Article

Usability Testing of an Interactive Virtual Reality Distraction Intervention to Reduce Procedural Pain in Children and Adolescents With Cancer

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Abstract

Purpose: Needle procedures are among the most distressing aspects of pediatric cancer-related treatment. Virtual reality (VR) distraction offers promise for needle-related pain and distress given its highly immersive and interactive virtual environment. This study assessed the usability (ease of use and understanding, acceptability) of a custom VR intervention for children with cancer undergoing implantable venous access device (IVAD) needle insertion. Method: Three iterative cycles of mixed-method usability testing with semistructured interviews were undertaken to refine the VR. Results: Participants included 17 children and adolescents (8-18 years old) with cancer who used the VR intervention prior to or during IVAD access. Most participants reported the VR as easy to use (82%) and understand (94%), and would like to use it during subsequent needle procedures (94%). Based on usability testing, refinements were made to VR hardware, software, and clinical implementation. Refinements focused on increasing responsiveness, interaction, and immersion of the VR program, reducing head movement for VR interaction, and enabling participant alerts to steps of the procedure by clinical staff. No adverse events of nausea or dizziness were reported. Conclusions: The VR intervention was deemed acceptable and safe. Next steps include assessing feasibility and effectiveness of the VR intervention for pain and distress.

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... This study examined the feasibility, clinical utility, tolerability, and in- Our results, showcasing VR feasibility at the study site, are consistent with the literature. 16,22,26,27,28,29,30,31,32,33,34 22,26,33,34,35 Patients especially enjoyed VR because it was an immersive, interactive, and distracting experience. 22,26,33,34,35 This implies that immersive and interactive VR experiences may provide the optimal environment for patients to forget about their medical procedure. ...
... This study examined the feasibility, clinical utility, tolerability, and in- Our results, showcasing VR feasibility at the study site, are consistent with the literature. 16,22,26,27,28,29,30,31,32,33,34 22,26,33,34,35 Patients especially enjoyed VR because it was an immersive, interactive, and distracting experience. 22,26,33,34,35 This implies that immersive and interactive VR experiences may provide the optimal environment for patients to forget about their medical procedure. ...
... 16,22,26,27,28,29,30,31,32,33,34 22,26,33,34,35 Patients especially enjoyed VR because it was an immersive, interactive, and distracting experience. 22,26,33,34,35 This implies that immersive and interactive VR experiences may provide the optimal environment for patients to forget about their medical procedure. An ill-fitted VR headset is reported to reduce the ease of use as it may fall down during the procedure. ...
Article
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Medical procedures cause pain and anxiety in children. Distraction techniques, including virtual reality (VR), may be used in healthcare settings to reduce rates of undertreated procedural pain and anxiety. A mixed‐methods, concurrent triangulation design was piloted at a pediatric orthopedic hospital to assess the feasibility, clinical utility, tolerability, and initial clinical efficacy of VR distraction during medical procedures received by patients with complex musculoskeletal conditions. Questionnaire, scale, interview, observation, and focus group data were collected from patients, their parents, and healthcare professionals. Triangulation of key quantitative and qualitative findings produced final themes and meta‐themes. A total of 44 patients and their parents undergoing intravenous insertions (n = 30), pin removals (n = 7), blood draws (n = 3), Botox injections (n = 2), dressing change (n = 1), and urodynamic test (n = 1) were recruited along with 11 healthcare professionals performing the medical procedures. The following themes resulted from triangulation of data sources: VR intervention was (a) feasible because VR was easily implemented into the clinical workflow, (b) clinically useful as VR was accepted by stakeholders and easy to use, (c) tolerable as VR caused minimal discomfort, and (d) showed initial clinical efficacy in managing procedural pain and anxiety. These findings will inform policies and procedures for VR use in practice and a sustainable implementation across the [name of hospital removed for peer review] network.
... 11 Our research group recently evaluated the usability (ease of use and understanding) of a VR platform for children with cancer and found VR to be safe and easy to use. 12 Our next step and the primary objective of this pilot randomized controlled trial (RCT) was to determine the feasibility of implementing a VR intervention for children and adolescents with cancer undergoing SCP needle insertion. The secondary objective was to estimate preliminary treatment effects of VR compared with an active distraction control (iPad). ...
... Children and adolescents were excluded if they: (1) had visual, auditory or cognitive impairments precluding interaction with the intervention (VR) or control (iPad) equipment; (2) had major comorbid medical or psychiatric conditions (including needle-phobia) as reported by their health care provider or parent; (3) were receiving end-of-life care; (4) had a methicillinresistant Staphylococcus aureus infection or symptoms of respiratory or gastrointestinal infection as reported by any member of their health care team which could contaminate the intervention or control equipment; or (5) had participated in the prior study examining usability of the VR intervention. 12 ...
... The same equipment was previously used by our research group to evaluate the usability of the VR platform. 12 The VR headset was placed on the participant and they were given instructions for how to use the controller to interact with the underwater VR environment. Once the participant was able to navigate the game, headphones were placed over their ears. ...
Article
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Objectives: First, we aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. Second, we aimed to estimate preliminary treatment effects of VR compared to an active distraction control (iPad). Methods: A single-site pilot randomized controlled trial (RCT) comparing VR to iPad distraction was conducted. Eligible children were aged 8-18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using pre-procedure scores as covariates. Results: Twenty participants (mean age 12▒y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children (62%) participated, and one withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared to the iPad group. Fear was similar across groups, with approximately 60% of the sample indicating no fear. Discussion: VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared to iPad distraction. These data will inform design of a future full-scale RCT.
... Among the 18 articles that were reviewed, VR interventions for pain or anxiety were attributed to a wide range of medical treatment in children; MRI/radiology exams [14], wound debridement [15] and specifically burn wound [16][17][18][19], Venipuncture [20][21] and Phlebotomy/ blood draw [22][23], cold pressor experiment [24], pre-operative care in hospital and anesthesia [25][26], cancer treatment and chemotherapy [27][28], injection, for instance Botalium Toxin -BoNT [29], and local anesthesia in dental care [30]. One study described the design of a VR application for broadly defined medical procedures, without specifying one [31]. ...
... Among those, seven articles addressed pain directly [15,18,[21][22][23][24]30] while six articles addressed anxiety associated with pain during a procedure [17, 19-20, 22-23, 29]. Four articles addressed anxiety linked to a medical procedure [14,[25][26][27]. ...
... A number of games were characterized as distraction therapy but cited more specific techniques for modulating pain or anxiety output. For instance, Birnie et al. [27] suggested that enabling the user to maintain a point of focus on an object in front of them is important and designed a game where children can shoot rainbow balls at moving objects. Furthermore, Piskorz & Czub [20] used a Multiple Object Tracking (MOT) paradigm to set priorities for cognition and shifting the player's attention from one virtual object to another during a venipuncture procedure. ...
Preprint
Full-text available
Note-------------------full paper now published, see paper section-----------------------------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. Specifically, we wanted to gain an understanding of the techniques and goals used in selecting or designing VR apps in this context. 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 published between 2013 and 2018 were identified. In total 18 articles were included in the review, with 7 reporting significant reduction in pediatric pain or anxiety, 3 testing but finding no significant impact of the VR apps employed, and the rest not conducting any test of significance. We identified 9 articles that were based on VR apps specifically designed and tailored for pediatric patients. 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 a viable choice for managing pain and anxiety in a range of medical treatments. However, commercial products lack diversity and meaningful 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 an active participant in managing their own care. To achieve this, design must be part of the development.
... According to Birnie et al. [8], "needle procedures are among the most distressing aspects of pediatric cancer-related treatment. Virtual Reality (VR) distraction offers promise for needle-related pain and distress given its highly immersive and interactive virtual environment." ...
... Virtual Reality (VR) distraction offers promise for needle-related pain and distress given its highly immersive and interactive virtual environment." The researcher studied the ease of use and acceptability of using a VR intervention with children diagnosed with cancer who were undergoing the implantation of an intravenous access device (IVAD) for needle insertion [8]. The researchers found that 82% of study participants found the intervention easy to use, 94% found the intervention easy to understand, and 94% indicated they would like to use the intervention for subsequent needle procedures [8]. ...
... The researcher studied the ease of use and acceptability of using a VR intervention with children diagnosed with cancer who were undergoing the implantation of an intravenous access device (IVAD) for needle insertion [8]. The researchers found that 82% of study participants found the intervention easy to use, 94% found the intervention easy to understand, and 94% indicated they would like to use the intervention for subsequent needle procedures [8]. In addition to this, the study findings revealed no adverse events such as nausea or dizziness were reported by the participants; hence, with the right refinements based on the need of each clinical procedure, VR can still provide an alternative intervention for pain management. ...
Article
Full-text available
Virtual care extends beyond the walls of healthcare organizations to provide care at a distance. Although virtual care cannot be regarded as a solution for all health-related inquiries, it provides another care delivery channel for specific patient populations with appointments that do not require in-person physical examinations or procedures. A scoping review was conducted to define the meaning of virtual care, understand how virtual care has influenced the healthcare industry and is being expanded to complement the existing healthcare system, and describe the outcomes of using virtual care for patients and providers. Findings from the scoping review suggest that virtual care encompasses the provision of care using advanced video conferencing technology to support remote care that takes place between patients and providers and the use of virtual reality technology to simulate care environments. Some of virtual care’s use in healthcare includes application to pain and anxiety management, virtual consultations and follow-up visits, rehabilitation and therapy services, outpatient clinics, and emergency services. Lastly, from a provider and patient perspective, while both saw benefits of virtual care and scored the service relatively high on satisfaction after using virtual care, the greatest barrier to using virtual care may be technological challenges.
... VR sickness is similar to motion sickness and is thus characterized by symptoms such as nausea, dizziness, headaches or blurry vision (20). Some studies have specifically assessed nausea with a separate question or scale (1,3,5,21), whereas others have assessed simulator sickness with a specific questionnaire (10,22). In general, VR seems to be well-tolerated by pediatric patients with studies reporting no nausea or other side effects, and only mild when present. ...
... In general, VR seems to be well-tolerated by pediatric patients with studies reporting no nausea or other side effects, and only mild when present. Concerning feasibility, this concept has been assessed by measuring experienced fun during VR use (3,23), ease of use and understanding (usability) (8,21), the occurrence of technical issues and procedure time (8). Together, these studies have shown that VR use is feasible for patients with burn wounds during physical therapy (3,23), for patients with sickle cell disease (14), and during pediatric hemophelia care for distraction during intravenous interventions (8). ...
... Together, these studies have shown that VR use is feasible for patients with burn wounds during physical therapy (3,23), for patients with sickle cell disease (14), and during pediatric hemophelia care for distraction during intravenous interventions (8). With respect to acceptability, researchers have assessed this concept with openended questions or by measuring their intention or willingness to use VR again and found that VR use was acceptable for pediatric patients (14,21). Taken together, these studies have each shown that various VR applications for distracting pediatric patients (from pain procedures) are feasible, acceptable and tolerable, each for use in a specific patient sample or during a specific medical procedure. ...
Article
Full-text available
Accumulating evidence supports the use of virtual reality (VR) as an effective pain and anxiety management tool for pediatric patients during specific medical procedures in dedicated patient groups. However, VR is still not widely adopted in everyday clinical practice. Feasibility and acceptability measures of clinicians' experiences are often missing in studies, thereby omitting an important stakeholder in VR use in a clinical setting. Therefore, the aim of this mixed-methods study was to investigate the feasibility, acceptability, tolerability (primary outcomes), and preliminary effectiveness (secondary outcome) of Relaxation-VR in both pediatric patients aged 4–16 years and clinicians. Relaxation-VR is a VR application prototype aimed to provide distraction and relaxation for a variety of patient populations and procedures and is used to reduce anxiety, stress (tension) and pain for children in hospital. Multiple measures of acceptability, feasibility and tolerability, and pre-to-post changes in measures of pain, anxiety, stress and happiness were assessed in pediatric patients. At the end of the study, acceptability and feasibility of VR use was assessed in clinicians. Results indicate that VR use (in particular, the Relaxation-VR prototype) for both distraction and relaxation is acceptable, feasible and tolerable for a variety of pediatric patients aged 4–16 years, as assessed in both patients and clinicians, and can reduce anxiety, pain and tension (stress), and increase happiness in a hospital setting.
... Os recursos tecnológicos foram abordados em dois aspectos: dispositivo e tecnologia. Pode-se observar a utilização de um ou mais dispositivos nos artigos, como a aplicação Sisom [26], compatível com smartphone e tablet, e a aplicação desenvolvida por Birnie et al. [7], que utiliza óculos de realidade virtual (RV) e smartphone para distrair crianças durante procedimento invasivo. Outros artigos também empregaram recursos específicos dos dispositivos, tais como Near Field Communication (NFC) e tags Radio-Frequency IDentification (RFID) para comunicação com sensores [14]. ...
... Onze artigos utilizaram recursos tecnológicos para motivar os pacientes no uso da aplicação, tais como gamificação [9, 22-24, 40, 43, 44], RV [7] Outro foco de pesquisa relevante (25,8% dos artigos) é a disponibilidade de conteúdo informativo sobre sintomas, efeitos colaterais e alimentação adequada [6,8,15,18,26,27,29,38]. Há também pesquisas na área de comunicação (29,03%), envolvendo integração social com outros pacientes ou com profissionais de saúde [6,15,21,32,48], e serviços de lembrete de datas de consulta e exames [8,26,27,30]. Apenas um artigo enfocou o estímulo de movimentos físicos [5]. ...
... Apenas um artigo enfocou o estímulo de movimentos físicos [5]. O entretenimento durante procedimentos invasivos [7] também foi abordado apenas por um artigo. ...
Conference Paper
Cancer is the disease that most affects children and young people around the world. The treatment is long and ineffective when detected late. The technologies of mobile computing can be used to develop applications to assist patients during the cancer treatment. This article presents a systematic mapping of literature to identify articles that apply mobile applications to assist patients in cancer treatments, in order to show an overview of the literature, identifying gaps and research opportunities. The systematic mapping study was conducted in six databases including papers from January 2008 to December 2018. The initial search resulted in 41,888 papers, of which 31 were selected after applying the filter criteria. The main results obtained are: (1) most papers (61,29%) reported solutions based on native mobile applications; (2) majority (67,74%) focused on monitoring symptoms and side effects of cancer treatment; (3) most papers (61,29%) aimed physical benefits; (4) only two papers (6,45%) provided applications to leukemia patients; (5) four papers (12,9%) focused on palliative care; and (6) most papers (83,87%) conducted an experiment with oncological patients. The results corroborate with the need for mobile applications to help individuals in monitoring, psychological support, and information regarding about the disease, as well as evidence of research opportunities in palliative and supportive care.
... Although the number of cases has increased, the survival rate has also reached to 80% to 85%. With the increase in survival rate, children with cancer frequently go through prolonged medical processes involving repeated injection processes that can cause anxiety (Birnie et al., 2018;Loeffen et al., 2020). Therefore, needle procedures are still one of the most painful and stressful procedures used as part of the treatment of cancer in children (Jibb et al., 2015). ...
... In recent years, many studies have shown that using virtual reality (VR) as a distraction method is effective in reducing procedural pain in children (Chan et al., 2019;Gerçeker et al., 2020;Piskorz & Czub, 2018). VR has been used in children to manage a number of painful experiences, including injection procedures, dressing changes, burns, and chronic and postoperative pain (Atzori et al., 2018b;Birnie et al., 2018;Chan et al., 2019;del Castillo et al., 2019;Gerçeker et al., 2020;Sharar et al., 2008). ...
... However, the new generation of head-mounted VR equipment is affordable and easy to use, making it a popular and innovative approach for a wide variety of ages (Gold & Mahrer, 2017). Also, more of the studies which were conducted on pediatric oncology patients have reported that VR is effective in reducing the pain caused by needle procedures (Birnie et al., 2018;Nilsson et al., 2009;Sander Wint et al., 2002). However, only a limited number of randomized clinical studies have assessed the effect of VR on reducing pain during venous port access (Windich-Biermeier et al., 2007). ...
Article
Abstract Purpose: Needle procedures are one of the most distressing practices for pediatric oncology patients. Virtual reality (VR) is a distraction method which offers an extremely realistic and interactive virtual environment and helps reduce needle-related pain and distress. The aim of this study was to evaluate the effects of VR method on pain during venous port access in pediatric oncology patients aged 7 to 18 years. Method: Children who had cancer and were between the ages of 7 and 18 years and undergoing a port-a-cath access were randomly assigned through blocked randomization to either the VR intervention group or control group. A commercially available VR headset was fitted to children in the intervention group. Immediately after the port access, pain scores were obtained from children’s self-reports and parents’ proxy reports, using the Wong–Baker FACES Pain Rating Scale. Results: Descriptive characteristics of the children (n = 71) showed a homogeneous distribution between groups. During the procedure, children in the control group (n = 36; 5.03 ± 3.35) experienced more pain than the children in VR group (n = 35; 2.34 ± 2.76; p < .001). Proxy reports of the parents in the experimental group (1.77 ± 2.46) were found to be lower than those in the control group (4.67 ± 2.56; p < .001). Conclusions/Implications for Practice: VR method is effective for reducing pain during venous port access in pediatric oncology patients. VR should be used as a distraction method during venous port access. Keywords virtual reality, distraction, pain, venous port access
... Recently, many studies showed that virtual reality (VR) could be used as a distraction method to successfully reduce procedural pain in children (Piskorz and Czub, 2018;Chan et al., 2019;Ozalp Gerceker et al., 2020). VR can be used to manage several painful experiences in children, including punctures, changing dressings, cleaning and draping burns, and management of chronic and acute pain (Sharar et al., 2008;Atzori et al., 2018;Birnie et al., 2018;Chan et al., 2019;Toledo Del Castillo et al., 2019;Ozalp Gerceker et al., 2020). VR involves the active participation of the patients in a task requiring cognitive or behavioral functioning, thereby distracting the brain from pain (Dumoulin et al., 2019). ...
... Fortunately, the new generation of head-mounted VR equipment is affordable and easy to use, making it a popular and innovative approach for a wide variety of individuals. Furthermore, VR effectively reduces pain caused by punctures in pediatric oncology patients (Nilsson et al., 2009;Birnie et al., 2018;Dunn et al., 2019;Gerceker et al., 2021;Semerci et al., 2021). A recent meta-analysis attempted to analyze seven VR studies but could not demonstrate an advantage of VR because the studies were too heterogeneous to be pooled (Czech et al., 2021). ...
... Although these interventions have certain effectiveness, they often stimulate a single sensory pathway. On the other hand, VR is an immersive intervention with sound, moving images, and interactive components that require some thinking and cognitive power (Nilsson et al., 2009;Birnie et al., 2018;Dunn et al., 2019;Gerceker et al., 2021;Semerci et al., 2021). Furthermore, the HMD changes the perception of the surrounding environment. ...
Article
Full-text available
Background Needle-related pain, fear, and anxiety can be a deterrent to treatments in children and adolescents. Virtual reality (VR) can be used to manage the poor experience of needle procedures. Objective This meta-analysis aimed to examine the effects of VR on pain, fear, and anxiety related to needle procedures in children and adolescents. Methods PubMed, EMBASE, and the Cochrane Library were searched for potentially eligible studies published up to June 2021. The outcomes were pain assessed by the Wong-Baker Faces Pain Scale (WBS) or Faces Pain Scale-Revised (FPS-R), and Visual Analog Scale (VAS), fear assessed by Children's Fear Scale (CFS), and anxiety assessed by Children's Anxiety Meter (CAM), VAS, or CFS. Because of expected heterogeneity among studies, all analyses were conducted using the random-effects model. Results Ten studies were included (571 children in the VR group and 575 in the control group). Based on the WBS, VR reduced pain, either self-reported (WMD = −2.17, 95%CI: −3.37, −0.97), parent-reported (WMD = −3.52, 95%CI: −4.62, −2.42), nurse-reported (WMD = −3.29, 95%CI: −5.59, −0.99), and physician/investigator-reported (WMD = −3.48, 95%CI: −5.93, −1.04). Using the FPS-R, VR reduced needle-related pain compared with controls (WMD = −0.85, 95%CI: −1.64, −0.06). Similar results were observed for fear (children/adolescents: WMD = −1.52, 95%CI: −2.18, −0.86; parents: WMD = −1.71, 95%CI: −2.30, −1.13; nurses: WMD = −1.55, 95%CI: −2.47, −0.63; physicians/investigators: WMD = −0.59, 95%CI: −1.00, −0.18) and anxiety (self-reported: WMD = −2.79, 95%CI: −4.07, −1.54; parent-reported: WMD = −3.87, 95%CI: −5.58, −2.15; nurse-reported: WMD = −4.64, 95%CI: −6.56, −2.71; physician/investigator-reported: WMD = −2.06, 95%CI: −4.13, −0.00). Conclusion A VR-based intervention could reduce needle-related pain, fear, and anxiety in children and adolescents.
... Among the 18 articles that were reviewed, VR interventions for pain or anxiety were attributed to a wide range of medical treatment in children: magnetic resonance imaging (MRI) and radiology examinations [17]; wound debridement [18], specifically, burn wound [19][20][21][22]; venipuncture [23,24]; phlebotomy or blood draw [25,26]; cold pressor experiment [27]; preoperative care in hospital and anesthesia [28,29]; cancer treatment and chemotherapy [30,31]; injection, for instance, botulinum toxin [32]; and local anesthesia in dental care [33]. One study described the design of a VR app for broadly defined medical procedures, without specifying one [34]. ...
... Among those that specified a procedure, 7 articles addressed pain directly [18,21,24,26,33], whereas 6 articles addressed anxiety associated with pain during a procedure [20,22,23,25,32]. In addition, 4 articles addressed anxiety linked to a medical procedure [17,[28][29][30]. ...
... A number of games were characterized as distraction therapy but cited more specific focus-shifting techniques for modulating pain or anxiety output. For instance, Birnie et al [30] suggested that enabling the user to maintain a point of focus on an object in front of them is important and designed a game where children can shoot rainbow balls at moving objects. Furthermore, Piskorz and Czub [23] used a Multiple Object Tracking paradigm to set priorities for cognition and shifting the player's attention from one virtual object to another during a venipuncture procedure. ...
Article
Full-text available
Background: Virtual reality (VR) technology has been explored in the health sector as a novel tool for supporting treatmentside effects, including managing pain and anxiety. VR has recently become more available with the launch of low-cost devicesand apps. Objective: This study aimed to provide an updated review of the research into VR use for pain and anxiety in pediatric patientsundergoing medical procedures. Specifically, we wanted to gain an understanding of the techniques and goals used in selectingor designing VR apps in this context. Methods: We performed a scoping review. To identify relevant studies, we searched three electronic databases. Two authorsscreened the titles and abstracts for relevance and eligibility criteria. Results: Overall, 1386 articles published between 2013 and 2018 were identified. In total 18 articles were included in the review,with 7 reporting significant reduction in pediatric pain or anxiety, 3 testing but finding no significant impact of the VR appsemployed, and the rest not conducting any test of significance. We identified 9 articles that were based on VR apps specificallydesigned and tailored for pediatric patients. 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 a viable choice for managing pain and anxiety in a range of medical treatments.However, commercial products lack diversity and meaningful design strategies are limited beyond distraction techniques. Wepropose future VR interventions to explore skill-building goals in apps characterized by dynamic feedback to the patient andexperiential and product qualities that enable them to be an active participant in managing their own care. To achieve this, designmust be part of the development.
... In 2000, VR made its debut in health care when SnowWorldVR was developed to act as an alternative analgesic for burn patients [13]. This original application of VR to medicine paved the way for several more applications developed for pain treatment, physician education and patient education [11,12,14,15]. Increased implementation of VR in a clinical setting has been shown to decrease patient anxiety by increasing patient understanding and by acting as a distraction during painful procedures [9,13,15,16]. ...
... This original application of VR to medicine paved the way for several more applications developed for pain treatment, physician education and patient education [11,12,14,15]. Increased implementation of VR in a clinical setting has been shown to decrease patient anxiety by increasing patient understanding and by acting as a distraction during painful procedures [9,13,15,16]. While the technology was originally applied to areas of general medicine, recent applications in pediatrics have shown similar effects, decreasing patient anxiety and pain [15,17]. ...
... Increased implementation of VR in a clinical setting has been shown to decrease patient anxiety by increasing patient understanding and by acting as a distraction during painful procedures [9,13,15,16]. While the technology was originally applied to areas of general medicine, recent applications in pediatrics have shown similar effects, decreasing patient anxiety and pain [15,17]. ...
Preprint
Full-text available
A bioinformatics researcher and a game design researcher walk into a lab... This paper shares two case-studies of a collaboration between a bioinformatics researcher who is developing a set of educational VR simulations for youth and a consultative game design researcher with a background in games User Research (GUR) techniques who assesses and iteratively improves the player experience in the simulations. By introducing games-based player engagement strategies, the two researchers improve the (re)playability of these VR simulations to encourage greater player engagement and retention.
... Many VR solutions in health care fail to engage stakeholders such as users and medical professionals, in the design process [9]. However, a few studies suggest that incorporating the needs and perspectives of stakeholders in the design results in better usability, experience and acceptability of the intervention [3]. ...
... For instance, storytelling [17], mediating breathing exercises [5], and music [11] have all been shown to be effective for distraction. Additionally, recent research has explored VR interventions to reduce periprocedural anxiety, for example in children and adolescents with cancer [3]. ...
... However, research is still limited in using participatory and/or co-design approach that would account for stakeholders inputs into the development of medical VR applications [1]. Many studies to date rely on commercial products for enabling paediatric and adult patients self-manage their pain or anxiety [1] whereas bespoke and tailored VR experiences are shown to positively impact patient satisfaction [3]. We conducted a study to identify key insights for developing VR applications for managing periprocedural anxiety in children, based on clinician feedback. ...
Conference Paper
Full-text available
Many children experience periprocedural anxiety (occurring before, during, or immediately after the a medical procedure such as induction of anaesthesia or immunisation) in hospital settings. A number of strategies, such as distraction and focus shifting, are commonly used in medical practice to help paediatric patients man- age their anxiety. In recent years, Virtual Reality (VR) has been investigated as a promising tool in hospital settings, particularly through mediating distraction. In this paper, we present the findings from a focus group with four clinicians and attempt to explore key elements inherent in their practice that can be leveraged for designing impactful VR applications for managing periprocedural anxiety in paediatric hospitals. Our contribution is a set of insights relevant to patients, their needs, tailoring of strategies, and future design directions. We benchmark three existing VR applications against our findings to generate potential design opportunities for VR applications. -------------------------------------------------------------------------------------------------------------------------------------------Citation: Yoo, S., Ahmadpour, N., Weatherall, A., Menezes, M., Pillai, A., Scott, S., Wong, G., Wood, N. (2019). Clinician perspective on VR Games for Managing Periprocedural Anxiety in Children. In proc Australian Computer-Human Interaction conference (OzCHI’19), ACM Digital Library.
... All studies (23/23) examined the applicability of VR in cancer. However, the type of cancer in each study differs considerably, as shown in Table 2. Approximately, 23% of the papers were focused on breast cancer treatments [22], [23], [26]- [28], [31], [35], [37], [39], [41] followed by blood cancer (e.g., leukaemia, lymphoblastic, etc.) (12%) [21], [25], [33], [36], [38], bone cancer (12%) [25], [29], [33], [38], [40], and brain cancer (12%) [25], [32], [33], [38], [40]. Various studies examined lymphoma cancer (9%) [25], [33], [38], [39] and lung cancer (7%) [20], [30], [35] while some studies focused on sarcoma (5%) [32], [40], and germ cell tumors (5%) [33], [38]. ...
... All studies (23/23) examined the applicability of VR in cancer. However, the type of cancer in each study differs considerably, as shown in Table 2. Approximately, 23% of the papers were focused on breast cancer treatments [22], [23], [26]- [28], [31], [35], [37], [39], [41] followed by blood cancer (e.g., leukaemia, lymphoblastic, etc.) (12%) [21], [25], [33], [36], [38], bone cancer (12%) [25], [29], [33], [38], [40], and brain cancer (12%) [25], [32], [33], [38], [40]. Various studies examined lymphoma cancer (9%) [25], [33], [38], [39] and lung cancer (7%) [20], [30], [35] while some studies focused on sarcoma (5%) [32], [40], and germ cell tumors (5%) [33], [38]. ...
... All studies (23/23) examined the applicability of VR in cancer. However, the type of cancer in each study differs considerably, as shown in Table 2. Approximately, 23% of the papers were focused on breast cancer treatments [22], [23], [26]- [28], [31], [35], [37], [39], [41] followed by blood cancer (e.g., leukaemia, lymphoblastic, etc.) (12%) [21], [25], [33], [36], [38], bone cancer (12%) [25], [29], [33], [38], [40], and brain cancer (12%) [25], [32], [33], [38], [40]. Various studies examined lymphoma cancer (9%) [25], [33], [38], [39] and lung cancer (7%) [20], [30], [35] while some studies focused on sarcoma (5%) [32], [40], and germ cell tumors (5%) [33], [38]. ...
Article
Full-text available
Virtual Reality is a computer-simulated 3-Dimensional technology in which the user interacts via different senses: visual, auditory, tactile, and/or olfactory. In the past decades, it has been argued that Virtual Reality as a technique could be applied in the clinical environment to successfully manage pain. This article provides a systematic review of research on Virtual Reality and pain management for patients who are suffering from cancer. More specifically, this article focuses on all types of Virtual Reality technologies (Non-Immersive, Semi-Immersive, Fully-Immersive) which has been developed and released to manage the pain which evokes from the treatment of cancer. An exhaustive search identified 23 relevant studies from 2010 to 2020. Overall, the identified studies indicated that Virtual Reality can improve the experience of pain for patients who are suffering from cancer. It was also found that, if Virtual Reality is appropriately designed, the pain which is arising from cancer treatments can be reduced. Even though some positive outcomes have been reported, overall, the results are inconclusive and studies that examine specifically the treatment of pain in cancer patients are limited. Further research needs to be conducted, to articulate clearly, under what circumstances Virtual Reality is an effective tool for cancer patients, and under what factors Virtual Reality can be the solution to the pain patients are experiencing.
... Again another study proved that using VR technology during needle-related procedures offered promise for pain and distress reduction [73]. The study included seventeen participants aged (8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18) years who suffered from cancer and their treatment required the insertion of an implantable venous access device (IVAD). ...
... Variations of VR hardware were used with cancer patients during receiving their chemotherapy treatment. Some used the i-glasses HMDs [67], [68], [70], [72], while [69], [73], [74]used normal HMD, and [71] used a standard personal computer. All of these studies used specially designed VR environments. ...
Article
Full-text available
Virtual reality refers to the technology used to create multi-sensory three-dimensional environments that can be navigated, manipulated, and interacted by a user. This paper's objective is to categorize the most common areas that use virtual reality (VR) for managing pain (psychological and physical). To our knowledge, this is the first survey that summarizes all of these areas in one place. This paper reviews the conducted studies that used VR for psychological treatment, especially with phobias. Also, this paper summarizes the current literature on using virtual reality interventions for managing acute, chronic, and cancer pain. Based on the review, virtual reality shows great potential for controlling acute pain-such as pain associated with burn wound care. However, limited studies only investigated the impact of using virtual reality on patients with chronic pain. The findings indicated that VR distraction has a great impact on pain and distress related to cancer and its treatments. This paper also discusses the challenges and limitations of the current research. Notably, the identified studies recommend VR distraction as a promising adjunct for pain reduction and psychological treatment. However, further research needs to be conducted to determine under what conditions VR distraction will provide more analgesic effects.
... A more sensitive study is represented in the paper "Usability Testing of an Interactive Virtual Reality Distraction Intervention to Reduce Procedural Pain in Children and Adolescents With Cancer" [4] which describes an application dedicated to distract children (with ages between 8 and 18 years old) who suffer from cancer in order to make it easier for the medical to finish needle procedures. The paper goes over the multiple iterations done in order to improve the VR app, which can offer useful insights into what to look for when it comes to developing a personal application on our own. ...
... 3. I thought the VR application was easy to use. 4. I think that I would need the support of a technical person to be able to use this VR application. ...
Conference Paper
Full-text available
Although virtual reality (VR) was initially created as an entertainment medium way back over 70 years ago, it has developed beyond its scope and we are now using it for many other purposes, like education, training and medicine. When it comes to an amazing VR experience, what glues everything together is the level of interactivity and the usability of the application itself. In this paper, we describe a mix of in-person and remote usability testing sessions, with analytics and questionnaires, that we performed to evaluate an educational VR application which was built for Politehnica University of Timisoara (Romania). We conclude with some general feedback and insights that might help other researchers and practitioners in improving similar applications.
... 14,15 Generally, a VR system uses a microprocessing computer, a headmounted three dimensional display and specialized built-in software to generate an immersive virtual environment. 16 VR distraction is considered an effective pain treatment for patients undergoing various invasive procedures, such as dental surgery, urological endoscopies or burn wound dressing changes. [16][17][18][19] However, to date, there are no data on the impact of VR on pain during postoperative daily wound care in patients after haemorrhoid surgery. ...
... 16 VR distraction is considered an effective pain treatment for patients undergoing various invasive procedures, such as dental surgery, urological endoscopies or burn wound dressing changes. [16][17][18][19] However, to date, there are no data on the impact of VR on pain during postoperative daily wound care in patients after haemorrhoid surgery. In this study, VR sets were used to evaluate the effect of VR distraction on relieving pain during postoperative daily wound dressing changes in patients following surgery for haemorrhoids. ...
Article
Full-text available
Objective To investigate whether immersive virtual reality (VR) distraction could decrease pain during postoperative dressing changes. Methods This was a prospective, open-label randomized clinical trial that enrolled patients that had undergone haemorrhoidectomy. Patients were randomly assigned to one of two groups: a control group that received the standard pharmacological analgesic intervention during dressing change and a VR group that received VR distraction during dressing change plus standard pharmacological analgesic intervention. Pain scores and physiological measurements were collected before, during and after the first postoperative dressing change. Results A total of 182 patients were randomly assigned to the control and VR groups. The baseline characteristics of the VR and control groups were comparable. There was no significant difference in mean pain scores prior to and after the dressing change procedure between the two groups. The mean pain scores at the 5-, 10-, 15- and 20-min time-points during the first dressing change were significantly lower in the VR group compared with the control group. Heart rates and oxygen saturation were not significantly different between the two groups. Conclusion Immersive VR was effective as a pain distraction tool in combination with standard pharmacological analgesia during dressing change in patients that had undergone haemorrhoidectomy.
... Distraction is easily applied in various contexts, and there is a variety of distraction methods available, including iPads, singing, televisions, looking away, talking to other people, squeezing someone's hand, and the application of something cold. Music, bubbles, medical clowns, virtual reality, sweet-tasting solutions for infants, and devices that produce cold sensations and vibrations (for example, "Buzzy") have been shown to be effective in previous research [13,[37][38][39]. Computer tablets (iPads, iPods, and smartphones) are popular among children and easy to use. ...
Article
Full-text available
Background Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living. Methods This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years ( n = 7) and their parents ( n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years ( n = 9) and parents ( n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. Results The main themes; “challenges,” “motivational factors,” and “routines” captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children’s experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. Conclusions Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.
... Clinicians and researchers have been implementing VR at SickKids over the past 8 years in diagnostic imaging and emergency departments for intravenous insertions [33], perioperative services to prepare children for anesthesia during the perioperative period, and for subcutaneous port-a-cath access in oncology (Aqua KindVR) [34,35]. In a single-site pilot randomized controlled trial comparing VR (peaceful underwater gamified environment) with iPad (Apple Inc; underwater video with headphones) for oncology procedures, nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion, an underassessed outcome metric in studies of VR for pediatric pain. ...
Article
Full-text available
Background: Virtual reality (VR) and augmented reality (AR) interventions are emerging as promising tools in the treatment of pediatric chronic pain conditions, but in this young field there is little consensus to guide the process of engaging in the development and evaluation of targeted VR-based interventions. Objective: The INOVATE-Pain consortium aims to advance the field of VR for pediatric chronic pain rehabilitation by providing guidance for best practices in the design, evaluation, and dissemination of VR-based interventions targeting this population. Methods: An interdisciplinary meeting of 16 academics, clinicians, industry and philanthropy partners was held in January 2020. Results: Reviewing the state of the field, the consortium identified important directions for research-driven innovation in VR/AR clinical care, highlighted key opportunities and challenges facing the field, and established a consensus on best methodological practices to adopt in future efforts to advance the research and practice of VR/AR in pediatric pain. The consortium also identified important next steps to undertake to continue to advance the work in this promising new area of digital health pain interventions. Conclusions: To realize the promise of this realm of innovation, key ingredients for the success include productive partnerships among industry, academic, and clinical stakeholders, a uniform set of outcome domains and measures for standardized evaluation, and widespread access to the latest opportunities, tools and resources. The INOVATE-Pain collaborative hopes to promote the creation, rigorous yet efficient evaluation, and dissemination of innovative VR-based interventions to reduce pain and improve quality of life for children. Clinicaltrial:
... In this study, different immersive VR distractions were used. In a study, Birnie et al. (2018) tested the interactive VR distraction to reduce pain in 17 children/adolescents with cancer during the port needle insertion. Children reported that the VR is easy to use, understandable, and would like to use it at port needle procedures. ...
Article
Purpose Port needle insertions are painful and distressing for Pediatric Hematology-Oncology patients. Virtual Reality (VR) can be used during needle-related procedures in these patients. This study aimed to investigate the effect of VR distraction during access to the venous port with a Huber needle in reducing needle-related pain, fear, and anxiety of children and adolescents with cancer. Methods This randomized controlled study used a parallel trial design guided by the CONSORT checklist. The sample of children (n=42) was allocated to the VR group (n=21) and the control group (n=21). Port needle-related pain was assessed using the Wong-Baker Faces Pain Rating Scale after the procedure. Before and after the port needle insertion procedure, anxiety and fear assessed using self- and parent-report using the Children’s Anxiety Meter and Child Fear Scale. The primary outcome was the patient-reported pain scores after the procedure and fear and anxiety scores before and after the procedure. Pain, anxiety, and fear scores of the two groups and within groups were analyzed and also Spearman correlation analysis was used. Results Self-reported pain scores of patients in the VR and control group were 2.4 ± 1.8 and 5.3 ± 1.8, respectively. This study found a statistically significant difference between groups in pain scores ( p < .001). A statistically significant difference was found between groups according to the self- and parent-reported fear and anxiety scores after the procedure. Self-reported fear scores in the VR and control group were 0.8 ± 0.9, 2.0 ±1.0, self-reported anxiety scores were 2.9 ± 2.0, 5.4 ± 2.0, respectively ( p < .001). Conclusion Virtual reality is an effective distraction method in reducing port needle-related pain, fear, and anxiety in Pediatric Hematology-Oncology patients. ClinicalTrials.gov NCT04093154
... The use of VR as a therapeutic means is increasing in childhood, especially for the treatment of pain in children with cancer [51] and anxiety before dental treatment [52,53]. In the case of neurorehabilitation, different studies address it in cerebral palsy and Down's syndrome to improve motor control, gait, and balance [54,55], and in the field of childhood mental health to treat anxiety (social phobia, school phobia) and eating disorders [56]. ...
Article
Full-text available
Self-regulation refers to the ability to control and modulate behavior, and it can include both emotional and cognitive modulation. Children with neurodevelopmental disorders may show difficulties in self-regulation. The main objective of this study is to improve self-regulation skills in children between 6 and 11 years of age with neurodevelopmental disorders. Methodology: A randomised controlled trial will be conducted with the use of “SR-MRehab: Un colegio emocionante”, based on non-immersive virtual reality system where virtual objects can be managed by children in a natural way using their hands. Children will be recruited from several schools of Granada (Spain) and they will be randomly allocated to two groups. An assessment will be conducted before and after the intervention and 24 weeks after the end of the intervention process. The experimental group will receive the intervention using virtual reality. The control group will receive a standard self-regulation program. Both interventions will be performed once a week for a total of 10 sessions. Changes in self-regulation, as well as acceptability of technology with the use of SR-MRehab will be evaluated. The results will be published and will provide evidence regarding the use of this type of intervention in children with neurodevelopmental disorders.
... 8 Clinical studies in pediatric patients have the most commonly utilized VR for pain and/or anxiety reduction in post-burn injury wound care. [9][10][11][12][13][14][15] Studies have also used VR for pediatric patients undergoing chemotherapy, 16,17 lumbar puncture, 18 and port access, [19][20][21] as well as dental care, 22 venipuncture, [23][24][25] and preoperative care. 26 While VR has been used in one study in the adult otolaryngology setting during postoperative sinonasal debridements, 27 there have been no studies to our knowledge exploring the use of VR in pediatric otolaryngology. ...
Article
Full-text available
Objectives/Hypothesis While virtual reality (VR) has been used as analgesia and anxiolysis for invasive procedures, no literature exists on the use of VR in the pediatric otolaryngology setting. The purpose of this study was to determine the efficacy of VR in reducing pain and anxiety for pediatric otolaryngology patients. Methods A total of 53 patients aged 7–17 undergoing in‐office nasal endoscopies were included. Patients were randomized to receive VR or standard of care. Procedural pain, anxiety, and satisfaction scores were recorded from patients and caregivers. The physician filled out a childhood emotional manifestation scale (CEMS). Study Design Randomized controlled trial. Results Patients in VR group reported a significant decrease in pain (0.80 ± 1.06 vs. 2.26 ± 2.38, P = .018) and anxiety (9.50 ± 12.48 vs. 38.48 ± 29.83, P = .0002) and increase in procedural satisfaction (6.40 ± 0.77 vs. 4.74 ± 1.74, P = .0002) compared to patients in control group. CEMS scores were significantly reduced in VR group (5.15 ± 0.46 vs. 9.64 ± 5.66, P = .0001) and caregiver anxiety levels were significantly reduced in VR group (11.50 ± 17.67 vs. 27.39 ± 30.48, P = .041) compared to control group. There were no reported side effects. Procedural time did not significantly differ between groups. Conclusions For pediatric otolaryngology patients undergoing in‐office nasal endoscopies, VR is a safe and effective form of distraction analgesia and anxiolysis, significantly reducing pain and increasing procedural satisfaction for patients. In addition, VR significantly reduces anxiety for both patients and caregivers without disrupting procedural efficiency and workflow.
... Distraction is easily applied in various contexts, and there is a variety of distraction methods available, including iPads, singing, televisions, looking away, talking to other people, squeezing someone's hand, and the application of something cold. Music, bubbles, medical clowns, virtual reality, sweet-tasting solutions for infants, and devices that produce cold sensations and vibrations (for example, "Buzzy") have been shown to be effective in previous research (13,(36)(37)(38). Computer tablets (iPads, iPods, and smartphones) are popular among children and easy to use. ...
Preprint
Full-text available
Background Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fear of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living. Methods This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years (n = 7) and their parents (n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years (n = 9) and parents (n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. Results The main themes; “challenges,” “motivational factors,” and “routines” captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The children’s experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. Conclusions Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.
... control group ( Table 4). On subgroup analysis, VAS and SUDS scores were compared between VR and control treatment based on age (18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)(47)(48)(49)(50), and 51-65 years), sex, ethnicity, and surgical procedure. There were no significant differences in VAS scores between control and VR treatment among various subgroups during the first postoperative visit (Supplement Table S1). ...
Article
Full-text available
Objective The purpose of this study was to explore the use of immersive and interactive virtual reality (VR) for analgesia, anxiety reduction, and overall satisfaction in patients undergoing outpatient postoperative debridements. Study Design Randomized crossover-controlled trial. Setting Academic outpatient clinic. Subjects and Methods Adult patients who had functional endoscopic sinus surgery and skull base surgery and were undergoing office-based postoperative nasal endoscopy and debridement were recruited and followed for 2 consecutive office visits. Participants were randomized to receive either the control or experimental analgesia for the first postoperative visit (PO1) and crossed over into the opposite treatment arm during the second postoperative visit (PO2). Outcomes included procedural pain, anxiety and satisfaction scores, procedural time, and reflexive head movements per minute (RHM). Results Eighty-two participants were recruited. At PO1, 39 received standard analgesia, and 43 received an immersive VR experience. At PO1, the VR group experienced significantly less anxiety ( P = .043) and fewer RHM ( P = .00016) than the control group. At PO2, the VR group experienced significantly fewer RHM ( P = .0002). At PO2, patients who received the experimental treatment after initially receiving the control treatment had significantly decreased pain, anxiety, and RHM. This effect was not seen in the second group. Overall, 69.51% of patients felt that the VR treatment was better; 19.51% thought that it was the same; and 9.76% found it to be worse. Conclusion VR technology holds promise as a nonpharmacologic analgesic and anxiolytic intervention for otolaryngology office-based procedures. Further study of VR use in other procedures is warranted. Level of Evidence 1, randomized controlled trial.
... Additionally, it is important to note that 5.7% (n = 2) of the women experienced dizziness prior to VRT. In contrast to these results, current evidence suggests that the incidence of side effects due to VRT is between 0 and 6%, a much lower rate than we encountered 15,[32][33][34][35][36][37][38][39] . However, these studies are not comparable to our own as they were not undertaken post-operatively, where exposure to general anaesthetics can induce similar side effects to VRT 40,41 . ...
Article
Full-text available
Pain following laparoscopic surgery remains a neglected healthcare issue. Virtual reality-mediated therapy’s (VRT) analgesic potential could address this. However, its effect in this setting remains unexplored. We aimed to establish the feasibility and safety of VRT as an adjunct analgesic following gynaecological laparoscopy and explore differences between active distraction and passive meditation content. 35 women were enrolled into an open crossover pilot and randomised to either intervention group 1 (active then passive content) or intervention group 2 (passive then active content) following surgery. VRT was administered in two 10-min segments with a 10-min washout period in between. Pain scores, opioid requirements and side effects were recorded before and after each segment whilst questionnaires evaluated acceptability. We observed a significant reduction in pain over time for the entire study population (F = 8.63, p < 0.0005) but no differences between intervention groups, in contrast to many studies demonstrating an increase in pain during this time. During segment one, intervention group 1 (n = 18) were administered significantly less opioid than intervention group 2 (n = 17) [0.0 (0.0–7.5) vs. 3.0(0.0–10.0), p = 0.04]. Intervention group 1 rated the VRT experience significantly higher than intervention group 2 (7.97 vs. 6.62. p = 0.017). 97.1% (n = 34) would recommend VRT to a friend and use it as the standard-of-care in future procedures. These results demonstrate that post-operative VRT is feasible and safe. However, adequately powered studies are needed to appropriately determine its efficacy.
... As well as significantly reducing pain, VR has been found to reduce anxiety and improve care satisfaction for patients and caregivers during clinical procedures associated with anticipatory pain and anxiety, such as venepuncture for children and young people [12]. As well as reducing unpleasant effects of treatment, interactive VR can create positive effects for a user during interventions, such as enjoyment and entertainment, as demonstrated with child and adolescent cancer patients undergoing implantable venous access device needle insertion [16]. In that study, 82% reported finding the custom-made intervention easy to use; 94% found it understandable and wished to use it again during subsequent procedures. ...
Article
Full-text available
Purpose: Children who sustain Upper Limb Injuries (ULIs), including fractures and burns, may undergo intensive rehabilitation. The discomfort of therapy can reduce their compliance, limit their range of motion (ROM) and lead to chronic pain. Virtual Reality (VR) interventions have been found to reduce anticipated and procedural pain.This feasibility study aimed to explore perceptions and impacts of a custom-made, fully immersive Head-Mounted Display VR (HMD-VR) experience within a United Kingdom (UK) National Health Service (NHS) outpatient rehabilitation service for children with ULIs. Methods: Ten children aged 9-16 in one UK Children's hospital trialled HMD-VR during one rehabilitation session. They, their parents (n = 10), and hospital physiotherapy staff (n = 2) were interviewed about their perceptions of pain, difficulty, enjoyability, therapeutic impacts, benefits, and limitations. Children rated the sessions on enjoyability, difficulty, and pain compared to usual rehabilitation exercises. Physiotherapists were asked to provide range of motion readings. Results: Inductive thematic analysis of interview data generated three themes, 'Escape through Engagement'; 'Enhanced Movement'; and 'Adaptability and Practicality'. Children rated the session as more enjoyable, less difficult and painful than their usual rehabilitation exercises. Findings suggested that HMD-VR was an engaging, enjoyable experience that distracted children from the pain and boredom of therapy. Also, it seemed to enhance the movement they achieved. Participants perceived it was useful for rehabilitation and adaptable to individual needs and other patient groups. Suggestions were made to increase adaptability and build in practical safeguards. Conclusion: Findings from this small-scale feasibility study suggested HMD-VR was perceived as usable, acceptable, and effective with potential for further development. Future work could include larger scale trials.
... One of the key factors underlying the distracting power of VR is its multisensory and interactive aspect allowing people to be involved in the virtual world (Indovina et al., 2018;Chirico et al., 2019;Ahmadpour et al., 2020). This involvement in the immersive task, understood as the interactive potentials allowing it to act on the environment (e.g., move around, make certain elements appear, solve a cognitive task, etc.), is correlated with the intensity of the feeling of presence guarantor of VR efficiency (Birnie et al., 2018;Ahmadpour et al., 2020). The quality of the immersion, the degree of interaction and the involvement of the individual would therefore be crucial parameters impacting the effectiveness of distraction under VR. ...
Article
Full-text available
Background Even though virtual reality (VR) is more and more considered for its power of distraction in different medical contexts, the optimal conditions for its use still have to be determined in order to design interfaces adapted to therapeutic support in oncology.Objective The objective of this study was to examine the benefits of VR using two immersion methods (i.e., one participatory, one contemplative) and comparing them with each other in a population of women with breast cancer who have undergone breast surgery, during scar massage sessions.Methods In a physiotherapy center, each patient participated in four experimental conditions in a random order: two sessions used virtual immersion (i.e., one participatory and one contemplative), one session proposed musical listening and the fourth one was a standard session care. The impact of the level of patient involvement in the virtual world was apprehended through the evaluation of the feeling of presence; the estimation of elapsed time of the physiotherapy sessions and particular attention was paid to the evaluation of patient emotional state.ResultsOur study showed an increase in positive emotions (i.e., joy and happiness) and a decrease in anxiety regardless which support methods were offered. Participatory VR created a feeling of more intense spatial presence.Conclusion Our results highlight the importance of the context in which VR should be offered. The presence of the practitioner and his interactions with the patient can provide a context just as favorable in reducing anxiety as the emotional regulation tools used (VR, music). The use of technological tools should be favored when the practitioner is unavailable during the treatment phase or, even, in order to reduce the monotonous nature of repetitive therapeutic sessions.
... Our protocol offered VR to children as young as 7 years. Other study protocols that used standard-sized VR headsets included children as young as 7-10 years [1][2][3]5,19,23]. In addition, unique to our protocol was the study of an off-the-shelf headset with VR games that were not specifically designed for child use during medical procedures. ...
Article
Background Virtual reality (VR) has shown promise in reducing children’s pain and anxiety during venipuncture, but studies on VR lack objective observations of pediatric coping. Notably, the process of capturing objective behavioral coping data can be labor- and personnel-intensive. Objective The primary aims of this pilot trial were to assess the feasibility of conducting a trial of VR in a pediatric emergency department and the feasibility of documenting observed coping behaviors during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the pediatric emergency department. Methods This stratified, randomized, controlled pilot trial compared coping and distress between child life–supported VR engagement and child life specialist support without VR during painful procedures in children aged 7-22 years in the pediatric emergency department. An external control (reference group) received no standardized support. Primary feasibility outcomes included rates of recruitment, rates of withdrawal from VR, and rates of completed Child Adult Medical Procedure Interaction Scale-Short Form (CAMPIS-SF) observations. Secondary clinical outcomes were applied to venipuncture procedures and included CAMPIS-SF coping and distress (range 0-1.0), pain and anxiety on a visual analog scale (range 0-10), and cybersickness symptoms. Results Overall recruitment was 93% (66/71), VR withdrawal rate was 27% (4/15), and of the completed procedures, 100% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the pediatric emergency department were included in the analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to child life specialist support, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in the VR group and child life specialist group than in the reference group (P=.046). There were no significant differences in the distress and pain ratings for patients and caregivers between the groups. Caregivers rated the lowest perceived anxiety in the child life specialist group (P=.03). There was no apparent change in cybersickness symptoms before and after VR use (P=.37). Conclusions Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR was utilized, particularly with the availability of research staff. VR and child life specialists improved coping in children during venipuncture procedures. Given the high participation rate, future studies to evaluate the efficacy of VR are recommended to determine whether an off-the-shelf VR headset can be a low-cost and low-risk tool to improve children’s coping during venipuncture or other related procedures. Trial Registration ClinicalTrials.gov NCT03686176; https://clinicaltrials.gov/ct2/show/NCT03686176
... It was also feasible to implement with commercially available technology and cleaning protocols that adhered to institution-specific infection-control standards. In line with other research, children and adolescents in this study reported very high satisfaction with VR intervention (Birnie et al., 2018;Gold et al., 2006;Sander Wint et al., 2002;Schneider & Workman, 2000). High overall "enjoyment" ratings indicated strong engagement with VR. ...
Article
Objective: Virtual reality (VR), a novel and highly immersive technology, offers promise in addressing potential psychological impacts of cancer treatments and hospitalization. The primary aim of this study was to examine multiple key user perspectives on the acceptability and feasibility of an Immersive VR therapeutic intervention for use with hospitalized patients with cancer. Secondary aims were to identify issues and opportunities related to the adoption and clinical implementation of VR in pediatric oncology settings. Method: The study was conducted at The Royal Children’s Hospital (RCH), Melbourne, Australia. Thirty multidisciplinary oncology health care professionals participated in an initial test of VR intervention usability (Stage 1). Ninety oncology inpatients (7-19 years) and their parent caregivers participated in a pilot randomized controlled study to examine the effectiveness of an Immersive VR therapeutic intervention (Stage 2). This mixed methods study reports Stages 1 and 2 quantitative and qualitative data related to VR feasibility and acceptability. Results: Results indicate favorable perceptions from health care professionals with respect to ease of use and usefulness of VR, and had positive intentions to use it in the future. Parent caregivers reported high acceptability of VR for their hospitalized child. Patients reported high satisfaction of the VR intervention within minimal adverse effects. Barriers and facilitators to VR use with seriously ill children and specific recommendations for content development were elicited. Conclusion: This study shows that there are several potential clinical uses for Immersive VR intervention, beyond medical procedural distraction, to support psychological adjustment to hospitalization and patient quality of life.
... It was also feasible to implement with low-cost, commercially available technology and cleaning protocols that adhered to institution-specific infectioncontrol standards, with minimal adverse events and technical difficulties encountered. Strong intervention uptake (88%) and child completion rates (100%) were comparable to previous studies utilizing VR exposure in other pediatric radiology settings, including MRI [28] and chest radiography [29] as well as previous studies in pediatric oncology, where patients have shown a preference for VR intervention over usual care strategies to manage distress and improve coping during cancerrelated procedures (e.g., chemotherapy, lumbar puncture) [22,23,26,40,41]. ...
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Background Procedural anxiety in children undergoing radiation therapy (RT) is common and is associated with poor procedural compliance and an increased used of general anaesthesia (GA). There is emerging evidence that Virtual Reality (VR) technology may reduce medical procedural distress through realistic and educative exposure to actual procedures via virtual simulation. Objective To examine the feasibility, acceptability and efficacy of an Immersive VR exposure intervention aimed at reducing anxiety and enhancing preparedness for pediatric patients undergoing radiation therapy, and their parents. Method A convenience sample of patients (6–18 years) scheduled for RT, and their parent caregivers, were recruited consecutively over a 14-month period. Patients were exposed to a virtual simulation of both CT Simulation (Phase 1) and RT (Phase 2), prior to these procedures occurring. Pre-and-post VR intervention measures (anxiety, health literacy) were administered across multiple time points. GA requirement following VR intervention was also recorded. Results Thirty children and adolescents were recruited (88% participation rate). High VR acceptability and satisfaction was reported by patients, parents and radiation therapists. There were minimal adverse effects associated with VR. The VR intervention was found to improve children’s understanding of the RT procedures (health literacy) and lower pre-procedural child and parental anxiety. Only one child in the study required GA (3.33%). Conclusions This study provides novel and preliminary support for utilizing VR to prepare children and families for RT. Subsequent implementation of VR into routine paediatric RT has the potential to improve clinical and operational outcomes.
... Usability is defined as the extent to which a product can be used by a particular consumer to achieve a purpose or objective determined through the effectiveness, efficiency and satisfaction in a particular usage context specification (ISO, 2018;Van der Weegen et al., 2014). The usability assessment can be seen from the aspect of ease of use, ease of understanding and acceptability of an evaluated product (Birnie et al., 2018). ...
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Advancement in Virtual Reality (VR) technology can be benefited for educational purposes. This article reports on a study undertaken to evaluate the usability of a Virtual Reality (VR) Interactive Music Appreciation Module (E-Marz) for the Lower Secondary School. The study has employed the Design and Development Research (DDR) which comprised of three different phases as its methodology. E-Marz was developed systematically based on the m-ADDIE Model which include the Evaluation Phase. The objective of the evaluation phase was to measure the level of usability of the module by using the System Usability Scale Questionnaire given to the field experts and the Post-Study System Usability Questionnaire given to students as the end users. The findings of the evaluation phase showed that E-Marz had obtained a high level of usability based on the expert views and the surveys on students as end users. The outcome of this study has contributed in terms of the development of an educational media which incorparated elements of VR for the teaching and learning of music appreciation in secondary schools. The module has the potential to assist teachers and students in facilitating for a more active and fun learning environment in the classroom through the application of the VR technology. The E-Marz module also served as a medium of early exposure for students to be familiar with the VR technology which will be widely used in the era of the 4.0 Industrial Revolution. Keywords: Virtual Reality in Education, Music Appreciation Lesson, Usability Test, Design and Development Research, Interactive Module
... Algo parecido ocurre con la investigación de Eijlers et al. (47) quienes realizan un metaanálisis sobre la Realidad Virtual en población pediátrica, pero no miden la efectividad ni se focalizan en población oncológica. También encontramos otros estudios, como el de Birnie et al. (48) quienes exploran la utilidad de la intervención con Realidad Virtual en población infantil y juvenil, o el estudio de casos de Sáez-Rodríguez y Chico-Sánchez (49) . ...
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Introducción: Aunque se han publicado muchos estudios que han intentado demostrar la eficacia de diferentes tratamientos psicológicos en pacientes con cáncer; hasta la fecha no se ha revisado la evidencia disponible sobre la eficacia de la Realidad Virtual (RV) para disminuir el distrés en niños y adolescentes con cáncer. Objetivo: El objetivo principal es evaluar la efectividad de la intervención con Realidad virtual en la disminución del distrés que padecen los niños y adolescentes con cáncer ante los procedimientos médicos, la hospitalización, o la propia enfermedad. Resultados: De los 22 artículos encontrados, se han seleccionado para la revisión un total de 8, que seguían un diseño experimental o cuasiexperimental en pacientes niños y jóvenes diagnosticados de cáncer tratados con RV. Conclusiones: Los resultados, aunque heterogéneos, sugieren mejorías a medio–largo plazo en las variables de ansiedad, depresión, aceptación, calidad de vida, distrés y flexibilidad psicológica. Además, la RV ha resultado ser más eficaz que otras técnicas. De este modo, a pesar de las limitaciones encontradas en este estudio, se han obtenido resultados prometedores para futuras revisiones y/ o metaanálisis.
... IVR was used to provide patients with sensory information unrelated to their current situation or condition, the immersive nature of the virtual environments being a key factor in this application. Distraction through modified sensory input showed a reduction in pain sensations [5,24,26,32] and has been used to assist with painful procedures or exercises such as phlebotomy [28,33], dental appointments [41], dressing changes [29][30][31]35,40], and movement therapy for burns patients [1]. IVR has been used in both pediatric and adult populations for this purpose, in the hospital, clinic, and home settings [29][30][31]35,40]. ...
Article
Background Immersive virtual reality (IVR) presents new possibilities for application in health care. Health care professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, evoke targeted emotional responses, inspire, or distract from an experience occurring in reality. Objective This review aimed to identify patient-focused applications for head-mounted IVR for acute treatment of health conditions and determine the technical specifications of the systems used. Methods A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. The databases included PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, Scopus, and Web of Science. Search terms relating to health and IVR were used. To be included, studies had to investigate the effectiveness of IVR for acute treatment of a specific health condition. IVR was defined as a head-mounted platform that provides virtual and auditory immersion for the participant and includes a minimum of 3 degrees of orientation tracking. Once identified, data were extracted from articles and aggregated in a narrative review format. Results A total of 58 studies were conducted in 19 countries. The studies reported IVR use for 5 main clinical areas: neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and others (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=28). Conclusions IVR has a promising future in health care, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for acute treatment of health conditions, evidence for the effectiveness of IVR is still developing.
... The use of VR as a therapeutic tool for managing acute pain has already proven effective in several areas through its potential distractor effect. The results of several meta-analyses [22] [23] demonstrate the effectiveness of VR at reducing pediatric pain during a medical procedure in oncology [24] [25], burn care [26] [27], intravenous placement [28] [29] [30] [31], and the emergency room [32]. ...
... Distraction is easily applied in various contexts, and there is a variety of distraction methods available, including iPads, singing, televisions, looking away, talking to other people, squeezing someone's hand, and the application of something cold. Music, bubbles, medical clowns, virtual reality, sweet-tasting solutions for infants, and devices that produce cold sensations and vibrations (for example, "Buzzy") have been shown to be effective in previous research (13,(36)(37)(38). Computer tablets (iPads, iPods, and smartphones) are popular among children and easy to use. ...
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Background Overall outcomes of pediatric rheumatic diseases (RD) have improved due to treatment with biologic agents and methotrexate. For many children, this treatment often entails regular needle injections. Pain and fair of needle injections are common in childhood, but how children and parents handle long-term needle injections at home has not been fully explored. This study aimed to explore how regular needle injections affect children with RD and their parents in their daily living. Methods This explorative qualitative study used individual interviews and focus groups to ensure a comprehensive investigation of the topic. Children aged 6 to 16 years (n = 7) and their parents (n = 8) were interviewed individually 4 to 6 months after the onset of needle injection treatment. The focus groups included children aged 11 to 17 years (n = 9) and parents (n = 8) with a minimum of 6 months of experience with injection treatment. Data were analyzed using thematic analysis. Results The main themes; “challenges,” “motivational factors,” and “routines” captured experiences and strategies that influenced the continuation of needle injections at home. Many children feared the moment immediately before the needle stick, although they had become accustomed to the pain. Most parents felt insecure about handling needle injections and lacked follow-up from healthcare providers. The experience of treatment effects and self-confidence were essential to maintain motivation for further injections. A number of coping strategies helped children focus away from injection related discomfort, often discovered by chance. Facilitating firm routines and shared responsibility within families helped children develop self-confidence during the procedure. Children and parents struggled to find suitable information on the Internet. Conclusions Children and parents experienced long-term needle injections challenging. They used their own limited resources and cooperated within the families to create routines and to introduce coping strategies necessary to manage and keep up with the procedure. Although the injection itself was not experienced very painful, the discomfort, worries and impact on daily life represented far more than a little needle stick, and thus needs more attention from healthcare providers.
Article
Objective: The objective of this review is to determine if electronic health (eHealth) educational interventions for infant procedural pain and pain management impact parental outcomes (mental health outcomes, knowledge utilization outcomes, and parental involvement in care outcomes) and infant outcomes (morbidity outcomes, pain outcomes, health system outcomes). Introduction: Pain in infants is a common concern for parents. Routine postpartum care for infants in early life requires them to endure painful procedures, yet infants often receive little to no pain management. While research has shown that parents can reduce their infant's pain during procedures by breastfeeding or skin-to-skin contact, parents may not be aware of their role in pain management. Despite the recent rapid increase in eHealth resources to educate parents about infant pain management, their impact has yet to be evaluated. Inclusion criteria: This review will consider studies that include eHealth educational interventions targeted at parents during pregnancy and up to one year postpartum. All experimental study designs will be included. Primary outcomes will include: parental stress and anxiety, self-efficacy, knowledge, attitudes, eHealth intervention usage, acceptance of eHealth intervention, involvement in pain management, and infant pain response. Methods: PubMed, CINAHL, PsycINFO, Embase, Scopus, Web of Science, and SciELO will be searched for studies published in English. Critical appraisal and data extraction will be conducted by two independent reviewers using standardized tools. Quantitative data, where possible, will be pooled in statistical meta-analysis, or if statistical pooling is not possible, the findings will be reported narratively.
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Background: Virtual Reality (VR) technology is a powerful tool for augmenting patient experience in pediatric settings. Incorporating the needs and values of stakeholders in the design of VR apps in healthcare can contribute to better outcomes and meaningful experiences for patients. Objective: This study follows a multi-perspective approach to investigate how future VR apps can be designed to improve the periprocedural experiences of children and adolescents, particularly those with severe anxieties. Methods: This study conducted research with clinicians through a focus group (n=4) and survey (n=56). Semi-structured interviews were conducted with children and adolescents in an immunization clinic (n=3) and perioperative setting (n=65) and with parents and carers in the immunization clinic (n=3) and perioperative setting (n=35). Results: Qualitative data was examined to determine the experience needs, psychological needs, intervention strategies and design strategies that may contribute to better experiences for children in three age groups of 4-7, 8-11 and 12-17 years old. Quantitative data was used to identify areas of priority for future VR interventions. Conclusions: A set of ten design considerations are proposed for creating future VR experiences for pediatric patients. Enhancing patient experience may be achieved by combining multiple VR solutions through a holistic approach considering the roles of clinicians and carers and the temporality of the patient’s experience. This involves delivering personalized solutions to fulfill the needs of pediatric patients before and during the medical procedure. In particular, communication should be placed at the center of pre-procedure solutions while emotional goals can be embedded into a procedure-focused VR app to help patients shift their focus in a meaningful way to build skills to manage their anxiety.
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Over the past 20 years, virtual reality (VR) has been the subject of growing interest in oncology. More and more researchers are studying the effects of virtual environments to contribute to current thinking on technologies likely to support patients undergoing oncological treatment. Recent research highlights how VR can divert attention while reducing anxiety in stressful healthcare situations through its multisensory and participative nature. VR appears to be a promising tool capable of reducing cancer-related anxiety symptoms, improving treatment adherence, and increasing satisfaction with oncology care. While the literature reports these positive effects in the therapeutic management of cancer, few studies have focused on theoretical models capable of explaining the psychological benefits of virtual immersion. This literature review provides a theoretical framework combining results from all relevant empirical work in oncology. The review can help researchers identify the optimal conditions for using VR in oncology and bridge the gap between divergent devices, modalities, and practices (e.g., headmounted displays, environments, interactivity, immersion time).
Article
Context Virtual reality (VR) has emerged as a novel form of non-pharmacological analgesia therapy. We wished to review the use of VR to treat pain and anxiety in cancer related medical procedures and chemotherapy. Objective To determine if immersive VR influences pain and/or anxiety outcomes in cancer patients undergoing medical interventions. To discuss critical limitations in the current evidence-base and provide suggestions for future areas of research. Methods A systematic review was performed on Ovid MEDLINE, PubMed and Google Scholar from 1999 to December 2019. The following search terms were run in each of the databases: "Virtual Reality" and "pain or anxiety". Papers were assessed by two independent authors for inclusion. Results From 999 retrieved citations, nine studies met inclusion criteria for review. Methodological limitations and small sample sizes preclude strong guidance for clinical applications. While studies demonstrated a trend towards improvement in pain and anxiety, only two studies reached statistical significance. Conclusion There is inconclusive evidence on the significance of immersive VR in reducing pain (5 studies) or anxiety (6 studies) for cancer patients undergoing medical interventions or receiving chemotherapy. Further research on the effect of immersive VR as a tool for medical procedures and/or cancer patients undergoing treatment is required.
Chapter
Recent years have seen digital game mediums taking conventional amusement, entertainment, and leisure industries by storm. They have revolutionized the system to the extent that the industry cannot now even dream of doing without this overwhelming reality. The same game mediums that have capitalized on intrinsic leisure aspects have simultaneously focused with equal vigour on other equally, if not more, important collateral objectives. This chapter builds on this concept and discusses work currently being carried out at the University of Malta. The research brings together various concepts synonymous with the field of artificial intelligence and automation to propose the use of games as a means of distraction therapy for individuals undergoing painful clinical treatment procedures.
Chapter
To ensure that nurses are able to practice in evidence informed environments, nursing research has become an essential part of the profession. This chapter provides a foundational overview of the research process commonly used in nursing study, while highlighting how informatics can contribute to the research process but also be a researched topic in itself. The chapter begins with a detailed description of the common steps taken when conducting nursing research for both nursing informatics and other topics. Then, a number of ways nursing informatics can be used to support the research process itself are given using practical examples. The chapter concludes with a discussion of current and future opportunities for nursing informatics research.
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Virtual reality has been used in the last years as a non-invasive treatment that distracts patients from some painful procedures applied to them during their treatment. This distraction decreases anxiety and pain, so that the patient can have more adherence to the treatment. The patient that uses virtual reality has a decrease in the perception of time that has passed since the beginning of the treatment, so the patient feels more relax and with less pain and anxiety. Pediatric patients have more anxiety and stress caused by invasive procedures. We can improve the quality of life of our patients with the use of virtual reality by diminishing symptoms such as anxiety, fatigue and pain during their treatments.
Article
Background: Children with acute and chronic illness undergo frequent, painful, and distressing procedures. Objective: This randomized controlled trial was used to evaluate the effectiveness of guided imagery (GI) versus virtual reality (VR) on the procedural pain and state anxiety of children and young adults undergoing unsedated procedures. We explored the role of trait anxiety and pain catastrophizing in intervention response. Methods: Children and young adults were recruited from the hematology, oncology, and blood and marrow transplant clinics at a children's hospital. Each study participant completed the GI and VR intervention during separate but consecutive unsedated procedures. Self-report measures of pain and anxiety were completed before and after the procedures. Results: A total of 50 participants (median age 13 years) completed both interventions. GI and VR performed similarly in the management of procedural pain. Those with high pain catastrophizing reported experiencing less nervousness about pain during procedures that used VR than those using GI. State anxiety declined pre- to postprocedure in both interventions; however, the decrease reached the level of significance during the VR intervention only. Those with high trait anxiety had less pain during GI. Conclusions: In our sample, VR worked as well as GI to manage the pain and distress associated with common procedures experienced by children with acute or chronic illnesses. Children who are primed for pain based on beliefs about pain or because of their history of chronic pain had a better response to VR. GI was a better intervention for those with high trait anxiety. Trial registration: ClinicalTrials.gov NCT04892160; https://clinicaltrials.gov/ct2/show/NCT04892160.
Article
Immersive virtual reality computer programs provide new experimental and treatment interventions that hold great promise for nursing. Immersive virtual reality uses sensory cues to represent real-world environments in a way that makes participants feel as if they are in a physical space different from the one in which they currently exist. As the acceptance of immersive virtual reality as a clinical and experimental tool has grown, so has the need to ensure that the context depicted in the environment mirrors both the sensory and the task requirements of the real-world situation. Here, we describe the use of nurse expert key informant group interviews to generate requirements that must be fulfilled in immersive virtual reality environments designed to evoke and engage participants in self-management tasks. An expert panel of four home care nurses participated in three sessions designed to elicit details of common home care challenges, frequency of variation, and typical participants. More than 20 potential scenarios were identified. The design team later used this information to create design requirements for two key scenarios and subsequently develop immersive virtual reality environments for use in research studies, mapping sensory and functional expectations to immersive virtual reality implementations. Challenges in mapping from key informant group findings to requirements are addressed.
Article
Purpose: Cognitive impairments frequently occur in children and adolescents with acquired brain injury (ABI), causing significant disabilities in daily life. Current paper-and-pencil neuropsychological tests do not capture the complexity of daily life activities, often failing to objectify subtle cognitive impairments. Virtual Reality (VR) simulations might overcome this discrepancy, as it resembles daily life situations. The aim of this study was to evaluate the feasibility, user-experience and preference of a VR simulation with a non-immersive (computer monitor; CM)) and immersive (head mounted display; HMD)) VR setup. Methods: Children and adolescents with ABI (n = 15) and typically developing children and adolescents (n = 21) completed a VR-task with a CM and HMD. Results: Both VR setups were feasible for children and adolescents with ABI. User-experience was enhanced with the HMD compared to CM in both groups. Side effects were low and comparable for both groups, and there were no differences between setups (HMD and CM). The majority of the children and adolescents with ABI preferred the HMD. Conclusion: VR simulations appear feasible to use in paediatric rehabilitation. The preference for a VR setup should be discussed with the child. Further research is needed to develop more sensitive measures to further explore the potential of VR for cognitive assessment.
Article
Objectives: The primary objective of this study was to co-design and conduct a pilot evaluation of a novel, immersive virtual reality (VR) experience for procedural pain and anxiety in an Australian healthcare setting. The secondary objective was to identify key parameters that can facilitate the development and implementation of VR experiences in clinical practice. Method: A qualitative, Design Box method was selected for co-design. It was used with adult burns survivors and adolescents and young adults (AYAs) with cancer, and healthcare professionals from these fields to identify the practical and design parameters required for the application of VR technology within the clinical setting. Results informed the development of the VR experience that was evaluated by consumers and healthcare professionals, who completed qualitative surveys. Thematic analysis was conducted on co-design notes and survey data. Results: Procedural pain and management was a challenge for both cohorts, but particularly the burns cohort. Anxiety was significant challenge for both cohorts. Boredom and quality of life was a significant challenge, particularly for the AYA oncology cohort. These results informed the development of "A Wanderers Tale," an Australiana-themed, gaze-controlled VR application for Oculus Quest platforms. Thematic analysis results suggest that cultural preferences, procedural contexts of use, and agency through customization and interaction are three parameters to consider when creating or selecting VR experiences for application in health. Significance of results: This work describes a novel method for the use VR as an adjuvant pain management tool in patients with burns and cancer. The VR experience may provide a culturally, practice and procedure-appropriate tool in comparable settings of care. The study also describes interdisciplinary co-design and evaluation approaches that can help maximize the use of VR to improve healthcare approaches that address clinical challenges in pain, anxiety, and quality of life for patients while in hospital.
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L’utilisation de la réalité virtuelle (RV) dans le domaine médical est en pleine expansion depuis plusieurs années. Ces dispositifs ont été adaptés dans le domaine de la psychiatrie et pour la réalisation d’actes médicaux. Il y a une grande nécessité de trouver de nouveaux moyens non pharmacologiques afin de soulager les patients de la douleur, et la RV peut être un outil puissant pour cela. Cette courte revue de la littérature sur l’utilisation de la RV dans la clinique a pour but de faire un état des lieux du sujet aujourd’hui et d’identifier les limites de cette technique de distraction innovante.
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Children must often endure painful procedures as part of their treatment for various medical conditions. Those with chronic pain endure frequent or constant discomfort in their daily lives, sometimes severely limiting their physical capacities. With the advent of affordable consumer-grade equipment, clinicians have access to a promising and engaging intervention for pediatric pain, both acute and chronic. In addition to providing relief from acute and procedural pain, virtual reality (VR) may also help to provide a corrective psychological and physiological environment to facilitate rehabilitation for pediatric patients suffering from chronic pain. The special qualities of VR such as presence, interactivity, customization, social interaction, and embodiment allow it to be accepted by children and adolescents and incorporated successfully into their existing medical therapies. However, the powerful and transformative nature of many VR experiences may also pose some risks and should be utilized with caution. In this paper, we review recent literature in pediatric virtual reality for procedural pain and anxiety, acute and chronic pain, and some rehabilitation applications. We also discuss the practical considerations of using VR in pediatric care, and offer specific suggestions and information for clinicians wishing to adopt these engaging therapies into their daily clinical practice.
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PURPOSE/OBJECTIVES: To identify and appraise current evidence related to the effectiveness of psychological and physical (nonpharmacologic) pain management modalities for children and young adults with cancer .
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Abstract The experience of pain is affected by remarkable psychological factors. The concept of neuromatrix suggests that pain is an amalgam of affect, cognition, and sensation mediated through diverse brain regions. Moreover, the experience of pain appears to be reduced by environmental stimuli that drive attention away from the noxious events. Accordingly, immersion in a computer-generated, three-dimensional virtual environment has been used as an efficient distraction tool in a number of studies on pain management. However, no systematic approaches have explored the psychological factors that influence the effectiveness of virtual reality (VR) as a distraction technology. This review aims to outline the fundamental psychological factors involved in the use of VR to provide pain management. An analysis of the literature revealed some important elements associated with the patients' subjective experience. Eleven studies met the inclusion criteria and were included in the review. The results suggest the importance of different psychological factors in the effectiveness of the analgesic distraction. While sense of presence influence the effectiveness of VR as a distraction tool, anxiety as well as positive emotions directly affect the experience of pain. Future challenges for pain management via VR include adopting properly validated measures to assess psychological factors and using different experimental conditions to better understand their complex effects.
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Saturation is mentioned in many qualitative research reports without any explanation of what it means and how it occurred. Recognizing the saturation point presents a challenge to qualitative researchers, especially in the absence of explicit guidelines for determining data or theoretical saturation. This research note examines the saturation concept in naturalistic inquiry and the challenges it presents. In particular, it summarizes the saturation process in a grounded theory study of community-based antipoverty projects. The main argument advanced in this research note is that claims of saturation should be supported by an explanation of how saturation was achieved and substantiated by clear evidence of its occurrence.
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Pain is one of the most common and distressing symptoms reported by adolescents with cancer. Despite advancements in pain assessment and management research, pain due to cancer and/or its treatments continues to be poorly managed. Our research group has developed a native iPhone application (app) called Pain Squad to tackle the problem of poorly managed pain in the adolescent with cancer group. The app functions as an electronic pain diary and is unique in its ability to collect data on pain intensity, duration, location, and the impact pain has on an adolescent's life (ie, relationships, school work, sleep, mood). It also evaluates medications and other physical and psychological pain management strategies used. Users are prompted twice daily at configurable times to complete 20 questions characterizing their pain and the app transmits results to a database for aggregate reporting through a Web interface. Each diary entry represents a pain case filed by an adolescent with cancer and a reward system (ie, moving up through law-enforcement team ranks, built-in videotaped acknowledgements from fictitious officers) encourages consistent use of the diary. Our objective was to design, develop, and test the usability, feasibility, compliance, and satisfaction of a game-based smartphone pain assessment tool for adolescents with cancer. We used both low- and high-fidelity qualitative usability testing with qualitative semi-structured, audio-taped interviews and iterative cycles to design and refine the iPhone based Pain Squad app. Qualitative thematic analysis of interviews using constant comparative methodology captured emergent themes related to app usability. Content validity was assessed using question importance-rating surveys completed by participants. Compliance and satisfaction data were collected following a 2-week feasibility trial where users were alarmed to record their pain twice daily on the app. Thematic analysis of usability interviews showed the app to be appealing overall to adolescents. Analyses of both low- and high-fidelity testing resulted in minor revisions to the app to refine the theme and improve its usability. Adolescents resoundingly endorsed the game-based nature of the app and its virtual reward system. The importance of app pain diary questions was established by content validity analysis. Compliance with the app, assessed during feasibility testing, was high (mean 81%, SD 22%) and adolescents from this phase of the study found the app likeable, easy to use, and not bothersome to complete. A multifaceted usability approach demonstrated how the Pain Squad app could be made more appealing to children and adolescents with cancer. The game-based nature and built-in reward system of the app was appealing to adolescents and may have resulted in the high compliance rates and satisfaction ratings observed during clinical feasibility testing.
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This study examined whether increasing the demand for central cognitive processing involved in a distraction task, by involving the child in ongoing, effortful interaction with the distraction stimulus, would increase children's tolerance for cold pressor pain. Seventy-nine children ages 6-15 years underwent a baseline cold pressor trial followed by two cold pressor trials in which they received interactive distraction (i.e., used voice commands to play a videogame) or passive distraction (in which they merely watched the output from the same videogame segment) in counterbalanced order. Both distraction conditions were presented via a virtual reality-type helmet. As expected, children demonstrated significant improvement in pain tolerance during distraction relative to baseline. Children showed the greatest improvement during the interactive distraction task. The effects of distraction on children's cold pressor pain tolerance are significantly enhanced when the distraction task also includes greater demands for central cognitive processing.
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Alleviating pain is of high importance for children undergoing chemotherapy. Eutectic mixture of lidocain-prilocain cream (EMLA) is assumed to require 60 min application time. We prospectively compared the pain during port-à-cath punctures after 40 min compared to 60 min of application time. A prospective, unblinded, cross-over study was performed. The children received two punctures during their chemotherapy protocol. Patients in group 1 had the first puncture after 40 min EMLA application time. Their second puncture (approximately a week later) was done after 60 min. Patients in group 2 started after 40 min. Pain was scored using the visual analogue scale (VAS) and the Bieri scale. Patients, parents and a nurse scaled the pain after the intervention. Eighty-seven children between 2 and 18 years with different malignant diseases were included. On the VAS pain scale, the mean pain was 2.3 (minimum 0, maximum 9.2) after 40 min and 1.9 (minimum 0, maximum 9.4) after 60 min according to the observations of the nurse and very similarly according to the parents' observations. The children expressed more pain after 40 min of EMLA application time (mean pain, 3.5) and a significant pain reduction after 60 min application time (mean pain 1.7). In this study children experienced less pain after 60 min application time, but pain reduction was already seen after 40 min. The child's perception of pain differed from observers' point of view and should therefore always be included in pain management.
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This study examined the effects of videogame distraction and a virtual reality (VR) type head-mounted display helmet for children undergoing cold pressor pain. Fifty children between the ages of 6 and 10 years underwent a baseline cold pressor trial followed by two cold pressor trials in which interactive videogame distraction was delivered via a VR helmet or without a VR helmet in counterbalanced order. As expected, children demonstrated significant improvements in pain threshold and pain tolerance during both distraction conditions. However, the two distraction conditions did not differ in effectiveness. Using the VR helmet did not result in improved pain tolerance over and above the effects of interactive videogame distraction without VR technology. Clinical implications and possible developmental differences in elementary school-aged children's ability to use VR technology are discussed.
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Virtual reality (VR) is a relatively new technology that enables individuals to immerse themselves in a virtual world. This multisensory technology has been used in a variety of fields, and most recently has been applied clinically as a method of distraction for pain management during medical procedures. Investigators have posited that VR creates a nonpharmacologic form of analgesia by changing the activity of the body's intricate pain modulation system. However, the efficacy of VR has not been proven and the exact mechanisms behind VR's action remain unknown. This article presents a comprehensive review of the literature to date exploring the clinical and experimental applications of VR for pain control. The review details specific research methodologies and popular virtual environments. Limitations of the research, recommendations for improvement of future studies, and clinical experiences with VR are also discussed.
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These commonly used methods are appropriate for particular research questions and contexts Qualitative research includes a variety of methodolo-gical approaches with different disciplinary origins and tools. This article discusses three commonly used approaches: grounded theory, mixed methods, and action research. It provides background for those who will encounter these methodologies in their reading rather than instructions for carrying out such research. We describe the appropriate uses, key characteristics, and features of rigour of each approach.
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The objective of this study was to test the efficacy and suitability of virtual reality (VR) as a pain distraction for pediatric intravenous (i.v.) placement. Twenty children (12 boys, 8 girls) requiring i.v. placement for a magnetic resonance imaging/computed tomography (MRI/CT) scan were randomly assigned to two conditions: (1) VR distraction using Street Luge (5DT), presented via a head-mounted display, or (2) standard of care (topical anesthetic) with no distraction. Children, their parents, and nurses completed self-report questionnaires that assessed numerous health-related outcomes. Responses from the Faces Pain Scale-Revised indicated a fourfold increase in affective pain within the control condition; by contrast, no significant differences were detected within the VR condition. Significant associations between multiple measures of anticipatory anxiety, affective pain, i.v. pain intensity, and measures of past procedural pain provided support for the complex interplay of a multimodal assessment of pain perception. There was also a sufficient amount of evidence supporting the efficacy of Street Luge as a pediatric pain distraction tool during i.v. placement: an adequate level of presence, no simulator sickness, and significantly more child-, parent-, and nurse-reported satisfaction with pain management. VR pain distraction was positively endorsed by all reporters and is a promising tool for decreasing pain, and anxiety in children undergoing acute medical interventions. However, further research with larger sample sizes and other routine medical procedures is warranted.
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Context Diagnostic tests and treatment regimens for paediatric cancers involve invasive and painful procedures. Effective management of such pain has been shown to be sub-optimal in many parts of the world, often due to the cost and limited availability of appropriate medications. Current evidence suggests that distraction (a relatively low-cost technique) is a promising intervention for procedural pain management. There is, however, limited evidence demonstrating its effectiveness in paediatric oncology patients. Objectives A systematic review was conducted to ascertain the effectiveness of distraction as a procedural pain management technique in paediatric oncology patients. Methods Using a comprehensive search strategy, MEDLINE, PsycINFO, Cochrane Library, AMED, CINAHL, Web of Science and EMBASE electronic databases were searched for studies comparing distraction techniques to standard care/any intervention. Using the selected studies, a systematic review and meta-analysis of randomised controlled trials was conducted. Results 299 studies were identified, with 7 randomised control trials identified as eligible for inclusion. Pain was assessed using self-report, observer-report, and physiological measures. A meta-analysis of 4 studies showed distraction as effective in reducing procedural pain, based on self-reported pain. A meta-analysis of 3 studies, based on pulse rates, demonstrated similar results. For observer-report pain, limited evidence supported the effectiveness of distraction. Conclusion This systematic review demonstrates that distraction is a promising intervention for procedural pain. Future research should assess effectiveness of distraction in varied populations, to explore evidence of cultural influences upon pain expression, measurement and management approaches.
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Purpose: A user-centered design approach was used to refine the mHealth Pain Squad+ real-time pain self-management app for adolescents with cancer for its usability (defined as being easy to use, easy to understand, efficient to complete, and acceptable). Method: Three iterative usability testing cycles involving adolescent observation and interview were used to achieve this objective. During each cycle, adolescents used the app while "thinking aloud" about issues encountered. Observed difficulties and errors were recorded and a semistructured interview about the experience was conducted. Using a qualitative conventional content analysis approach, themes related to app usability were identified. Results: Participants required an average of 4.3 minutes to complete the pain assessment component of Pain Squad+. Overall, the app was acceptable. Problematic issues related to software malfunction, interface design flaws, and confusing text. Software revisions were made to address each issue. Conclusion: The multifaceted usability approach used provided insight into how a real-time app can be made acceptable to adolescents with cancer and succeeded in developing a Pain Squad+ app that is fit for future effectiveness testing.
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Virtual reality uses computer technology to immerse the individual in a multisensory, 3-dimensional environment. This meta-analysis is the first to quantify the effect of virtual reality distraction on pain. To be included in the meta-analysis, studies were required to use a between-subjects or mixed-model design in which virtual reality distraction was compared with a control condition in reducing pain. Of the 299 records screened, 14 studies met the inclusion criteria. The mean weighted effect size for virtual reality distraction was .90, indicating that the average participant receiving this intervention showed more improvement than about 82% of control participants. Virtual reality distraction was more effective in reducing experimental than clinical pain and when used with adults versus children. However, there was no difference in the relief produced by computer software developed specifically for virtual reality distraction and commercial games with a 3-dimensional environment. The findings of the meta-analysis suggest that virtual reality distraction is a highly effective pain intervention. More research is needed on the application of this intervention to chronic pain, as well as the role of presence and fun as moderator variables. Clinicians may wish to consider virtual reality distraction as a promising treatment choice for patients who suffer from pain.
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Youth with cancer undergo many repeated and invasive medical procedures that are often painful and highly distressing. A systematic review of published research since 1995 identified 65 papers (11 review articles and 54 empirical studies) that investigated preparatory information and psychological interventions for a variety of medical procedures in pediatric cancer. Distraction, combined cognitive-behavioral strategies, and hypnosis were identified as effective for reducing child pain and increasing child coping. Low- to high-quality evidence informed strong recommendations for all youth with cancer to receive developmentally appropriate preparatory information and psychological intervention for invasive medical procedures.