Mobile phone virtual reality game for pediatric home burn dressing pain management: a randomized feasibility clinical trial

• Authors: Megan Armstrong, The Abigail Wexner Research Institute at Nationwide Children’s Hospital; Jonathan Lun, The Abigail Wexner Research Institute at Nationwide Children’s Hospital; Jonathan I Groner, The Abigail Wexner Research Institute at Nationwide Children’s Hospital,; Rajan K Thakkar, The Abigail Wexner Research Institute at Nationwide Children’s Hospital,; Renata Fabia, The Abigail Wexner Research Institute at Nationwide Children’s Hospital; Dana Noffsinger, The Abigail Wexner Research Institute at Nationwide Children’s Hospital; Ai Ni, The Ohio State University College of Public Health; Rohali Keesari, Emory University; Henry Xiang, The Abigail Wexner Research Institute at Nationwide Children’s Hospital
• Journal Title: Pilot and Feasibility Studies
• Volume: Volume 8
• Publisher: BMC | 2022-08-18
• Type of Work: Article | Final Publisher PDF
• Publisher DOI: http://doi.org/10.1186/s40814-022-01150-9
• Subjects: Health Sciences, Medicine and Surgery; Biology, Biostatistics
• Keywords: Virtual reality; Burn; Injury; Pain management; Pediatrics

Abstract

Background Virtual reality (VR) gaming is considered a safe and effective alternative to standard pain alleviation in the hospital. This study addressed the potential effectiveness and feasibility of a VR game that was developed by our research team for repeated at-home burn dressing changes. Methods A randomized clinical trial was conducted among patients recruited from the outpatient burn clinic of a large American Burn Association–verified pediatric burn center between September 2019 and June 2021. We included English-speaking burn patients aged 5–17 years old requiring daily dressing changes for at least 1 week after first outpatient dressing change. One group played an interactive VR game during dressing changes, while the other utilized standard distraction techniques available in the home for up to a week. Both child and caretaker were asked to assess perceived pain on a numerical rating scale (NRS) of 0–10. For the VR group, patients were also asked to rate various aspects of the VR game on a NRS of 0–10 and caregivers were asked questions assessing ease of use. Results A total of 35 children were recruited for this study with 24 fully completing study measures. The majority of participants were male (n=19, 54.3%), White (n=29, 82.9%), and with second degree burns (n=32, 91.4%). Children and caregivers in the VR group reported less pain than the control group at the 4th dressing change. Participants in the VR group showed a clinically meaningful (≥30%) reduction in child-reported overall pain (33.3%) and caregiver-reported worst pain (31.6%) in comparison with subjects in the control group. Children’s satisfaction with the VR remained at a high level across dressing changes over the 1-week period, with reported realism and engagement increasing over time. Over half of the children (54.5%) enjoyed playing the game and did not report any challenges nor any side effects. Conclusions Subjects found the VR to be a useful distraction during home dressing changes and reported no challenges/side effects. VR should be considered as a nonpharmacologic companion for pain management during at-home burn dressing changes.