] score, 32.9 [4.0]; P = .03). Moreover, the length of venipuncture procedure in the IVR group (mean [SD] duration, 4.43 [3.47] minutes) was significantly shorter than that in the control group (mean [SD] duration, 6.56 [7.39] minutes; P = .03). CONCLUSIONS AND RELEVANCE In this randomized clinical trial, integrating procedural information and distraction in an IVR intervention for pediatric patients undergoing venipuncture significantly improved pain and anxiety in the IVR group compared with the control group. The results shed light on the global trends of research on IVR and its clinical development as an intervention for other painful and stressful medical procedures. TRIAL REGISTRATION Chinese Clinical Trial Registry identifier: ChiCTR1800018817.
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Affiliation(s)
- Cho Lee Wong
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
| | - Kai Chow Choi
- The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong
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García AS, Fernández-Sotos P, González P, Navarro E, Rodriguez-Jimenez R, Fernández-Caballero A. Behavioral intention of mental health practitioners toward the adoption of virtual humans in affect recognition training. Front Psychol 2022; 13:934880. [PMCID: PMC9600723 DOI: 10.3389/fpsyg.2022.934880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Accepted: 08/29/2022] [Indexed: 11/13/2022] Open
Abstract
This paper explores the key factors influencing mental health professionals' behavioral intention to adopt virtual humans as a means of affect recognition training. Therapies targeting social cognition deficits are in high demand given that these deficits are related to a loss of functioning and quality of life in several neuropsychiatric conditions such as schizophrenia, autism spectrum disorders, affective disorders, and acquired brain injury. Therefore, developing new therapies would greatly improve the quality of life of this large cohort of patients. A questionnaire based on the second revision of the Unified Theory of Acceptance and Use of Technology (UTAUT2) questionnaire was used for this study. One hundred and twenty-four mental health professionals responded to the questionnaire after viewing a video presentation of the system. The results confirmed that mental health professionals showed a positive intention to use virtual reality tools to train affect recognition, as they allow manipulation of social interaction with patients. Further studies should be conducted with therapists from other countries to reach more conclusions.
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Affiliation(s)
- Arturo S. García
- Unidad Multidisciplinar de Investigación de la Neurocognición y Emoción en Entornos Virtuales y Reales, Instituto de Investigación en Informática de Albacete, Albacete, Spain
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
| | - Patricia Fernández-Sotos
- Servicio de Salud Mental, Complejo Hospitalario Universitario de Albacete, Albacete, Spain
- Biomedical Research Networking Center in Mental Health (CIBERSAM), Madrid, Spain
| | - Pascual González
- Unidad Multidisciplinar de Investigación de la Neurocognición y Emoción en Entornos Virtuales y Reales, Instituto de Investigación en Informática de Albacete, Albacete, Spain
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
- Biomedical Research Networking Center in Mental Health (CIBERSAM), Madrid, Spain
| | - Elena Navarro
- Unidad Multidisciplinar de Investigación de la Neurocognición y Emoción en Entornos Virtuales y Reales, Instituto de Investigación en Informática de Albacete, Albacete, Spain
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
- Biomedical Research Networking Center in Mental Health (CIBERSAM), Madrid, Spain
| | - Roberto Rodriguez-Jimenez
- Biomedical Research Networking Center in Mental Health (CIBERSAM), Madrid, Spain
- Cognición y Psicosis, Area de Neurociencias y Salud Mental, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- CogPsy-Group, Universidad Complutense de Madrid, Madrid, Spain
| | - Antonio Fernández-Caballero
- Unidad Multidisciplinar de Investigación de la Neurocognición y Emoción en Entornos Virtuales y Reales, Instituto de Investigación en Informática de Albacete, Albacete, Spain
- Departamento de Sistemas Informáticos, Universidad de Castilla-La Mancha, Albacete, Spain
- Biomedical Research Networking Center in Mental Health (CIBERSAM), Madrid, Spain
- *Correspondence: Antonio Fernández-Caballero
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Russo L, Tozzi AE, Mastronuzzi A, Croci I, Gesualdo F, Campagna I, Miller KP, Ciaralli I, Amicucci M, Secco DE, Dell’Anna VA, Ripà A, Piccinelli E. Feasibility of a VR Intervention to Decrease Anxiety in Children with Tumors Undergoing CVC Dressing. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11953. [PMID: 36231250 PMCID: PMC9565196 DOI: 10.3390/ijerph191911953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/18/2022] [Accepted: 09/19/2022] [Indexed: 06/16/2023]
Abstract
Virtual reality (VR) represents a promising digital intervention for managing distress and anxiety in children with tumors undergoing painful medical procedures. In an experimental cross-over study, we administered a VR intervention consisting of relaxing games during central venous catheter (CVC) dressing. The VR sessions were compared with no-VR during CVC medication. We used the distress thermometer and RCMAS-2 scale to assess distress and anxiety levels. We also explored the satisfaction level in patients and families. We enrolled 22 children. The distress levels after medication were lower in the VR group than in those without VR (VR: median 2; IQR 0-2; no-VR: median 4; IQR: 3-5). No variation in anxiety levels was detected by VR intervention. Satisfaction for using VR was very high in children and their families although a total of 12% of children were disappointed by the effect of VR. Most healthcare workers felt that VR would be useful in routine clinical practice. A VR intervention is highly acceptable, may be efficacious in decreasing distress in children with cancer undergoing painful procedures, but it is less likely that it has a measurable impact on anxiety. Evidence from larger studies is needed to assess VR translation into the clinical workflow.
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Affiliation(s)
- Luisa Russo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Alberto Eugenio Tozzi
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Angela Mastronuzzi
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Ileana Croci
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Francesco Gesualdo
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Ilaria Campagna
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Kiersten P. Miller
- Multifactorial and Complex Diseases Research Area, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Italo Ciaralli
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Matteo Amicucci
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Domitilla Elena Secco
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Vito Andrea Dell’Anna
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Adele Ripà
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
| | - Elisa Piccinelli
- Department of Onco Hematology and Cell and Gene Therapy, Bambino Gesù Children’s Hospital, Istituto di Ricerca e Cura a Carattere Scientifico (IRCCS), 00165 Rome, Italy
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