Can virtual reality experience reduce distress among children undergoing IV insertions

Canada: A team of researchers will conduct a study based on the hypothesis that immersive virtual reality (VR) reduces stress in children undergoing intravenous (IV) insertions.

IV insertions are painful and stressful not only for children but also for their caregivers. Paediatric distress and pain on inadequate treatment cause frightened and uncooperative child, repeated IV attempts. This leads to frustration with care for the family and the clinical team.

VR is a combination of visual, auditory and tactile stimuli. A head-mounted display delivers the VR video and audio to the child. It blocks out the view and sounds of the hospital room. The child's attention is diverted away from surrounding painful and anxiety-evoking stimuli. This gives an illusion of being fully immersed in an artificial 3D environment.

VR distraction therapy to date is promising even in burn wound cleaning, chest radiography, dental interventions and chemotherapy. It has therapeutic benefits for anxiety, phobias, post-traumatic stress disorder and eating disorders.

Previous studies have mentioned that VR positively impacts IV insertion-related pain and satisfaction. Still, there is a lack of data regarding distress and adverse effects.

The VR game menu: Easy/Novice is:

· Henry (Category: Immersive 12 min)

· YouTube (Immersive Passive)

· Myth: A Frozen tale (Immersive: 8 min)

· Color space (Interactive)

· Tilt Brush (Interactive)

· Bonfire (Interactive 15 min)

The VR game menu "Experienced" is:

· Jurassic world

· Tetris effects

· Fruit Ninja

· Moss

· Vader Immortal I, II and III

Some study points of the planned protocol are stated below:

· The nature of the study is a two-armed randomised controlled superiority trial.

· The study will be conducted in a Canadian paediatric emergency department and will enrol 80 children.

· Children will be randomised into groups: Departmental standard of care alone or standard of care with immersive VR experience. The reduction of distress will be compared between the two arms.

· The study will include Children aged 6–17 years undergoing IV insertion and having the application of topical anaesthetic.

· In the VR intervention group, the RA will set up the VR equipment and spend approximately 5–10 min explaining the intervention to the child, including proper use of the goggles and controller. The RA will then help the child put on and secure the goggles and headphones and hand them the controller

· Observational Signs of Behavioral Distress-Revised tool will measure the distress score.

· The study will measure secondary outcomes like the child's pain intensity and fear, the anxiety of parents, satisfaction with the IV procedure and adverse events.

· Recruitment launched in September 2020 and is expected to end in March 2022.

· The study is approved by the Health Research Ethics Board (the University of Alberta and will take informed consent from parents and Guardians.

· Women and Children's Health Research Institute Innovation grant funded the study.

· VR equipment purchase is facilitated through a Stollery Children's Hospital Foundation small equipment grant.

The researchers have mentioned that this study will measure patient-relevant (distress, pain, fear, safety) and family-relevant (anxiety and satisfaction). These will be assessed based on the questionnaires. They said that based on the study's intervention, blinding is not possible for patients, parents/caregivers, healthcare providers or outcome assessors. However, the statistician will be blinded.

The study recruitment will be limited to English-speaking families. Critically ill children requiring immediate IV insertion will also be excluded so there is no medical care delay.

The study team plans to publish trial results in a high-impact, peer-reviewed journal. They also plan to present the study results at national and international meetings.

Further reading:

Ali S, Rajagopal M, Stinson J, et al. Virtual reality-based distraction for intravenous insertion-related distress in children: a study protocol for a randomised controlled trial

BMJ Open 2022;12: e057892. doi: 10.1136/bmjopen-2021-057892