Factors Influencing the Efficacy of Virtual Reality Distraction Analgesia During Postburn Physical Therapy: Preliminary Results from 3 Ongoing Studies (original) (raw)
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The Effect of Virtual Reality on Pain and Range of Motion in Adults With Burn Injuries
Journal of Burn Care & Research, 2009
Few studies have empirically investigated the effects of immersive virtual reality (VR) on postburn physical therapy pain control and range of motion (ROM). We performed a prospective, randomized controlled study of the effects of adding VR to standard therapy in adults receiving active-assisted ROM physical therapy, by assessing pain scores and maximal joint ROM immediately before and after therapy on two consecutive days. Thirty-nine inpatients, aged 21 to 57 years (mean 35 years), with a mean TBSA burn of 18% (range, 3-60%) were studied using a within-subject, crossover design. All patients received their regular pretherapy pharmacologic analgesia regimen. During physical therapy sessions on two consecutive days (VR one day and no VR the other day; order randomized), each patient participated in active-assisted ROM exercises with an occupational or physical therapist. At the conclusion of each session, patients provided 0 to 100 Graphic Rating Scale measurements of pain after each 10-minute treatment condition. On the day with VR, patients wore a head-position-tracked, medical care environment-excluding VR helmet with stereophonic sound and interacted in a virtual environment conducive to burn care. ROM measurements for each joint exercised were recorded before and after each therapy session. Because of nonsignificant carryover and order effects, the data were analyzed using simple paired t-tests. VR reduced all Graphic Rating Scale pain scores (worst pain, time spent thinking about the pain, and pain unpleasantness by 27, 37, and 31% respectively), relative to the no VR condition. Average ROM improvement was slightly greater with the VR condition; however, this difference failed to reach clinical or statistical significance (P = .243). Ninety-seven percent of patients reported zero to mild nausea after the VR session. Immersive VR effectively reduced pain and did not impair ROM during postburn physical therapy. VR is easily used in the hospital setting and offers a safe, nonpharmacologic adjunctive analgesic treatment.
Virtual reality as an adjunctive pain control during burn wound care in adolescent patients
Pain, 2000
For daily burn wound care procedures, opioid analgesics alone are often inadequate. Since most burn patients experience severe to excruciating pain during wound care, analgesics that can be used in addition to opioids are needed. This case report provides the ®rst evidence that entering an immersive virtual environment can serve as a powerful adjunctive, nonpharmacologic analgesic. Two patients received virtual reality (VR) to distract them from high levels of pain during wound care. The ®rst was a 16-year-old male with a deep¯ash burn on his right leg requiring surgery and staple placement. On two occasions, the patient spent some of his wound care in VR, and some playing a video game. On a 100 mm scale, he provided sensory and affective pain ratings, anxiety and subjective estimates of time spent thinking about his pain during the procedure. For the ®rst session of wound care, these scores decreased 80 mm, 80 mm, 58 mm, and 93 mm, respectively, during VR treatment compared with the video game control condition. For the second session involving staple removal, scores also decreased. The second patient was a 17-year-old male with 33.5% total body surface area deep¯ash burns on his face, neck, back, arms, hands and legs. He had dif®culty tolerating wound care pain with traditional opioids alone and showed dramatic drops in pain ratings during VR compared to the video game (e.g. a 47 mm drop in pain intensity during wound care). We contend that VR is a uniquely attentioncapturing medium capable of maximizing the amount of attention drawn away from the`real world', allowing patients to tolerate painful procedures. These preliminary results suggest that immersive VR merits more attention as a potentially viable form of treatment for acute pain.
Physical Therapy and Rehabilitation, 2019
Objective: the purpose of this study was to evaluate effectiveness of virtual reality (VR) in decreasing pain and facilitating physical therapy (PT) procedures for adolescent burned Patients. Methods: A two-weeks randomized controlled study including fifty-six adolescent burned patients who randomly divided into two groups. VR group received VR during PT session while control group received PT without VR. Pain was assessed by adolescent pediatric pain tool (APPT) and ROM was assessed by goniometer at the end of each session. Results: The results of study reported highly significant and substantial declines in all pain outcomes (mean total painful areas, pain intensity, sensory, affective, evaluative and temporal dimensions of pain) in VR group compared to control group, p value ≤0.001. The percentage of decrement of pain intensity in VR group was 55.6% while for control group was 15.6%. Regarding ROM measurement, for the first three sessions, the results of the study showed that there was no significant difference between both groups in mean ROM of hip extension, hip abduction, knee extension and ankle dorsiflexion, p value >0.05, however for the last three sessions, there was highly significant difference between both groups, p value <0.05. The percentage of improvement in ROM of Hip extension, hip abduction, dorsiflexion and knee extension in VR group were 14.2%, 85.2%, 26.1% and 82.2% respectively, while for control group the percentage of improvement were 8.3%, 24.7%, 11.8% and 24.1% respectively. Conclusion: Based on the obtained results and previous studies results, our study concluded that virtual reality is powerful analgesic non-pharmacological adjunctive tool that helps in decreasing procedural pain during PT procedures. Its analgesic effects have beneficial effects on ROM of lower extremity of adolescent burned patients.
Virtual reality distraction for acute pain in children
Cochrane Database of Systematic Reviews, 2020
Background Virtual reality (VR) computer technology creates a simulated environment, perceived as comparable to the real world, with which users can actively interact. The e ectiveness of VR distraction on acute pain intensity in children is uncertain. Objectives To assess the e ectiveness and adverse e ects of virtual reality (VR) distraction interventions for children (0 to 18 years) with acute pain in any healthcare setting. Search methods We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO and four trial registries to October 2019. We also searched reference lists of eligible studies, handsearched relevant journals and contacted study authors. Selection criteria Randomised controlled trials (RCTs), including cross-over and cluster-RCTs, comparing VR distraction to no distraction, non-VR distraction or other VR distraction. Data collection and analysis We used standard Cochrane methodological processes. Two reviewers assessed risk of bias and extracted data independently. The primary outcome was acute pain intensity (during procedure, and up to one hour post-procedure). Secondary outcomes were adverse e ects, child satisfaction with VR, pain-related distress, parent anxiety, rescue analgesia and cost. We used GRADE and created 'Summary of findings' tables. Main results We included 17 RCTs (1008 participants aged four to 18 years) undergoing various procedures in healthcare settings. We did not pool data because the heterogeneity in population (i.e. diverse ages and developmental stages of children and their di erent perceptions and reactions to pain) and variations in procedural conditions (e.g. phlebotomy, burn wound dressings, physical therapy sessions), and consequent level of pain experienced, made statistical pooling of data impossible. We narratively describe results. We judged most studies to be at unclear risk of selection bias, high risk of performance and detection bias, and high risk of bias for small sample sizes. Across all comparisons and outcomes, we downgraded the certainty of evidence to low or very low due to serious study limitations and serious or very serious indirectness. We also downgraded some of the evidence for very serious imprecision.
Opioids are the most frequently used pain medications by US burn centers to control severe procedural pain during wound care. Concerns for long-term opioid use have prompted the exploration of non-pharmaceutical interventions, such as virtual reality (VR), for procedural pain management. The primary objective of this pilot study was to evaluate the feasibility and efficacy of VR pain alleviation treatment on reducing adult burn patients’ perceived pain during burn dressing changes. Adult patients aged 18-70 years were recruited from the inpatient unit of a single American Burn Association–verified burn center between May 2019 and February 2020 and randomly assigned to one of three arms. Active VR participants played four VR games; passive VR participants were immersed in the same VR environment without the interaction elements; and a standard of care control group. 71 patients were screened for eligibility and 33 were deemed eligible to approach for informed consent, with 14 agreein...
2009
Background Albeit Virtual Reality (VR) has been shown to be a useful adjunct in the reduction of pain during burn care and therapy, the current VR systems are expensive and may not be economically feasible for developing countries such as South Africa, where health budgets are stringent. Objective The purpose of this study was to ascertain the effect of a lowcost VR system (eMagin Z800 3DVisor), used in conjunction with pharmacologic analgesics, on reducing pain and anxiety in adult burn injury patients undergoing physiotherapy treatment, compared to pharmacologic analgesics alone at a South African hospital. Study design Single-blinded, within-subject study design. Methods Pain and anxiety outcome measures were measured by a blinded assessor using the Numeric Pain Rating Scale and Burn Specific Pain and Anxiety Scale. Descriptive statistics, Chi-square tests as well as the Student's paired t-test were used to analyze data. Main findings Eleven eligible adult burn injury patients consented to participate in this study (3 female, 8 male; median age 33 years: range 23-54 years). A marginal (p=0.06) to insignificant (p=0.13) difference between the two conditions (analgesics with VR and analgesics alone) in reducing pain was found. No significant difference (p=0.58) was found between the two conditions (analgesics with VR and analgesics alone) for anxiety. Interpretation There is a trend that a low-cost VR system, when added to routine pharmacologic analgesics, is an economically feasible and safe adjunct therapy and could be of considerable benefit if implemented into the current pain management regimen of burn injury patients at a South African Hospital.
Virtual Reality Analgesia for Children With Large Severe Burn Wounds During Burn Wound Debridement
Frontiers in Virtual Reality, 2020
The objective of this study was to compare the effect of adjunctive virtual reality vs. standard analgesic pain medications during burn wound cleaning/debridement. Participants were predominantly Hispanic children aged 6–17 years of age, with large severe burn injuries (TBSA = 44%) reporting moderate or higher baseline pain during burn wound care. Using a randomized between-groups design, participants were randomly assigned to one of two groups, (a) the Control Group = pain medications only or (b) the VR Group = pain medications + virtual reality. A total of 50 children (88% Hispanic) with large severe burns (mean TBSA > 10%) received severe burn wound cleaning sessions. For the primary outcome measure of worst pain (intensity) on Study Day 1, using a between groups ANOVA, burn injured children in the group that received virtual reality during wound care showed significantly less pain intensity than the No VR control group, [mean worst pain ratings for the No VR group = 7.46 (SD ...
Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank
The Clinical Journal of Pain, 2008
Most burn-injured patients rate their pain during burn wound debridement as severe to excruciating. We explored the adjunctive use of water-friendly, immersive virtual reality (VR) to distract patients from their pain during burn wound debridement in the hydrotherapy tank (hydrotank). Setting: This study was conducted on inpatients at a major regional burn center. Patients: Eleven hospitalized inpatients ages 9 to 40 years (mean age, 27 y) had their burn wounds debrided and dressed while partially submerged in the hydrotank. Intervention: Although a nurse debrided the burn wound, each patient spent 3 minutes of wound care with no distraction and 3 minutes of wound care in VR during a single wound care session (within-subject condition order randomized). Outcome Measures: Three 0 to 10 graphic rating scale pain scores (worst pain, time spent thinking about pain, and pain unpleasantness) for each of the 2 treatment conditions served as the primary dependent variables. Results: Patients reported significantly less pain when distracted with VR [eg, ''worst pain'' ratings during wound care dropped from ''severe'' (7.6) to ''moderate'' (5.1)]. The 6 patients who reported the strongest illusion of ''going inside'' the virtual world reported the greatest analgesic effect of VR on worst pain ratings, dropping from severe pain (7.2) in the no VR condition to mild pain (3.7) during VR. Conclusions: Results provide the first available evidence from a controlled study that immersive VR can be an effective nonpharmacologic pain reduction technique for burn patients experiencing severe to excruciating pain during wound care. The potential applications of VR analgesia to other painful procedures (eg, movement or exercise therapy) and other pain populations are discussed.
Virtual Reality as Distraction Technique for Pain Management in Children and Adolescents
Encyclopedia of Information Science and Technology, Fourth Edition
For a growing number of medical procedures, patients remain awake during the procedure, they feel pain during the medical procedure, and they remember the pain after the procedure is over. Inadequately controlled pain during medical procedures using pain medications alone for pain control, is a worldwide medical problem. Having patients conscious and feeling pain during medical procedures is especially problematic in children who need repeated medical procedures, such as pediatric patients with large severe burn injuries. Because pain has a strong psychological component, a number of unhelpful psychological factors can unintentionally amplify how much pain, fear and anxiety children experience during painful medical procedures. Fortunately, psychological treatments can be used to help reduce pain and anxiety. Virtual Reality is one promising adjunctive analgesic. There is a growing literature showing the potential of immersive virtual reality as a psychological pain control techniqu...
Background: Each year 1.1 million people report having a burn injury, with 45,000 people requiring hospitalization. Patients suffering from a burn, experience one of the most excruciating types of pain, that is most commonly unsuccessfully treated though analgesics. Physical therapy increases a patient’s pain thus decreasing a patient’s compliance with treatment and willingness to move. Virtual reality has been proven to decrease burn pain, but there is limited information on the effects it has on range of motion and treatment enjoyment. The purpose of this study is to determine the effectiveness of VR as a treatment tool to increase ROM and enjoyment as part of cognitive distraction while decreasing reported pain when compared to standard physical therapy in patients with acute burns. Methods: The search between Science Direct, Cinahl and PubMed yielded a total of 242 articles in total which were reviewed based on relevance of titles and abstracts. Prior to reviewing abstracts there were 77 duplicates removed, leaving 165 non-duplicate articles. There were 131 articles removed after reading the abstract and finding the articles did not fit within the meta-analysis leaving 34 articles left to review for inclusion/exclusion criteria. After review-ing the articles, 8 studies eligible for this meta-analysis based on the inclusion and exclusion criteria were analyzed though Microsoft Excel. The studies were used for the following three outcome measures: range of motion, pain and enjoyment. Results: Range of motion presented with homo-genous results with a grand effect size of 0.19. Pain was found to have homogeneity with grand effect size of -0.45. Enjoyment was the only outcome measure that presented with heterogeneity and a grand effect size of 1.30. Virtual reality was proven to be an effective way to decrease pain and improving enjoyment. Range of motion had a trend to favoring virtual reality; therefore, virtual reality is a feasible treatment tool for patient’s suffering from an acute burn injury. Future research is needed to determine the effects of each joint on range of motion, and the correlation between enjoyment and movement. Conclusion: Based on these findings, physical therapists can use VR as a treatment tool to help their patients recover faster with less pain compared to traditional physical therapy. One of the most common complications of a burn injury is contracture formation. This is typically due to decreased move-ment from the patient during the healing stage, but VR can help improve movement as mentioned above. Having a decrease in pain and an increase in enjoyment can lead to a decrease in anxiety to physical therapy and movement in general thereby leading to better patient outcomes and improve their quality of life.