The use of Virtual Reality in pain management during the burn wound dressing change in children: systematic review and meta-analysis.

Abstract

Aims and objectives The present study had the objectives of evaluating and discussing the effectiveness of virtual reality to control pain intensity during dressing changes of burn wounds in children. Background Burns are the fifth most frequent nonfatal injuries in children and currently affect 11 million people globally who require medical care. The nature of this injury and its severity make its treatment extremely painful because it requires frequent dressing changes to avoid deterioration, promote comfort, and speed up recovery. Nurses must pay special attention to affected children in order to effectively manage their pain. Virtual reality is an innovative cognitive distraction technique that shows great potential for controlling and reducing procedural pain. It has the goal of reorienting children’s available attention to process the painful stimuli into a more pleasant experience by means of the virtual world. Design Systematic literature review with meta-analysis. Methods Twelve databases were searched, and studies from 2005 to 2021 were considered for inclusion. The PRISMA guidelines for study methodology were followed, RevMan software was used for statistical calculations and estimation of heterogeneity, the RoB 2 tool was used to assess risk of bias, the PEDro scale was applied to evaluate methodological quality, and funnel plots were obtained to check for publication bias. Results Eleven studies were selected that had a total of 299 participants, both children and adults, and seven publications that involved 218 exclusively paediatric participants were included in the meta-analysis. The results showed an important effect size (ES = 0.93) regarding pain reduction, with a confidence interval of 0.68–1.18 and a p-value < 0.00001. Conclusions Virtual reality is an effective nonpharmacological strategy to reduce pain during burn dressing wound changes and other painful interventions in paediatric and adult patients. Regarding future clinical research in this area, studies should focus on what type of virtual reality hardware is best and account for the evolution of this technology, as well as its appropriate use and the ways in which it should be applied. Relevance to clinical practice Virtual reality as a nonpharmacological strategy shows favourable evidence and had a positive impact on pain control in children with burn wound dressing. Therefore, its inclusion in clinical practice can be beneficial, reducing pain during this procedure, which is known to be highly painful, and facilitating its execution.

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

“…The Children's Hospital Association (2019) listed VR as the first of 19 innovations for children's healthcare in 2019. Individual research studies, systematic reviews, and metaanalyses provide evidence supporting the effectiveness of VR as an engaging, effective distraction intervention for various healthcare procedures including burn wound care (Czech et al, 2022;de Jesus Catalã et al, 2022;Eijlers et al, 2019;Ford et al, 2018;Hoag et al, 2022;Hoffman et al, 2020;Indovina et al, 2018;Lauwens et al, 2020;LeMay et al, 2021;Mahrer & Gold, 2009;Savaş et al, 2023;Vermelho & Curado, 2022;Xiang et al, 2021) Engagement with VR, or VR immersion defined as presence in the VR world, can affect pain management outcomes (Atzori et al, 2022;Hoffman et al, 2003;Lauwens et al, 2020;Law et al, 2011;Mahrer & Gold, 2009). VR is purported to reduce attention available to process pain by redirecting attention toward a more pleasant experience through presence in the VR (Atzori et al, 2022;Indovina et al, 2018).…”

“…The Children's Hospital Association (2019) listed VR as the first of 19 innovations for children's healthcare in 2019. Individual research studies, systematic reviews, and meta‐analyses provide evidence supporting the effectiveness of VR as an engaging, effective distraction intervention for various healthcare procedures including burn wound care (Czech et al, 2022; de Jesus Catalã et al, 2022; Eijlers et al, 2019; Ford et al, 2018; Hoag et al, 2022; Hoffman et al, 2020; Indovina et al, 2018; Lauwens et al, 2020; LeMay et al, 2021; Mahrer & Gold, 2009; Savaş et al, 2023; Vermelho & Curado, 2022; Xiang et al, 2021). Authors recommend that future research conduct more rigorous studies such as randomized controlled trials (RCTs), blind intervention outcomes, test VR throughout the healthcare procedure, compare VR to other distraction interventions, use larger sample sizes and robust statistical analyses, assess engagement with the VR distraction, and determine the best VR devices by factoring in technological evolution, setting, and time of exposure.…”