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

Abstract

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.

Effectiveness of virtual reality technology in symptom management of end-of-life patients: protocol of a systematic review and meta-analysis

“… 35 Niki et al 25 helped end-stage patients realise their wish of ‘going to an unforgettable place’ or ‘going home’ through VR technology, which not only improved the burden of patients’ symptoms but also met their needs, to improve the patient’s symptom burden while meeting the patient’s needs. At present, with the continuous development of science and technology, VR is increasingly applied to patients with cancer, 36 burn patients, 37 clinical teaching, 38 etc, providing a new way of thinking for the symptom management of end-stage patients. The feasibility of VR application in symptom management of end-stage patients has been confirmed, 24 39 and more and more new evidence has emerged.…”

Effectiveness of technology-based interventions compared with other non-pharmacological interventions for relieving procedural pain in hospitalized neonates: a systematic review

“…30,32 Previous systematic reviews and meta-analyses that have evaluated the effectiveness of technologybased interventions for pain management among neonates and children have focused on pediatric patients between the ages of 0 and 21 years. [23][24][25][26][27] Of these reviews, neonates were included only in the work of Ueki et al, 24 where one of the included randomized controlled studies evaluated the effectiveness of vibratory stimulation for alleviating heel stick-associated pain among neonates. The use of technology is becoming increasingly prevalent in neonatal care 33,34 and pain management, 35 and there are indications in the literature that virtual reality is also being used for pain management in newborns.…”

“…23,24 There is also evidence that virtual reality distraction is effective at relieving pain among children. Previous systematic reviews and meta-analyses have found that virtual reality interventions can relieve pain in pediatric burn patients, 26 as well as pain associated with needle-related procedures, dental treatment, and preoperative procedures. 25,27 However, due to the heterogeneity and limitations of the primary studies, there is currently limited evidence on the effectiveness of virtual reality interventions for relieving pain among children.…”

“…Previous systematic reviews and meta-analyses that have evaluated the effectiveness of technology-based interventions for pain management among neonates and children have focused on pediatric patients between the ages of 0 and 21 years 23–27 . Of these reviews, neonates were included only in the work of Ueki et al , 24 where one of the included randomized controlled studies evaluated the effectiveness of vibratory stimulation for alleviating heel stick–associated pain among neonates.…”

“…20 The use of technology-based interventions, such as electronic devices or digitalization, in the treatment of pediatric pain has increased over the past few years; for example, 2 recent systematic reviews investigated the effectiveness of vibratory stimulation for needle-related procedural pain management in children, 23,24 while 3 systematic reviews and metaanalyses investigated the impact of virtual reality technology on acute pain management in pediatric patients. [25][26][27] Vibration stimulation refers to a continuous, fast, mild shaking movement on the skin using electronic devices. Its effect is explained using gate control theory, whereby non-painful stimulus can activate the large A-beta nerve fiber, which inhibits the pain signals coming from the smaller A-delta and C-nociceptive fibers.…”