Virtual reality for pediatric periprocedural care

Wang, Ellen; Thomas, James J.; Rodríguez, Samuel; Kennedy, Kristin M.; Caruso, Thomas J.

doi:10.1097/aco.0000000000000983

Cited by 20 publications

(18 citation statements)

References 85 publications

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“…The majority of providers surveyed believe that VR helps their clients/patients progress in treatment compared to similar therapy without VR. These subjective findings corroborate previous studies that have shown the effectiveness of VR in treatment of phobias [4,11,12,[26][27][28], anxiety [5,6,10,13,20,29], PTSD [2,7,14], addictions [8,30,31], and pain management [2,3,15,16,18,32].…”

Section: Key Findingssupporting

confidence: 90%

Provider experiences of virtual reality in clinical treatment

et al. 2021

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Background Virtual reality (VR) has proven effective in the treatment of specific phobias and trauma particularly when in-vivo exposure therapy might be costly (e.g. fear of flying, combat scenes). Similarly, VR has been associated with improvement of chronic pain and of acute pain during medical procedures. Despite its effectiveness as a healthcare tool, VR technology is not well-integrated into common practice. This qualitative study aims to explore the provider perception of the value of VR and identify barriers to VR implementation among healthcare providers. Methods A 66-item self-report survey was created to examine application of VR to clinical practice, perceived value of this treatment, ease of learning the technology, billing considerations, and other obstacles. 128 providers (MDs and PhDs) who were located in the United States and had used VR as a therapeutic tool in the past year were identified through research papers, as well as user lists and news articles from VR application websites. Of the 128 providers contacted, 17% (22) completed our online self-report measure. Of these, 13% of respondents (N = 17) completed greater than 75% of the questionnaire and were considered completers. Provider responses were collected over a one-month period and qualitatively analyzed. Results The majority of providers were from an academic institution (n = 12, 70.6%), and all providers practiced in the outpatient setting. Providers most commonly reported using VR for the treatment of acute pain and/or anxiety related to medical procedures (n = 11, 64.7%), followed by specific phobia (n = 6, 35.3%) and social phobia (n = 6, 35.3%). All providers agreed VR is a valuable tool they would recommend to colleagues. The majority (n = 15, 93.8%) believed VR helped their patients progress in treatment, compared with other methods. Providers cited the ability to individualize treatment (n = 14, 87.5%) and increase patient engagement (n = 15, 93.8%) as main benefits of VR. A minority reported negative feedback from patients about content (n = 4, 25%) or about the technology in general (n = 6, 37.5%), whereas all reported some form of positive feedback. The slight majority (n = 10, 58.8%) of providers did not find transitioning to VR difficult. Of those who did, cost was the most commonly cited barrier (n = 6). Regarding reimbursement, only 17.6% (n = 3) of providers reported the ability to bill for VR sessions. Most providers (n = 15, 88.2%) received training on their VR platform which they found beneficial. Comparing the trained and untrained groups found no significant difference in VR comfort level (p = 0.5058), the value of VR in practice (p = 0.551) or whether providers would recommend VR to others (p = 0.551), though sample sizes were small. Conclusions In corroboration with previous research, this study demonstrates that VR is well-received by patients and providers, allowing increased patient engagement and treatment individualization. However, associated costs, including an inability to bill for this service, can present a barrier to further implementation. These findings will guide further development of virtual reality as a standardized tool in psychiatry and pain management.

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Section: Key Findingssupporting

confidence: 90%

Provider experiences of virtual reality in clinical treatment

et al. 2021

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“…Non-pharmacological interventions such as parental acupuncture, clowns/clown doctors, playing videos of the child’s choice, low sensory stimulation, and hand-held video games have promising potential for reducing anxiety and improving cooperation during preoperative sedation [ 70 ]. However, these methods do not usually provide adequate relief and thus, pharmacological sedation and analgesia are necessary [ 71 ]. Wang et al suggested that clinical programs that supplement virtual reality can be considered in pediatric periprocedural care [ 71 ].…”

Section: Perioperative Anesthetic Phasesmentioning

confidence: 99%

“…However, these methods do not usually provide adequate relief and thus, pharmacological sedation and analgesia are necessary [ 71 ]. Wang et al suggested that clinical programs that supplement virtual reality can be considered in pediatric periprocedural care [ 71 ]. By definition, pediatric patients with “special needs” (SN) are children suffering from psycho-physical disorders and relational and cognitive problems [ 1 , 2 ].…”

Section: Perioperative Anesthetic Phasesmentioning

confidence: 99%

The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature

Ciccozzi

Pizzi²,

Vittori

et al. 2022

Children

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The perioperative management of pediatric patients with psycho-physical disorders with related relational and cognitive problems must be carefully planned, in order to make the entire hospitalization process as comfortable and as less traumatic as possible. This article reports an overview of the anesthetic management of non-cooperative patients between 6 and 14 years old. The pathologies most frequently responsible for psycho-physical disorders can be summarized into three groups: (1) collaboration difficulties (autism spectrum disorders, intellectual impairment, phobia); (2) motor dysfunction (cerebral palsy, epilepsy, other brain pathologies, neuromuscular disorders), and (3) craniofacial anomalies (Down syndrome, other genetic syndromes). Anesthesia can be performed safely and successfully due to careful management of all specific problems of these patients, such as a difficult preoperative evaluation (medical history, physical examination, blood sampling, evaluation of vital parameters and predictive indices of difficult airway) and the inapplicability of a “standard” perioperative path (timing and length of the hospitalization, anesthetic premedication, postoperative management). It is necessary to ensure a dedicated perioperative process that is safe, comfortable, tailored to specific needs, and as less traumatic as possible. At the same time, all necessary precautions must be taken to minimize possible complications.

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“…Also, due to the visual contact with their surroundings, children are less likely to experience nausea, also known as "cybersickness." 19 Recent reports suggest that AR is a promising intervention to alleviate preoperative anxiety in children. 16 However, further empirical evidence-based on standardized randomized-controlled trials with larger samples-is needed to establish whether AR could serve as an efficient and safe non-pharmacological solution to managing preoperative anxiety in patients.…”

Section: Introductionmentioning

confidence: 99%

“…AR is unique in its ability to blend the unfamiliar surroundings of the perioperative setting of the hospital with playful holograms. Also, due to the visual contact with their surroundings, children are less likely to experience nausea, also known as “cybersickness.” 19 …”

Section: Introductionmentioning

confidence: 99%

The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial

Chamberland,

Bransi,

Boivin

et al. 2023

Pediatric Anesthesia

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Background and AimsVirtual reality has been shown to be an effective non‐pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention.MethodsChildren and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale.ResultsThe analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0–10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: −4.2 [−5.2–4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention.ConclusionTo our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.

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Virtual reality for pediatric periprocedural care

Cited by 20 publications

References 85 publications

Provider experiences of virtual reality in clinical treatment

Provider experiences of virtual reality in clinical treatment

The Perioperative Anesthetic Management of the Pediatric Patient with Special Needs: An Overview of Literature

The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial

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