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Teh JJ, Pascoe DJ, Hafeji S, Parchure R, Koczoski A, Rimmer MP, Khan KS, Al Wattar BH. Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. BMC Med 2024; 22:64. [PMID: 38355563 PMCID: PMC10865524 DOI: 10.1186/s12916-024-03266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses. RESULTS In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018. CONCLUSIONS Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.
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Affiliation(s)
- Jhia J Teh
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Safiya Hafeji
- Kings College Hospital, Denmark Hill, Brixton, London, UK
| | | | - Adam Koczoski
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Michael P Rimmer
- MRC Centre for Reproductive Health, Institute of Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK.
- . Johns Hospital, Livingston, West Lothian, Scotland, UK.
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Bassel H Al Wattar
- University College London, London, UK
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
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2
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Farzan R, Parvizi A, Haddadi S, Sadeh Tabarian M, Jamshidbeigi A, Samidoust P, Ghorbani Vajargah P, Mollaei A, Takasi P, Karkhah S, Firooz M, Hosseini SJ. Effects of non-pharmacological interventions on pain intensity of children with burns: A systematic review and meta-analysis. Int Wound J 2023; 20:2898-2913. [PMID: 36859758 PMCID: PMC10410361 DOI: 10.1111/iwj.14134] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 03/03/2023] Open
Abstract
Pain is one of the complications associated with burns, which can lead to anxiety and sleeplessness in children. Various studies evaluated the effects of non-pharmacological interventions on burn wound care. The present study was conducted to determine the effects of non-pharmacological interventions on pain intensity of children with burns. A comprehensive systematic search was conducted in various international electronic databases, such as Scopus, PubMed, Web of Science, and Persian electronic databases such as Iranmedex, and Scientific Information Database using keywords extracted from Medical Subject Headings such as 'Non-pharmacological', 'Virtual reality', 'Pain', 'Burn', 'Wound' and 'Child' from the earliest to December 1, 2022. The risk of bias in the final articles was also assessed with the Version 2 of the Cochrane risk-of-bias tool for randomised trials (RoB 2). Finally, a total of 1005 burn patients were included in 19 studies. The age range of the patients was from 0.5 to 19 years. Of the participants, 50.05% were in the intervention group. All studies had a randomised clinical trial design. The results found that non-pharmacological interventions significantly reduced pain intensity in children (ES: -0.73, 95% CI: -1.08 to -0.38, Z = 4.09, I2 :79.8, P < .001). Virtual reality (VR) (ES: -0.54, 95% CI: -1.19 to -0.18, Z = 2.90, I2 :72.9%, P = .004) and non-VR (ES: -0.86, 95% CI: -1.45 to -0.27, Z = 2.86, I2 :91.4%, P = .04) interventions decreased pain intensity significantly in children based sub-group analysis. Non-pharmacological interventions significantly reduced the pain intensity of dressing removal (ES: -0.77, 95% CI: -1.34 to -0.20, Z = 66.3, I2 :91.8%, P = .008), dressing application (ES: -0.53, 95% CI: -0.97 to -0.09, Z = 2.37, I2 :60.8%, P = .02), and physical therapy (ES: -1.18, 95% CI: -2.10 to -0.26, Z = 2.51, I2 :88.0%, P = .01). Also, interventions reduced the pain of burn wound care (ES: -0.29, 95% CI: -1.01 to 0.44, Z = 0.78, I2 :72.6%, P = .43), but it was statistically insignificant. In sum, the result of the present study indicated that using non-pharmacological interventions significantly reduced pain intensity in children. The reduction of pain intensity was greater in non-VR than in VR interventions. Future studies should focus on comparing VR interventions with non-VR and single versus multi-modal distraction to clarify the effectiveness of each.
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Affiliation(s)
- Ramyar Farzan
- Department of Plastic & Reconstructive SurgerySchool of Medicine, Guilan University of Medical SciencesRashtIran
| | - Arman Parvizi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Soudabeh Haddadi
- Anesthesiology Research Center, Department of AnesthesiologyAlzahra Hospital, Guilan University of Medical SciencesRashtIran
| | - Mansooreh Sadeh Tabarian
- Department of Medical‐Surgical NursingNorth Khorasan University of Medical SciencesNorth KhorasanIran
| | - Amirreza Jamshidbeigi
- Student Research Committee, Faculty of Nursing and MidwiferyMashhad University of Medical SciencesMashhadIran
| | - Pirouz Samidoust
- Razi Clinical Research Development UnitRazi Hospital, Guilan University of Medical SciencesRashtIran
| | - Pooyan Ghorbani Vajargah
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Amirabbas Mollaei
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Poorya Takasi
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Samad Karkhah
- Department of Medical‐Surgical NursingSchool of Nursing and Midwifery, Guilan University of Medical SciencesRashtIran
- Burn and Regenerative Medicine Research CenterGuilan University of Medical SciencesRashtIran
| | - Mahbobeh Firooz
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
- School of Nursing and MidwiferyGolestan University of Medical SciencesGorganIran
| | - Seyed Javad Hosseini
- Department of NursingEsfarayen Faculty of Medical SciencesEsfarayenIran
- Department of Pediatric NursingSchool of Nursing and Midwifery, Mashhad University of Medical SciencesMashhadIran
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Oh N, Parrish N, Lee IW, Temple S, Perkins O, Kokkinakis M. Using Virtual Reality to Reduce Anxiety and Improve Hospital Experience in Paediatric Orthopaedic Patients and Their Parents. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1409. [PMID: 37628408 PMCID: PMC10453231 DOI: 10.3390/children10081409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 08/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023]
Abstract
The hospital environment can be a stressful environment for paediatric patients and their parents, which is often characterised by heightened levels of pain and anxiety. To address these challenges, many innovative intervention methods has been explored. For example, immersive virtual reality (VR) headsets as a distraction method has become an increasingly popular intervention in recent years. This study aimed to evaluate the effectiveness of VR using 'Rescape DR.VR Junior' in reducing pain, anxiety, and enhancing the overall hospital experience for paediatric orthopaedic patients and their parents. A total of 64 patients aged 4-18 years were included in this study, which utilised a control group (interacting with a play specialist) and a VR intervention group (including pre-operative patients and fracture clinic patients). Anxiety and pain levels were measured using a 10-point Likert scale before and after the intervention, and validated questionnaires were used to assess parental anxiety and overall hospital experience. The results indicated that VR intervention significantly reduced patient and parental anxiety both before surgery and in the fracture clinic setting (p < 0.5). However, no significant reduction in pain scores was observed in either environments. Comparatively, VR intervention was found to be comparable to traditional play methods in terms of reducing anxiety in the pre-operative environment. All patients and parents agreed that the use of VR distraction methods significantly improved their hospital experience. In conclusion, VR is an effective method for reducing child and parental anxiety and enhancing the hospital experience and can be used alone or in conjunction with a play specialist.
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Affiliation(s)
- Natasha Oh
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - Nina Parrish
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - In Woo Lee
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
| | - Sasha Temple
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
| | - Oliver Perkins
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
| | - Michail Kokkinakis
- Faculty of Life Sciences and Medicine, King’s College London, London WC2R 2LS, UK; (N.P.); (I.W.L.); (M.K.)
- Paediatric Orthopaedic Department, Evelina London Children’s Hospital, London SE1 7EH, UK; (S.T.); (O.P.)
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Chen YJ, Wang CJ, Chen CW. Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials. J Clin Nurs 2023; 32:2494-2504. [PMID: 35672942 DOI: 10.1111/jocn.16394] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 03/17/2022] [Accepted: 05/16/2022] [Indexed: 11/28/2022]
Abstract
AIMS To synthesise and evaluate the effectiveness of virtual reality interventions in preoperative children. BACKGROUND Children consider operations as a predictable threat and stressful event. Children's anxiety before an operation increases as the time draws closer. Children could understand the operating room environment and process before the operation using virtual reality, which may reduce their anxiety before an operation. DESIGN A systematic review and meta-analysis of randomised controlled trials following the Cochrane method were conducted. METHOD CINAHL, Cochrane Library, Embase, Joanna Briggs Institute, MEDLINE and PubMed databases were searched for randomised controlled trials published before February 2021. A random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals was performed. Conduction of the review adheres to the PRISMA checklist. RESULTS Of 257 articles screened, six interventions involving 529 participants aged 4-12 years were included in the analysis. All study evidence levels were B2/Level 2, the quality was medium to high on the modified Jadad scale, with a low risk of bias. The results revealed that virtual reality significantly reduced preoperative anxiety in children (SMD: -0.91, 95% CI: -1.43 to -0.39, p = .0006). Furthermore, virtual reality significantly improved children's compliance with anaesthesia (SMD: 3.49, 95% CI: 1.32 to 9.21, p = .01). CONCLUSION Children who used virtual reality before an operation felt more familiar with the operating room environment and understood the preoperative preparation procedures. Virtual reality effectively reduced children's anxiety and improved their compliance with anaesthesia. RELEVANCE TO CLINICAL PRACTICE This systematic review and meta-analysis investigated the effect of virtual reality on preoperative anxiety in children and the findings supported its positive effects. The results could provide a reference for incorporating virtual reality into preoperative preparation guidelines.
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Affiliation(s)
- Yen-Ju Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Cheng-Ju Wang
- Department of Nursing, National Yang Ming Chiao Tung University Hospital, Yilan, Taiwan
| | - Chi-Wen Chen
- College of Nursing, National Yang Ming Chiao Tung University, Taipei, Taiwan
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Fernandez-Fairen M, Calderón-Ospina CA, Chen J, Duarte Vega M, Fernández-Villacorta F, Gómez-García F, López-Almejo L, Manzano-García A, Hernández-Méndez Villamil E, Helito CP, Ruiz-Rodríguez D, Salas-Morales G, Servin-Caamaño A, Lara-Solares A, Puello-Vales M, Vargas-Schaffer G. A Latin American consensus meeting on the essentials of mixed pain. Curr Med Res Opin 2023; 39:451-466. [PMID: 36772818 DOI: 10.1080/03007995.2023.2177401] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/12/2023]
Abstract
OBJECTIVES The term "mixed pain" has been established when a mixture of different pain components (e.g. nociceptive, neuropathic, and nociplastic) are present. It has gained more and more acceptance amongst pain experts worldwide, but many questions around the concept of mixed pain are still unsolved. The sensation of pain is very personal. Cultural, social, personal experiences, idiomatic, and taxonomic differences should be taken into account during pain assessment. Therefore, a Latin American consensus committee was formed to further elaborate the essentials of mixed pain, focusing on the specific characteristics of the Latin American population. METHODS The current approach was based on a systematic literature search and review carried out in Medline. Eight topics about the definition, diagnosis, and treatment of mixed pain were discussed and voted for by a Latin American consensus committee and recommendations were expressed. RESULTS At the end of the meeting a total of 14 voting sheets were collected. The full consensus was obtained for 21 of 25 recommendations (15 strong agreement and 6 unanimous agreement) formulated for the above described 8 topics (7 of the 8 topics had for all questions at least a strong agreement - 1 topic had no agreement for all 4 questions). CONCLUSION In a subject as complex as mixed pain, a consensus has been reached among Latin American specialists on points related to the definition and essence of this pain, its diagnosis and treatment. Recommendations for diagnosis and treatment of mixed pain in Latin America were raised.
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Affiliation(s)
| | - Carlos Alberto Calderón-Ospina
- Center for Research in Genetics and Genomics (CIGGUR), GENIUROS Research Group, School of Medicine and Health Sciences, Universidad del Rosario, Bogotá, Colombia
| | - Juythel Chen
- Clínica del Dolor. Hospital Santo Tomás, Ciudad de Panamá, Panama
| | - Manuel Duarte Vega
- Unidad de Medicina Basada en la Evidencia, Nuevo Hospital Civil de Guadalajara, Guadalajara, Mexico
| | | | | | - Leonardo López-Almejo
- Clinica de Cirugia y Rehabilitacion de Plexo Braquial y Nervio, Periférico, Aguascalientes, Mexico
| | | | | | | | - Delia Ruiz-Rodríguez
- Unidad de Tratamiento del Dolor, Servicio Medicina Física y Rehabilitación, Hospital Clínico, Universidad de Chile, Santiago de Chile, Chile
| | | | | | - Argelia Lara-Solares
- Departamento de Medicina del Dolor y Paliativa, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Ciudad de México, Mexico
| | - Marcelo Puello-Vales
- Hospital Central de las Fuerzas Armadas Doctor Vinicio Calventi, Santo Domingo, República Dominicana
| | - Grisell Vargas-Schaffer
- Clínica del Dolor, Centro Hospitalario de la Universidad de Montreal (CHUM), Montreal, Canadá
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Hao J, Li Y, Swanson R, Chen Z, Siu KC. Effects of virtual reality on physical, cognitive, and psychological outcomes in cancer rehabilitation: a systematic review and meta-analysis. Support Care Cancer 2023; 31:112. [PMID: 36633695 DOI: 10.1007/s00520-022-07568-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Accepted: 12/28/2022] [Indexed: 01/13/2023]
Abstract
PURPOSE To systematically examine and summarize the current evidence regarding the effects of virtual reality (VR) on physical, cognitive, and psychological outcomes in cancer rehabilitation. METHODS Six bioscience and engineering databases were searched. Two independent reviewers screened the titles and abstracts of 2397 records and retrieved 25 full-text articles. Inclusion criteria included patients with a current or previous diagnosis of cancer; VR was used as an intervention for physical, cognitive, or psychological impairments and functional limitations; and clinical trials with at least two arms and with both pre- and post-intervention assessments. Reviewers assessed methodological quality using the Physiotherapy Evidence Database scale. RESULTS Seventeen studies including 799 patients with cancer were identified. Within-group pooled analysis indicated that patients demonstrated significant improvement in pain (P < 0.001), fatigue (P < 0.001), anxiety (P < 0.001), upper extremity function (P < 0.001), and quality of life (P = 0.008) after VR intervention. Between-group pooled analysis indicated significant improvements with VR in pain (P = 0.004), anxiety (P < 0.001), and upper extremity function (P < 0.001) compared with the control. Three studies reported the positive effects of VR on cognition. CONCLUSIONS VR demonstrates promising effects in physical, cognitive, and psychological aspects of patients with cancer. VR can be incorporated into a comprehensive cancer rehabilitation program to alleviate impairments and functional limitations.
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Affiliation(s)
- Jie Hao
- Division of Physical Therapy Education, Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198-4420, USA
| | - Yanfei Li
- Division of Physical Therapy Education, Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198-4420, USA
| | - Rebecca Swanson
- Division of Pediatric Hematology/Oncology, Department of Pediatrics, College of Medicine, University of Nebraska Medical Center, Omaha, NE, 68198-6878, USA
| | - Zhen Chen
- Department of Neurorehabilitation, The First Rehabilitation Hospital of Shanghai, Shanghai, China
| | - Ka-Chun Siu
- Division of Physical Therapy Education, Department of Health & Rehabilitation Sciences, College of Allied Health Professions, University of Nebraska Medical Center, Omaha, NE, 68198-4420, USA.
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He ZH, Yang HM, Dela Rosa RD, De Ala MB. The effects of virtual reality technology on reducing pain in wound care: A meta-analysis and systematic review. Int Wound J 2022; 19:1810-1820. [PMID: 35318806 PMCID: PMC9615291 DOI: 10.1111/iwj.13785] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 03/02/2022] [Accepted: 03/05/2022] [Indexed: 12/11/2022] Open
Abstract
Virtual reality (VR) technology has been widely used in clinical nursing care in recent years. We aimed to systematically evaluate the effect and safety of VR technology on pain control in wound care, to provide evidence and support for clinical wound care. We searched PubMed, EMBASE, Cochrane Library, Web of Science, CINAHL, China Biomedical Literature Database, China National Knowledge Infrastructure (CNKI), Wanfang Data Knowledge Service Platform, and Chinese Science and Technology Journal databases for randomised controlled trials (RCTs) on the application of VR technology in wound care up to December 20, 2021. Two researchers independently assessed the quality of the included RCTs and extracted associated data. RevMan5.3 statistical software was used for data analysis. 13 RCTs involving 1258 adult patients were included, of whom 588 patients underwent VR intervention. VR technology intervention could reduce the VAS score(MD = -1.13, 95%CI:-2.01~-0.26, P < .001), pain cognition score(MD = -3.94, 95%CI:-4.59 ~ -3.30, P < .001), pain emotion score(MD = -5.21, 95%CI: -10.46 ~ -0.04, P < .001), pain sensation score (MD = -4.94, 95%CI: -9.46 ~ -0.42, P = .03) and blood pressure(MD = -4.66, 95%CI: -8.63 ~ -0.69, P = .02) during would care. There were no significant differences on the heart rate (MD = -1.85, 95%CI: -5.71 ~ -2.01, P = .45) and VR interestingness (MD = 28.96, 95%CI: -22.10 ~ 80.02, P = .27) of the VR group and control group. No publication biases among the synthesised outcomes were found (all P > .001). VR technology can effectively reduce the pain degree and sensation of patients during wound care, which may be an effective auxiliary non-drug method used for pain relief during wound care.
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Affiliation(s)
- Zhen-Hua He
- Faculty of Medicine and Health, Shaoxing University Yuanpei College, Shaoxing, China.,School of Nursing, Philippine Women's University, Manila, Philippines
| | - Hong-Mei Yang
- Department of One Surgery, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, China
| | - Ronnell D Dela Rosa
- School of Nursing, Philippine Women's University, Manila, Philippines.,College of Nursing and Midwifery, Bataan Peninsula State University, Bataan, Philippines
| | - Minerva B De Ala
- School of Nursing, Philippine Women's University, Manila, Philippines
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8
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Li T, Fu Y, Yang Y, Zhou YE. Control effect of virtual reality technology on procedural pain in children's wound: A meta-analysis. Medicine (Baltimore) 2022; 101:e30961. [PMID: 36221420 PMCID: PMC9542741 DOI: 10.1097/md.0000000000030961] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND Children who undergo wound manipulation usually experience pain. Virtual reality technology is a novel and effective non pharmaceutical therapy for reducing pain in children scheduled to undergo wound manipulation. However, the effectiveness of Virtual reality technology in controlling procedural pain in children's wounds has not been evaluated in a systematic review. METHODS It employed a meta-analysis design. We included studies with randomized controlled trials, reporting children's wound manipulation pain, and published them in English. Two reviewers independently evaluated the methodological quality of the included studies. RESULTS Of the 108 studies identified, 39 were eligible for the meta-analysis, with a total sample of 273 patients. The use of virtual reality technology has significantly reduced pain intensity during wound manipulation in children. There was a significant difference between the experimental group (virtual reality) and the control group (no virtual reality) in reducing the pain of the children's wound manipulation (P < .05). CONCLUSION As a distraction method of non drug assisted analgesia intervention, virtual reality technology can reduce children's procedural pain and discomfort symptoms.
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Affiliation(s)
- Tuan Li
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Yingping Fu
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Yanzheng Yang
- Yunnan University of Chinese Medicine, Kunming, Yunnan, People’s Republic of China
| | - Yu-E Zhou
- The Third People’s Hospital of Yunnan Province, Kunming, Yunnan, People’s Republic of China
- *Correspondence: Yu-e Zhou, The Third People’s Hospital of Yunnan Province, Kunming, Yunnan 650011, People’s Republic of China (e-mail: )
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9
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Ahmadi Marzaleh M, Peyravi M, Azhdari N, Bahaadinbeigy K, Sharifian R, Samad‐Soltani T, Sarpourian F. Virtual reality applications for rehabilitation of COVID-19 patients: A systematic review. Health Sci Rep 2022; 5:e853. [PMID: 36210874 PMCID: PMC9528946 DOI: 10.1002/hsr2.853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Revised: 08/16/2022] [Accepted: 09/08/2022] [Indexed: 11/28/2022] Open
Abstract
BACKGROUND AND AIMS The COVID-19 pandemic has changed people's lifestyles as well as the way healthcare services are delivered. Undoubtedly, the difficulties associated with COVID-19 infection and rehabilitation and those associated with quarantine and viral preventive efforts may exacerbate the need for virtual reality to be used as a part of a complete rehabilitation strategy for these individuals. Thus, the present research aimed to evaluate the potential uses of virtual reality for the rehabilitation of individuals suffering from COVID-19. METHODS From 2019 to March 1, 2022, a systematic search was conducted in PubMed, Cochran Library, Scopus, Science Direct, ProQuest, and Web of Science databases. The papers were selected based on search terms and those that discussed the use of virtual reality in the rehabilitation of COVID-19 patients were reviewed. Each step of the study was reviewed by two authors. RESULTS A total of 699 papers were found during the first search. Three papers were chosen for further investigation after a thorough evaluation of the publications' titles, abstracts, and full texts. Cross-sectional studies, randomized controlled clinical trials, and case reports comprised 33%, 33%, and 33% of the publications, respectively. Based on the results, people suffering from COVID-19 were the focus of two papers (66%) that employed immersion virtual reality for cognitive rehabilitation, whereas one study (33%) used non-immersive virtual reality for physical rehabilitation. In two papers (66%), virtual reality was also offered to patients in the form of a game. CONCLUSION According to the results of the present research, virtual reality games may enhance functional and cognitive consequences, contentment levels among patients, and their ability to take charge of their own health care. In light of the obstacles faced by COVID-19 patients, alterations in the delivery of healthcare, and the significance of rehabilitation in this group during quarantine, new techniques have been considered for these patients to maintain treatment, return to regular life, and enhance their standard of life.
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Affiliation(s)
- Milad Ahmadi Marzaleh
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
| | - Mahmoudreza Peyravi
- Department of Health in Disasters and Emergencies, Health Human Resources Research Center, School of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
| | - Negar Azhdari
- School of Rehabilitation SciencesShiraz University of Medical SciencesShirazIran
| | - Kambiz Bahaadinbeigy
- School of Management and Medical InformaticsKerman University of Medical SciencesKermanIran
| | - Roxana Sharifian
- Department of Health Information Technology, School of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
| | - Taha Samad‐Soltani
- Department of Health Information Management, School of Management and Medical InformaticsTabriz University of Medical SciencesTabrizIran
| | - Fatemeh Sarpourian
- Department of Health Information Technology, School of Management and Medical InformaticsShiraz University of Medical SciencesShirazIran
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10
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Goyal C, Vardhan V, Naqvi W. Non-Immersive Virtual Reality as an Intervention for Improving Hand Function and Functional Independence in Children With Unilateral Cerebral Palsy: A Feasibility Study. Cureus 2022; 14:e26085. [PMID: 35875273 PMCID: PMC9295637 DOI: 10.7759/cureus.26085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/19/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Non-immersive virtual reality (NIVR) is emerging as an advantageous intervention in the arena of neurorehabilitation. Promising results have been obtained by the application of NIVR in adults with various chronic neurological conditions such as stroke and Parkinson’s disease, but studies on the use of NIVR in children with unilateral cerebral palsy (CP) are limited. Materials and methods This preliminary study included 10 school-aged participants with unilateral CP who were allocated into experimental and control groups. In accordance with the allocation ratio of 1:1, there were five participants in each group. During six weeks of intervention, children in the experimental group received NIVR intervention in addition to conventional physiotherapy, while those in the control group received only conventional physiotherapy, with a goal to improve hand function and functional independence. Nine-hole peg test (9HPT), box and block test (BBT), ABILHAND kids, and self-care section of functional independence measure for children (WeeFIM) were used as outcome measures. Results There was significant improvement in all outcome measures in both groups. However, the improvement in the hand function and functional independence was significantly more in the experimental group than in the control group. Conclusion It can be concluded that NIVR intervention in the management of children with unilateral CP seems to be feasible and useful. Further research with a larger sample size must be undertaken to reinforce these preliminary findings.
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Găină MA, Szalontay AS, Ștefănescu G, Bălan GG, Ghiciuc CM, Boloș A, Găină AM, Ștefănescu C. State-of-the-Art Review on Immersive Virtual Reality Interventions for Colonoscopy-Induced Anxiety and Pain. J Clin Med 2022; 11:jcm11061670. [PMID: 35329993 PMCID: PMC8949336 DOI: 10.3390/jcm11061670] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality's (iVR) role in alleviating the complex stress-pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs). OBJECTIVE to assess the effect of iVR on patients' colonoscopy-induced anxiety and pain. MATERIALS AND METHODS A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction. RESULTS Four clinical trials were included: three on the patients' intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy. CONCLUSIONS The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management.
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Affiliation(s)
- Marcel-Alexandru Găină
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
- Correspondence:
| | - Andreea Silvana Szalontay
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Gabriela Ștefănescu
- Medical Semiology and Gastroenterology, Department of Medicine I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (G.Ș.); (G.G.B.)
- 2nd Gastroenterology Ward, Saint “Spiridon” County Hospital, Independence Bvd. No 1, 700111 Iasi, Romania
| | - Gheorghe Gh Bălan
- Medical Semiology and Gastroenterology, Department of Medicine I, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (G.Ș.); (G.G.B.)
- 2nd Gastroenterology Ward, Saint “Spiridon” County Hospital, Independence Bvd. No 1, 700111 Iasi, Romania
| | - Cristina Mihaela Ghiciuc
- Pharmacology, Clinical Pharmacology and Algeziology, Department of Morpho-Functional Sciences II, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania;
| | - Alexandra Boloș
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Alexandra-Maria Găină
- 1st Neurology Ward, Hospital of Neurosurgery “Prof. Dr. Nicolae Oblu” Iasi, 2 Ateneului Street, 700309 Iasi, Romania;
| | - Cristinel Ștefănescu
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.S.S.); (A.B.); (C.Ș.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
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12
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Sekula AD, Downey L, Puspanathan P. Virtual Reality as a Moderator of Psychedelic-Assisted Psychotherapy. Front Psychol 2022; 13:813746. [PMID: 35310225 PMCID: PMC8931418 DOI: 10.3389/fpsyg.2022.813746] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 02/11/2022] [Indexed: 12/20/2022] Open
Abstract
Psychotherapy with the use of psychedelic substances, including psilocybin, lysergic acid diethylamide (LSD), ketamine, and 3,4-methylenedioxymethamphetamine (MDMA), has demonstrated promise in treatment of post-traumatic stress disorder (PTSD), anxiety, addiction, and treatment-resistant depression. Psychedelic-assisted psychotherapy (PP) represents a unique psychopharmacological model that leverages the profound effects of the psychedelic experience. That experience is characterized by strong dependency on two key factors: participant mindset and the therapeutic environment. As such, therapeutic models that utilize psychedelics reflect the need for careful design that promotes an open, flexible, trusting mindset and a supportive setting. To meet this need, the PP model is increasingly supplemented by auxiliary methods, including meditation, relaxation, visualization or spiritual practices. We suggest virtual reality (VR) as a full-spectrum tool able to capitalize on and catalyze the innately therapeutic aspects of the psychedelic experience, such as detachment from familiar reality, alteration of self-experience, augmentation of sensory perception and induction of mystical-type experiences. This is facilitated by VR’s evidenced capacity to: aid relaxation and reduce anxiety; buffer from external stimuli; promote a mindful presence; train the mind to achieve altered states of consciousness (ASC); evoke mystical states; enhance therapeutic alliance and encourage self-efficacy. While these unique VR features appear promising, VR’s potential role in PP remains speculative due to lack of empirical evidence on the combined use of VR and PP. Given the increased commercial interest in this synergy there is an urgent need to evaluate this approach. We suggest specific VR models and their role within PP protocols to inspire future direction in scientific research, and provide a list of potential disadvantages, side effects and limitations that need to be carefully considered. These include sensory overstimulation, cyber-sickness, triggering memories of past traumatic events as well as distracting from the inner experience or strongly influencing its contents. A balanced, evidence-based approach may provide continuity across all phases of treatment, support transition into and out of an ASC, deepen acute ASC experiences including mystical states and enrich the psychotherapeutic process of integration. We conclude that the potential application of VR in modulating psychedelic-assisted psychotherapy demands further exploration and an evidence-based approach to both design and implementation.
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Affiliation(s)
- Agnieszka D. Sekula
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Enosis Therapeutics Pty. Ltd., Melbourne, VIC, Australia
- *Correspondence: Agnieszka D. Sekula,
| | - Luke Downey
- Centre for Human Psychopharmacology, Swinburne University of Technology, Hawthorn, VIC, Australia
- Institute for Breathing and Sleep, Austin Hospital, Melbourne, VIC, Australia
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Le May S, Genest C, Hung N, Francoeur M, Guingo E, Paquette J, Fortin O, Guay S. The Effect of Virtual Reality Game Preparation for Children scheduled for MRI (IMAGINE): a Randomized Controlled Trial Protocol (Preprint). JMIR Res Protoc 2021; 11:e30616. [PMID: 35700000 PMCID: PMC9237773 DOI: 10.2196/30616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Revised: 03/06/2022] [Accepted: 05/11/2022] [Indexed: 11/25/2022] Open
Abstract
Background It is known that magnetic resonance imaging (MRI) procedures generate fear and anxiety. Children may become restless during scanning, which results in movement artifacts requiring the MRI procedure to be repeated with sedation. Few studies seem to have looked at the effect of immersive virtual reality (IVR) on anxiety in children scheduled for MRI scans and how to identify which children are more responsive. Objective The aims of this study are 3-fold: develop an algorithm of predictability based on biofeedback, address feasibility and acceptability of preprocedural IVR game preparation for anxiety management during MRI procedures, and examine the efficacy of IVR game preparation compared with usual care for the management of procedural anxiety during MRI scans. Methods This study will have 2 phases. We will first conduct a field test with 10 participants aged 7 to 17 years to develop a predictive algorithm for biofeedback solution and to address the feasibility and acceptability of the research. After the field test, a randomized controlled trial will be completed using a parallel design with 2 groups: an experimental group (preprocedural IVR game preparation) and a usual care group (standard care as per the radiology department’s protocol) in an equal ratio of 49 participants per group for 98 participants. Recruitment will be carried out at a hospital in Quebec, Canada. The experimental group will receive a preprocedural IVR game preparation (IMAGINE) that offers an immersive simulation of the MRI scan. Participants will complete a questionnaire to assess the acceptability, feasibility, and incidence of side effects related to the intervention and the biofeedback device. Data collected will include sociodemographic and clinical characteristics as well as measures of procedure-related anxiety with the French-Canadian version of the State-Trait Anxiety Inventory for Children (score 1-3) and the Children’s Fear Scale (score 0-4). Physiological signs will be noted and include heart rate, skin conductance, hand temperature, and muscle tension. Measures of the level of satisfaction of health care professionals, parents, and participants will also be collected. Analyses will be carried out according to the intention-to-treat principle, with a Cronbach α significance level of .05. Results As of May 10, 2022, no participant was enrolled in the clinical trial. The data collection time frame is projected to be between April 1, 2022, and March 31, 2023. Findings will be disseminated through peer-reviewed publications. Conclusions Our study provides an alternative method for anxiety management to better prepare patients for an awake MRI procedure. The biofeedback will help predict which children are more responsive to this type of intervention. This study will guide future medical practice by providing evidence-based knowledge on a nonpharmacological therapeutic modality for anxiety management in children scheduled for an MRI scan. Trial Registration ClinicalTrials.gov NCT04988516; https://clinicaltrials.gov/ct2/show/NCT04988516 International Registered Report Identifier (IRRID) PRR1-10.2196/30616
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Affiliation(s)
- Sylvie Le May
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
| | - Christine Genest
- Faculty of Nursing, Université de Montréal, Montreal, QC, Canada
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île de Montréal, Montreal, QC, Canada
| | - Nicole Hung
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
- Faculty of Medicine, Université de Montréal, Montreal, QC, Canada
| | - Maxime Francoeur
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Estelle Guingo
- Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada
| | - Julie Paquette
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Olivier Fortin
- Research Center, Centre Hospitalier Universitaire Sainte-Justine, Montreal, QC, Canada
| | - Stéphane Guay
- Trauma Studies Centre, Institut Universitaire en Santé Mentale de Montréal, Centre Intégré Universitaire de Santé et de Services Sociaux de l'Est-de-l'Île de Montréal, Montreal, QC, Canada
- School of Criminology, Université de Montréal, Montreal, QC, Canada
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Firoozabadi R, Elhaddad M, Drever S, Soltani M, Githens M, Kleweno CP, Sharar SR, Patterson DR, Hoffman HG. Case Report: Virtual Reality Analgesia in an Opioid Sparing Orthopedic Outpatient Clinic Setting: A Case Study. FRONTIERS IN VIRTUAL REALITY 2020; 1:553492. [PMID: 33585832 PMCID: PMC7877803 DOI: 10.3389/frvir.2020.553492] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
Immersive virtual reality is proving effective as a non-pharmacologic analgesic for a growing number of painful medical procedures. External fixator surgical pins provide adjunctive stability to a broken pelvic bone until the bones heal back together, then pins are removed. The purpose of the present case study was to measure for the first time, whether immersive virtual reality could be used to help reduce pain and anxiety during the orthopedic process of removing external fixator pins from a conscious patient in the orthopedic outpatient clinic, and whether it is feasible to use VR in this context. Using a within-subject within wound care design with treatment order randomized, the patient had his first ex-fix pin unscrewed and removed from his healing pelvic bone while he wore a VR helmet and explored an immersive snowy 3D computer generated world, adjunctive VR. He then had his second pin removed during no VR, standard of care pain medications. The patient reported having 43% less pain intensity, 67% less time spent thinking about pain, and 43% lower anxiety during VR vs. during No VR. In addition, the patient reported that his satisfaction with pain management was improved with the use of VR. Conducting simple orthopedic procedures using oral pain pills in an outpatient setting instead of anesthesia in the operating room greatly reduces the amount of opioids used, lowers medical costs and reduces rare but real risks of expensive complications from anesthesia including oversedation, death, and post-surgical dementia. These preliminary results suggest that immersive VR merits more attention as a potentially viable adjunctive non-pharmacologic form of treatment for acute pain and anxiety during medical procedures in the orthopedic outpatient clinic. Recent multi-billion dollar investments into R and D and mass production have made inexpensive immersive virtual reality products commercially available and cost effective for medical applications. We speculate that in the future, patients may be more willing to have minor surgery procedures in the outpatient clinic, with much lower opioid doses, while fully awake, if offered adjunctive virtual reality as a non-pharmacologic analgesic during the procedure. Additional research and development is recommended.
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Affiliation(s)
- Reza Firoozabadi
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Moamen Elhaddad
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Sydney Drever
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Maryam Soltani
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Michael Githens
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Conor P. Kleweno
- Orthopedic Trauma Surgery Clinic, Harborview Medical Center, University of Washington, Seattle, WA, United States
| | - Sam R. Sharar
- Department of Anesthesiology & Pain Medicine, School of Medicine, University of Washington, Seattle, WA, United States
| | - David R. Patterson
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, United States
| | - Hunter G. Hoffman
- Department of Radiology, University of Washington, Seattle, WA, United States
- Department of Mechanical Engineering, College of Engineering, University of Washington, Seattle, WA, United States
- Department of Psychology, University of Washington, Washington, ME, United States
- Correspondence: Hunter G. Hoffman,
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