A Systematic Review of the Effectiveness of Virtual Reality-Based Interventions on Pain and Range of Joint Movement Associated with Burn Injuries (original) (raw)
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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.
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 therapy to control burn pain: systematic review of randomized controlled trials
Journal of Burn Care & Research
Background Virtual reality therapy has been shown to be an excellent alternative to non-pharmacological treatment for the control of burn pain. Objective To evaluate the effects of virtual reality therapy on pain control in people who have suffered burns published in the scientific literature. Method Systematic review carried out as recommended by Cochrane®. The search was carried out in the Embase, PubMed, Lilacs and Cochrane Library databases, in the period from March 2021. Randomized clinical trials were included without language restriction and year of publication. The risk of bias was assessed using the Cochrane® tool. Results Of the 3755 articles found, only 17 articles were selected for reading in full. Of these, only four articles met the inclusion criteria. The results of the studies showed that the use of virtual reality therapy reduced the intensity of pain in children and adolescents with burns, despite the fact that most results are not statistically significant. No sel...
… Clinical journal of pain, 2009
The authors' concluded that virtual reality may be an effective non-pharmacologic non-invasive adjunct analgesic technique to pain management for burn injury patients receiving wound dressing changes or physiotherapy treatment. The conclusions reflected the results presented. However, as the limited available evidence came from small studies, the conclusions should be interpreted cautiously. Authors' objectives To evaluate the effectiveness of virtual reality combined with pharmacologic analgesia in reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy.
Applications of virtual reality for pain management in burn-injured patients
Expert Review of Neurotherapeutics, 2008
The pain associated with burn injuries is intense, unremitting and often exacerbated by anxiety, depression and other complicating patient factors. On top of this, modern burn care involves the repetitive performance-often on a daily basis for weeks to months-of painful and anxietyprovoking procedures that create additional treatment-related pain, such as wound care, dressing changes and rehabilitation activities. Pain management in burn patients is primarily achieved by
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.
EFFECT OF VIRTUAL REALITY ON WOUND CARE RELATED PAIN AMONG PATIENTS WITH BURN
Xi'an ShiyouDaxueXuebao (ZiranKexue Ban)/ Journal of Xi'an Shiyou University, Natural Sciences Edition, 2023
Background: Burns are one of the most devastating injuries worldwide, burn injuries are a type of skin and tissue damage. Moreover, wound care of burned skin are frequently caring procedure but it is usually accompanied by pain. Virtual reality (VR) technology has been widely used in recent years, as an effective and safe strategy for management of pain associated with burn wound care. Head mounted displays (HMD) has made VR now more feasible for clinical use. Aim of the study: The aim is to evaluate the effect of virtual reality technology on wound care pain among patients with burn. Design: One-group pretest-posttest quasi-experimental design was used in the study. Setting: The study was conducted in two settings, the first was the burn units affiliated to Cairo university hospitals, while the other was the burn unit affiliated to a governmental hospital affiliated to Ministry of health, Egypt. Sample: A convenient sample of 60 male and female adult conscious patients with burn who fulfilled the eligibility criteria was recruited. Tools: Two tools were utilized to collect data; Demographic and Medical Data Questionnaire (DMDQ), Short-Form McGill Pain Questionnaire (SF-MPQ). Results: The mean age of the study sample was 35.40 ± 14.603 years and 43.3% of study sample their age ranged between 18 < 31 years; the female gender represented about 53.3 %. Concerning pain scores; there are high statistical significant differences between Visual Analog Scale (VAS) in the 2 nd wound care without using VR and 3 rd and 4 th wound care with VR, where T= 18.271 P=.000, T= 23.516 P=.000 respectively. Conclusion: The application of VR technology during burns wound care decrease pain severity of burn wound care. Recommendation: Application of VR technology during burn wound care is an effective non-pharmacological pain management strategy/technique.
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...
Designing effective virtual reality environments for pain management in burn-injured patients
2021
Burn patients engage in repetitive painful therapeutic treatments, such as wound debridement, dressing changes, and other medical processes high in procedural pain. Pharmacological analgesics have been used for managing pain, but with ineffective results and negative side effects. Studies on pain management for burn patients suggested that Virtual Reality can treat procedural pain. This paper describes the process of designing, testing, and deploying a Virtual Reality system into a hospital setting. Firstly, a workshop was conducted to identify the most suitable types of Virtual Reality contents for the needs of burn-injured patients. Then, an experimental study, with 15 healthy adults, explored the analgesic impact of the Virtual Reality contents. The pain was induced through a cold pressor. Finally, we deployed the Virtual Reality system into the hospital to examine its efficiency on burn-injured inpatients. This study presents factors for the effective design and deployment of Vi...
The use of video capture virtual reality in burn rehabilitation: the possibilities
Journal of burn care & research : official publication of the American Burn Association
We independently explored the use of the Sony PlayStation II EyeToy (Sony Corporation, Foster City, CA) as a tool for use in the rehabilitation of patients with severe burns. Intensive occupational and physical therapy is crucial in minimizing and preventing long-term disability for the burn patient; however, the therapist faces a difficult challenge combating the agonizing pain experienced by the patient during therapy. The Sony PlayStation II EyeToy is a projected, video-capture system that, although initially developed as a gaming environment for children, may be a useful application in a rehabilitative context. As compared with other virtual reality systems the EyeToy is an efficient rehabilitation tool that is sold commercially at a relatively low cost. This report presents the potential advantages for use of the EyeToy as an innovative rehabilitative tool with mitigating effects on pain in burn rehabilitation. This new technology represents a challenging and motivating way for...