Efficacy of Smartphone Active and Passive Virtual Reality Distraction vs Standard Care on Burn Pain Among Pediatric Patients

Xiang, Henry; Shen, Jiabin; Wheeler, Krista K.; Patterson, Jeremy; Lever, Kimberly; Armstrong, Megan; Shi, Junxin; Thakkar, Rajan K.; Groner, Jonathan I.; Noffsinger, Dana; Giles, Sheila; Fabia, Renata

doi:10.1001/jamanetworkopen.2021.12082

Cited by 55 publications

(80 citation statements)

References 41 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…When looked into different VR interventions, active VR yields medium to large effect sizes ranging from Cohen's d of 0.39 (Xiang et al, 2021) to 1.03 (Hoffman et al, 2019), which was similar to the studies using Multi-Modal Distraction (Cohen's d ranging from 0.4 to 1.72). VR was found to be effective in reducing self-reported pain when compared to standard distraction (e.g., TV, videos, books, and toys (Miller et al, 2011;Kipping et al, 2012;Brown et al, 2014)), as well as standard medication care (Hoffman et al, 2019;Hoffman et al, 2020).…”

Section: Meta-analysissupporting

confidence: 64%

“…Although insufficiently powered, the study conducted by Jeffs et al (2014) splits participants into three study groups (VR, passive movie distraction, standard care) allowing for stronger deductions to be made about the specific effects of interventions provided (Jeffs et al, 2014). Expanding Jeffs et al (2014) results, Xiang et al (2021 compared active VR versus passive VR versus standard care in reducing pediatric burn pain with a greater sample size (n 90) and found that children with burn injuries had lower worst pain when exposing to active VR that involves an interaction as compared to passive VR and the standard care, while passive VR and the standard care did not differ from one another in influencing the worst pain levels during the wound care (Xiang et al, 2021).…”

Section: Discussionmentioning

confidence: 99%

“…Passive VR. Xiang et al (2021) used a passive VR condition where participants watched a virtual reality context using the head-mounted-display without the joysticks, so that the interactive component was removed from the passive VR condition (Xiang et al, 2021).…”

Section: Non Vr-intervention/comparison Groupsmentioning

confidence: 99%

See 2 more Smart Citations

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

Smith

Wang

Colloca

2022

Front. Virtual Real.

View full text Add to dashboard Cite

Introduction: Virtual reality (VR) has the potential to lessen pain and anxiety experienced by pediatric patients undergoing burn wound care procedures. Population-specific variables require novel technological application and thus, a systematic review among studies on its impact is warranted.Objective: The objective of this review was to evaluate the effectiveness of VR on pain in children with burn injuries undergoing wound care procedures.Methods: A systematic literature review was performed using PubMed and CINAHL databases from January 2010 to July 2021 with the keywords “pediatric,” “burn,” “virtual reality,” and “pain.” We included experimental studies of between- and within-subjects designs in which pediatric patients’ exposure to virtual reality technology during burn wound care functioned as the intervention of interest. Two researchers independently performed the literature search, made judgements of inclusion/exclusion based on agreed-upon criteria, abstracted data, and assessed quality of evidence using a standardized appraisal tool. A meta-analysis was conducted to evaluate the effectiveness of the VR on burning procedural pain in pediatric population. Standardized mean difference (SMD) was used as an index of combined effect size, and a random effect model was used for meta-analysis.Results: Ten articles published between January 2010 and July 2021 passed the selection criteria: six randomized controlled trials and four randomized repeated-measures studies. Consistent results among the studies provided support for VR as effective in reducing pain and potentially pain related anxiety in children undergoing burn wound care through preprocedural preparation (n = 2) and procedural intervention (n = 8). A random effects meta-analysis model indicated a moderate and significant combined effect size (SMD = 0.60, 95% CI = 0.28–0.93, p = 0.0031) of VR effects on pain intensity ratings with no significant heterogeneity of VR intervention effects between studies. Only one study reported direct influence of VR intervention on pre-procedural situational anxiety with a moderate effect size (Cohen’s d = 0.575, 95%CI = 0.11–1.04).Conclusion: Children’s exposure to VR during burn care procedures was associated with lower levels of pain and pain related anxiety. Moderate to large effect sizes support the integration of VR into traditional pediatric burn pain protocols irrespective of innovative delivery methods and content required for use in burned pediatric patients.

show abstract

Section: Meta-analysissupporting

confidence: 64%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

Smith

Wang

Colloca

2022

Front. Virtual Real.

View full text Add to dashboard Cite

show abstract

“…Our VR-PAT consisted of a lightweight VR headset with a Virtual River Cruise game that is played on a smartphone. In our pilot study [ 31 ], we found that active VR (interacting with VR game) was significantly more beneficial than passive VR (watching the same VR game). Due to these findings, only active VR was used for our intervention group for this study.…”

Section: Methodsmentioning

confidence: 99%

“…VR-PAT is a standalone game developed by the Research Information Solutions and Innovation department at Nationwide Children’s Hospital and could be downloaded onto participants’ smartphones using either a QR code or a dedicated website. More information about the specific game can be found in our prior publication [ 31 ].…”

Section: Methodsmentioning

confidence: 99%

Mobile phone virtual reality game for pediatric home burn dressing pain management: a randomized feasibility clinical trial

Armstrong

Lun

Groner

et al. 2022

Pilot Feasibility Stud

Self Cite

View full text Add to dashboard Cite

Background Virtual reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital. This study addressed the potential effectiveness and feasibility of a VR game that was developed by our research team for repeated at-home burn dressing changes. Methods A randomized clinical trial was conducted among patients recruited from the outpatient burn clinic of a large American Burn Association–verified pediatric burn center between September 2019 and June 2021. We included English-speaking burn patients aged 5–17 years old requiring daily dressing changes for at least 1 week after first outpatient dressing change. One group played an interactive VR game during dressing changes, while the other utilized standard distraction techniques available in the home for up to a week. Both child and caretaker were asked to assess perceived pain on a numerical rating scale (NRS) of 0–10. For the VR group, patients were also asked to rate various aspects of the VR game on a NRS of 0–10 and caregivers were asked questions assessing ease of use. Results A total of 35 children were recruited for this study with 24 fully completing study measures. The majority of participants were male (n=19, 54.3%), White (n=29, 82.9%), and with second degree burns (n=32, 91.4%). Children and caregivers in the VR group reported less pain than the control group at the 4th dressing change. Participants in the VR group showed a clinically meaningful (≥30%) reduction in child-reported overall pain (33.3%) and caregiver-reported worst pain (31.6%) in comparison with subjects in the control group. Children’s satisfaction with the VR remained at a high level across dressing changes over the 1-week period, with reported realism and engagement increasing over time. Over half of the children (54.5%) enjoyed playing the game and did not report any challenges nor any side effects. Conclusions Subjects found the VR to be a useful distraction during home dressing changes and reported no challenges/side effects. VR should be considered as a nonpharmacologic companion for pain management during at-home burn dressing changes. Trial registration ClinicalTrials.gov Identifier: NCT04548635. Registered September 14, 2020—retrospectively registered

show abstract

Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture

Wong

Choi

2023

JAMA Netw Open

View full text Add to dashboard Cite

ImportanceVenipuncture 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.ObjectivesTo examine the effects of IVR on reducing the pain, anxiety, and stress experienced by pediatric patients undergoing venipuncture.Design, Setting, and ParticipantsThis 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.InterventionsParticipants 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 MeasuresThe 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.ResultsA 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 &lt; .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 RelevanceIn 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 RegistrationChinese Clinical Trial Registry identifier: ChiCTR1800018817

show abstract

Efficacy of Smartphone Active and Passive Virtual Reality Distraction vs Standard Care on Burn Pain Among Pediatric Patients

Cited by 55 publications

References 41 publications

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

Impact of Virtual Reality Technology on Pain and Anxiety in Pediatric Burn Patients: A Systematic Review and Meta-Analysis

Mobile phone virtual reality game for pediatric home burn dressing pain management: a randomized feasibility clinical trial

Effects of an Immersive Virtual Reality Intervention on Pain and Anxiety Among Pediatric Patients Undergoing Venipuncture

Contact Info

Product

Resources

About