JMIR Publications

ABSTRACT

Background:

The experience of undergoing a magnetic resonance imaging (MRI) study can be anxiety-provoking, particularly for paediatric patients and their families. In some cases, the increased anxiety can lead to movement that results in less effective imaging and the need for repeated procedures. Motivated by the need for alternative methods to improve success and experiences without the use of sedation, we developed and tested a digital learning experience that integrated the use of virtual reality (VR) media to provide pre-procedural preparation to children aged 4-to-13 and their families undergoing a simulated MRI study.

Objective:

To compare the effectiveness of a VR-based digital learning application (VR-MRI) to a standard preparatory manual and in-person hospital-based preparation workshop (delivered by Child Life Specialists) on success and anxiety during a simulated paediatric MRI scan. We also compared caregiver reported anxiety, procedural data, caregiver usability, child satisfaction, and fun.

Methods:

This non-blinded, randomized, triple-arm clinical trial involved 92 children aged 4-to-13 and their caregiver. Recruitment was conducted through posters at the hospital, public libraries, community centres, and social media. At a 2-hour session, participants and their caregivers were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials – the VR-MRI application, standard preparatory manual (SPM), or the hospital-based Child Life Preparatory Program (CLP). Data were collected before preparation, upon entering the simulator room, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were success of the simulated MRI scan, defined as less than 4mm of cumulative linear displacement from the initial head position (MotrakTM head motion tracking system) and child reported anxiety (Venham Picture Test). We secondarily measured caregiver reported anxiety (Short State-Trait Anxiety Inventory), preparation and assessment duration, usability (USE questionnaire), and child reported satisfaction and fun (visual analogue scales).

Results:

A total of 84 participants were included in the final analysis (VR-MRI n=30, SPM n=24, CLP n=30). There were no clinically significant differences between the groups on success during the MRI simulation (p = 0.267) or children’s reported anxiety at any timepoint (p > 0.05). However, caregivers reported being significantly more anxious after preparing with the manual than caregivers in either of the other two groups (p < 0.001). Child and caregiver anxiety had a significant relationship, increasing together with a moderate effect (r (84) = 0.421, p <0.001). The time spent preparing was also statistically different between groups (p < 0.001), with participants taking the most time to prepare using the VR-MRI application and the least when using the manual. No statistically significant relationships were found between the time spent preparing and the time required to complete the simulated assessment (p = 0.134). In terms of caregiver-perceived usability, there were no differences found on ease of use, ease of learning, and usefulness between the groups (p > 0.05); however, caregivers reported being significantly more satisfied with the VR-MRI application and Child Life program than the standard preparatory manual (p <0.001). Children also reported the most satisfaction with the in-person Child Life program (p < 0.001), but there were no differences in how fun the preparation materials were perceived to be (p = 0.367).

Conclusions:

Digital preparation experiences utilizing VR-based media could be a viable solution to improving the success of non-sedated MRI scans, with outcomes comparable to hospital-based in-person preparatory programs. Future research should focus on validating results in a non-simulated MRI setting. Clinical Trial: U.S. National Library of Medicine (#NCT03931382)