JMIR Publications

ABSTRACT

Background:

Virtual reality (VR) has shown promise to reduce children’s pain and anxiety during venipuncture, but these studies 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 (PED) and the adherence to a protocol for observing coping during pediatric procedures. Secondarily, this study examined whether VR affects child and caregiver coping and distress during venipuncture in the PED.

Methods:

This stratified, randomized, controlled pilot trial compared coping and distress between VR engagement and child life (CL) support during painful procedures in the PED, in children ages 7-22 years. 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 analogue scale (range 0-10), and cybersickness symptoms.

Results:

Overall recruitment was 93.0% (66/71), VR withdrawal was 26.7% (4/15), and of completed procedures 100% (63/63) CAMPIS-SF observations were completed. A total of 55 patients undergoing venipuncture in the PED were included in analyses of clinical outcomes: 15 patients (15 caregivers) randomized to VR, 20 patients (15 caregivers) randomized to CL, and 20 patients (17 caregivers) in the reference group. Patient coping differed across groups with higher coping in VR and CL than the reference group (P=0.05). There were no significant differences in distress and pain ratings for patients and caregivers between groups. Caregivers rated the lowest perceived anxiety in the CL group (P=0.03). There was no apparent change in cybersickness symptoms before and after VR use (P=0.37).

Conclusions:

Real-time documentation of observed behaviors in patients and caregivers was feasible during medical procedures in which VR is utilized, particularly with availability of research staff. VR and CL both 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. Clinical Trial: NCT03686176