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

Khadra, Christelle; Ballard, Ariane; Paquin, David; Cotes-Turpin, Casey; Hoffman, Hunter G.; Perreault, Isabelle; Fortin, Jean-Simon; Bouchard, Stéphane; Théroux, Jean; May, Sylvie Le

doi:10.1016/j.burns.2020.04.006

Cited by 34 publications

(52 citation statements)

References 55 publications

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“…Self-reported measures of pain were available in all but two studies (Wolitzky et al, 2005;Khadra et al, 2020), whereas observational measures had to be used for 11 of the anxiety studies. The Wong-Baker Faces Scale (Wong-Baker FACES Foundation, 2018) and the (revised) Faces Pain Scale (Hicks et al, 2001) were the most widely used pain measures, followed by visual analogue scales ([VAS], Bailey et al, 2012).…”

Section: Methodsmentioning

confidence: 99%

“…Head-mounted devices (HMDs) were used in all but three studies (k 62). In Khadra et al (2020), patients were placed in front of a wide, curved screen that images were displayed on with a projector. This study was included as the screen covered the majority of the patient's field of view and resembled a surrounding, dome-based VR system.…”

Section: Virtual Reality Characteristicsmentioning

confidence: 99%

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The Effects of Virtual Reality on Procedural Pain and Anxiety in Pediatrics: A Systematic Review and Meta-Analysis

Nordgård

Låg

2021

Front. Virtual Real.

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Distraction and procedural preparation techniques are frequently used to manage pain and anxiety in children undergoing medical procedures. An increasing number of studies have indicated that Virtual Reality (VR) can be used to deliver these interventions, but treatment effects vary greatly. The present study is a systematic review and meta-analysis of studies that have used VR to reduce procedural pain and anxiety in children. It is the first meta-analytic assessment of the potential influence of technical specifications (immersion) and degree of user-system interactivity on treatment effects. 65 studies were identified, of which 42 reported pain outcomes and 35 reported anxiety outcomes. Results indicate large effect sizes in favor of VR for both outcomes. Larger effects were observed in dental studies and studies that used non-interactive VR. No relationship was found between the degree of immersion or participant age and treatment effects. Most studies were found to have a high risk of bias and there are strong indications of publication bias. The results and their implications are discussed in context of these limitations, and modified effect sizes are suggested. Finally, recommendations for future investigations are provided.

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Section: Methodsmentioning

confidence: 99%

Section: Virtual Reality Characteristicsmentioning

confidence: 99%

The Effects of Virtual Reality on Procedural Pain and Anxiety in Pediatrics: A Systematic Review and Meta-Analysis

Nordgård

Låg

2021

Front. Virtual Real.

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“…For the current case study, a within-subject, within-wound care design was used ( Maani et al, 2011 ; Khadra et al, 2018 , 2020 ; Hoffman et al, 2019b ). During VR, the patient interacted with a 3D snowy canyon in virtual reality during his first pin removal, vs. No VR during his second pin removal, treatment order randomized using a number sequence from random.org .…”

Section: Methodsmentioning

confidence: 99%

Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study

Firoozabadi

El-Haddad

Drever

et al. 2020

Front. Virtual Real.

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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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“…For example, immersive virtual reality, rst reported by our team in the 1990s [24], is emerging as an unusually powerful adjunctive non-pharmacologic analgesic. [6,9,15,21,26,34,36,39,40,42,47,48,49,62,70] fMRI brain scans show that in addition to reducing participants subjective experience of pain, VR also reduces painrelated brain activity. [29] A follow up fMRI study showed that VR reduces pain as much as a moderate dose of hydromorphone.…”

Section: Introductionmentioning

confidence: 99%

Interacting With Virtual Objects via Embodied Avatar Hands Increases the Illusion of Presence, Increases Distraction, and Modulates VR Analgesia Effectiveness: A Randomized Crossover Trial.

Hoffman

2021

Preprint

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The current study introduces a new experimental environment and apparatus for exploring cognitive factors in pain. Interacting with virtual objects via embodied avatar hands increased the illusion of “being there” in the virtual world, increased VR analgesia for acute pain, and reduced accuracy on an attention demanding task. Twenty-four healthy volunteer college students participated in this within-subject randomized crossover design study. During Phase 1, each participant received brief thermal pain stimuli during interactive embodied avatar VR vs. passive VR (no avatar and no interactivity), VR treatment order randomized. After each pain stimulus, participants provided subjective 0-10 ratings of pain. Compared to the passive VR condition, during the interactive avatar VR, participants reported significant reductions in 1). worst pain, 2). pain unpleasantness, 3). time thinking about pain and 4). they had significantly more fun during the pain stimulus (p = .000 for each). During Phase 2, participants performed a divided attention task in each VR condition. Participants made significantly more errors on the divided attention task during the interactive avatar VR condition, compared to passive VR, implicating an attention mechanism for how virtual reality reduces pain and helping understand how VR influences pain perception.

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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

Cited by 34 publications

References 55 publications

The Effects of Virtual Reality on Procedural Pain and Anxiety in Pediatrics: A Systematic Review and Meta-Analysis

The Effects of Virtual Reality on Procedural Pain and Anxiety in Pediatrics: A Systematic Review and Meta-Analysis

Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study

Interacting With Virtual Objects via Embodied Avatar Hands Increases the Illusion of Presence, Increases Distraction, and Modulates VR Analgesia Effectiveness: A Randomized Crossover Trial.

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