Design Strategies for Virtual Reality Interventions for Managing Pain and Anxiety in Children and Adolescents: Scoping Review

Abstract

Background Virtual reality (VR) technology has been explored in the health sector as a novel tool for supporting treatment side effects, including managing pain and anxiety. VR has recently become more available with the launch of low-cost devices and apps. Objective This study aimed to provide an updated review of the research into VR use for pain and anxiety in pediatric patients undergoing medical procedures. Methods We performed a scoping review. To identify relevant studies, we searched three electronic databases. Two authors screened the titles and abstracts for relevance and eligibility criteria. Results Overall, 1386 articles were identified. In total, 18 articles were included in the review. Articles were published in English between 2013 and 2018. Our review determined that VR technology was being administered in a range of situations to modulate acute and chronic pain or anxiety, needle phobia, and procedural care in children and adolescents. We identified 9 articles that designed the bespoke VR apps. The findings were analyzed to develop a holistic model and describe the product, experience, and intervention aspects that need to be considered in designing such medical VR apps. Conclusions VR has been demonstrated to be effective for managing pain and anxiety in a variety of populations. However, design strategies are limited beyond distraction techniques. We propose future VR interventions to explore skill-building goals in apps characterized by dynamic feedback to the patient and experiential and product qualities that enable them to be active participants in managing their own care. To achieve this, design must be part of the development.

Synthesizing Multiple Stakeholder Perspectives on Using Virtual Reality to Improve the Periprocedural Experience in Children and Adolescents: Survey Study

“…Our findings suggest distraction paired with stimulating emotional experiences such as positive surprise, is desirable and may help children disconnect from distressing elements of the environment. Positive emotions are shown to alleviate psychological stress [ 22 ] and improve the efficacy of distraction through VR [ 18 ].…”

“…The diversity of the 10 design factors generated based on our findings reveals the complexities and potential challenges in meeting the experiential, psychological, and intervention needs of pediatric patients and their carers through one VR solution. Ahmadpour et al [ 18 ] called for skill-building in VR to allow patients to become active agents in their care in a variety of ways. Building meaningful skills in VR necessitates a holistic approach due to the temporality of periprocedural experience with different needs becoming prominent at different stages of the procedure.…”

“…We identified a limitation in methods used to assess the efficacy of pediatric VR apps in the literature when testing mainly relied on self-reported anxiety. Future research could address this limitation by investigating the efficacy of VR apps using a combination of meaningful clinical measures (eg, need for rescue analgesia), physiological measures of anxiety, and qualitative assessment (eg, satisfaction), as suggested by Ahmadpour et al [ 18 ].…”

“…Current examples of VR for managing pediatric anxiety do not exploit the multitude of strategies possible in VR, particularly active distraction. Additionally, there is a lack of knowledge about the needs of pediatric patients as well as the role of other stakeholders involved in patient care, including clinicians and parents, that can be incorporated into future pediatric VR solutions [ 18 ]. This study aimed to investigate opportunities for designing VR apps for children and adolescents in order to improve their experience and help them manage anxiety in the context of perioperative care and immunization.…”

Exploring User Needs in the Development of a Virtual Reality–Based Advanced Life Support Training Platform: Exploratory Usability Study

“…Some of the ways of addressing these challenges include simulation-based learning using the latest technologies (eg, virtual reality [VR], which has generated a growing interest in recent years [ 15 ]). Studies have demonstrated improved performance when using VR for basic life support training [ 16 ], but there is limited information about what users of ALS systems need, specific design considerations, and ways we can improve user experience and engagement with the training [ 17 ].…”