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

Abstract

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

Effects of non‐pharmacological interventions on pain intensity of children with burns: A systematic review and meta‐analysis

“…After a thorough analysis of the complete texts of the publications, 24 research were ignored for having insufficient methodology or findings, and five studies were disregarded for having insufficient data. Finally, 19 studies 26,27,39,40,54‐61,65‐71 remained in this systematic review and meta‐analysis.…”

“…As shown in Table 1, a total of 1005 burn patients were included in 19 studies 26,27,39,40,54‐61,65‐71 . The age range of the patients was from 0.5 to 19 years.…”

“…Although opioids were considered the main treatment intervention to manage burn pain, they cannot effectively cause analgesia 40 . Also, they can cause side effects such as nausea, constipation, drowsiness, and pharmacological tolerance and addiction in short and long‐term usage 39,56 . In addition; opioids are not always available to the patients and medical staff, especially for outpatients 55 .…”

Virtual reality used to distract children and young people with long‐term conditions from pain or pruritus: A scoping review using PAGER

“…As we did not identify any controlled studies, we were unable to gain insights from the included studies in this scoping review. In the wider literature active distraction controls for chronic pain have included watching a video on an iPad (Hundert et al., 2022), playing a video game (Wohlheiter & Dahlquist, 2013), and using toys, mobile phones and books (Armstrong et al., 2022). Possible active distraction controls for pruritis could include toys for example, fidget spinners, and audio‐visual or music/imagery distraction (Leibovici et al., 2009).…”

Comparing novel virtual reality and nursing standard care on burn wound care pain in adolescents: A randomized controlled trial

“…Virtual reality (VR) distraction is a promising, effective, non‐pharmacologic intervention due to its ability to capture attention through interactive, immersive, and fun games with the introduction of lower‐cost, high‐technology VR on the consumer market (Armstrong et al, 2022; Birnie et al, 2018; Zolfaghari et al, 2022). The adolescent population with its technology‐savviness seems particularly amenable to the use of VR in the healthcare setting (Ridout et al, 2021; Zolfaghari et al, 2022).…”