Home Technology Virtual Reality Virtual reality may decrease procedural distress in pediatric IV placement

Virtual reality may decrease procedural distress in pediatric IV placement

Virtual reality may decrease procedural distress in pediatric IV placement

1. In a single-center randomized control study, young children in the pediatric emergency department who participated in a virtual reality (VR) experience had lower standardized pain scores during intravenous catheter (IV) placement.

2. Subgroup analysis suggested that the effect of the VR experience in reducing visible distress and perceived pain was stronger for female patients.

Assessment Level Evidence: 2 (good)

Study overview: Inflicting procedural inconvenience on children is a major challenge for caregivers and caregivers in pediatric practice. Researchers at Seoul National University built on the growing body of evidence for the use of virtual reality as an effective means of reducing pain by creating a high-resolution VR simulation that placed pediatric patients in the middle of a forest exploration with four animal friends. this simulation on a vaulted ceiling in a procedural treatment room. Eighty-eight children aged 6 months to 4 years undergoing IV placement were randomized to standard distraction techniques or distraction with the VR experience. The children’s responses to IV placement were videotaped, with pain intensity ratings assigned by two protocol-blind physicians using the Face, Legs, Activity, Cry, and Consolability (FLACC) scale. Caregivers were given a questionnaire asking them their satisfaction with the procedure and their assessment of their child’s pain. Overall, the VR intervention resulted in a significantly reduced chance of higher FLACC scores. In addition, caregivers rated their child’s pain and anxiety significantly lower when assigned to the VR experimental group, although there was no difference in their satisfaction with the overall procedure. While this supports the growing interest in virtual reality as a method of psychological pain relief, the research suffers from technical and design limitations. Despite the overall reduction in FLACC scores throughout the procedure in the VR group, there was no significant difference between the control group and the experimental group at critical points in the procedure (ie, tourniquet placement, needle insertion). Interestingly, subgroup analysis stratified by gender showed a significant decrease in FLACC scores for girls randomized to the VR experience, but not for boys in the same experimental group, with the authors stating that social expectations and/or the content of the VR experience can contribute to this gender-specific difference.

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Click to read the study in JAMA Pediatrics

Relevant reading: The effectiveness of virtual reality distraction for pain relief: a systematic review.

In depth [randomized controlled trial]: This single-center, two-group, parallel, randomized, controlled trial identified eighty-eight children, ages 4 months to 6 years, who required non-emergency IV placement in the pediatric emergency room. The subjects were randomized into two groups: the control group received standard IV placement procedures while the second group participated in a new virtual reality experience consisting of an imagined forest exploration with four friendly animals. Primary outcomes were FLACC-standardized pain assessments at five time points (T0=baseline, T1=immediately after the child was bedridden, T2=applying a tourniquet, T3=alcohol swabbing, T4=venipuncture) which were assessed by two independent, protocol – blinded doctors watch a video recording of the procedure. Secondary outcome measures included parent/caregiver satisfaction with the procedure and their subjective ratings of their children’s pain and anxiety on a visual analog scale of 0-10. Children assigned to the VR experience were significantly less likely to have higher FLACC scores compared to children in the control group (IQR 1.1-5.4 vs. IQR 1.8-6.9, OR 0.53, p =0.049), although there was no significant difference when comparing individual time points between groups. Repeated analysis of variance for subgroups revealed that this effect persisted when only girls were assessed at both the experimental group and procedural time point (F = 6.56, P = 0.1 and F = 14.31, P < 0.001, respectively), but came did not emerge when only boys were included in the analysis. Caregivers reported significantly lower perceptions of their child's pain (5.0 [3.0-8.0] versus 7.0 [5.0-10.0]P=0.08) and anxiety (5.0 [3.0-7.0] versus 8.0 [6.5-10.0]P<0.001) if they were in the experimental VR group, although there were no significant differences in overall satisfaction with the procedure.

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Image: PD

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