Use of virtual reality in managing paediatric procedural pain and anxiety: An integrative literature review

Abstract

Aims: This integrative review aimed to identify, analyse and synthesise studies investigating the clinical efficacy of virtual reality (VR) distraction for children undergoing varying painful and anxiety-inducing medical procedures across different hospital settings and to identify implications for research and clinical practice.Background: Virtual reality has been leveraged as a distraction tool in the healthcare setting to help patients manage procedural pain and anxiety. Initial studies in the burn wound care setting using VR as a non-pharmacological analgesia led to the use of VR during other medical procedures.Design: An integrative review of the literature was conducted following the PRISMA guidelines across four electronic databases. Published studies between 2000 and 2020 investigating the clinical efficacy of VR in managing paediatric procedural pain or anxiety were included for review.Results: Reviewed studies collectively included 2,174 patients aged 6 months-18 years used VR during burn wound care, post-burn physiotherapy, dental, needle-related and other procedures. Additionally, ten studies included samples with adults, for which paediatric data could not be isolated (n = 507). Overall, studies supported the efficacy of VR in managing procedural pain and anxiety in the paediatric setting. Conclusion:Virtual reality is redefining pain management by immersing children in a virtual world, reducing pain and anxiety at the hospital. A notable gap was the neglected use of VR in children with chronic conditions receiving orthopaedic procedures as part of their standard care.Relevance to Clinical Practice: Ultimately, VR distraction will reduce the fear associated with medical interventions, preventing increased pain sensitivity, exacerbated anxiety and healthcare avoidance in adulthood. Nurses will play an important role in ensuring the smooth integration of VR in clinical practice by championing the technology and transferring evidence-based methods for VR use.

An Overview of Clinical Applications of Virtual and Augmented Reality

“…14 VR software that has been used in distraction therapy for pain includes VR experiences such as a rollercoaster ride, swimming underwater, travelling around the world, and enjoying nature. 15 VR programs studied that involved people with autism spectrum disorder include simulations that aim to teach various skills such as driving, interviewing, supermarket shopping, and emotion recognition. 10,16 Some VR interventions involve commercially available games, whereas others use games developed specifically for health applications.…”

“…40 Children A 2022 systematic review evaluated the use of VR distraction for pain and anxiety during medical procedures in pediatric patients. 15 The systematic review included a total of 77 studies (59 randomized controlled trials, 6 interventional/observational studies, 3 quasiexperimental studies, 2 cross-sectional studies, 1 retrospective chart review, and 6 case reports) that evaluated VR distraction in 2,174 patients aged from 6 months to 18 years undergoing medical procedures in a variety of settings. 15 The medical procedures in the included studies were burn wound care procedures, postburn injury physiotherapy, dental procedures, needle-related procedures, and other procedures.…”

“…15 The medical procedures in the included studies were burn wound care procedures, postburn injury physiotherapy, dental procedures, needle-related procedures, and other procedures. 15 The majority of studies used a head-mounted device for VR. Additional hardware used included projector-based VR systems, VR glasses, and smartphones inserted into disposable VR headsets.…”

“…Additional hardware used included projector-based VR systems, VR glasses, and smartphones inserted into disposable VR headsets. 15 Most studies used a VR game; in the other studies, the participants experienced a VR adventure (e.g., a rollercoaster ride, swimming underwater) or selected a cartoon or movie to watch in their VR headsets. 15 Overall, the results of the included studies suggested that VR distraction may effectively reduce pain and anxiety in pediatric patients undergoing medical procedures.…”

Feasibility of a VR Intervention to Decrease Anxiety in Children with Tumors Undergoing CVC Dressing

“…Virtual reality (VR) is a technology based on recreating an artificial three-dimensional interactive environment, in which the user has the illusion of movement. Several studies investigating the effect of VR during painful or distressing procedures have been conducted in adults and children [3,4]. Although VR interventions are not standardized, most available studies showed some effects on pain, with a high safety profile and high patient satisfaction [5,6].…”