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A Randomized Controlled Trial of Commercially Available Virtual Reality for Intravenous Cannulation-Related Distress
Samina Ali1, Summer Hudson2, Manasi Rajagopal2
1Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta, Edmonton, AB, Canada; Faculty of Medicine & Dentistry, University of Alberta, Women & Children's Health Research Institute (WCHRI), Edmonton, AB, Canada.
Insights
Virtual reality (VR) distraction did not reduce distress during intravenous insertion for children in the emergency department. Alternative distraction methods may be more effective due to lack of benefit and technical issues with VR.
Area of Science:
- Pediatric Emergency Medicine
- Medical Technology Integration
- Pain and Distress Management
Background:
- Intravenous insertion (IVI) in children can cause significant distress.
- Virtual reality (VR) is explored as a distraction tool to mitigate procedural pain and anxiety.
- Standard of care (SOC) provides baseline management for pediatric procedural distress.
Purpose of the Study:
- To evaluate if VR distraction, when added to SOC, reduces distress in children undergoing IVI.
- To compare distress, pain, and fear levels between VR and SOC groups.
- To identify the efficacy of commercially available VR software in a pediatric emergency setting.
Main Methods:
- A two-arm randomized controlled trial included children aged 6-17 years requiring IVI.
- Distress was measured using the Observational Scale of Behavioral Distress-Revised.
- Secondary outcomes included procedural pain (Numerical Rating Scale) and fear (Children's Fear Scale).
Main Results:
- No significant difference in procedural distress, pain, or fear was observed between the VR and SOC groups.
- Preprocedural distress scores were low and similar in both groups.
- Technical issues with VR equipment occurred in 26% of cases.
Conclusions:
- Commercially available VR distraction did not provide additional benefit over SOC for reducing distress during pediatric IVI.
- The frequency of technical issues suggests VR may not be optimal for this setting.
- Alternative distraction techniques should be considered for children undergoing IVI.
Objective:
To assess whether commercially available virtual reality (VR)-based distraction reduces distress when added to standard of care (SOC) for children undergoing intravenous insertion (IVI) in the pediatric emergency department.
Study Design:
Children aged 6-17 years requiring IVI were recruited for a two-arm randomized controlled trial. The primary outcome was child distress, measured using the Observational Scale of Behavioral Distress-Revised (score range 0-23.5). Secondary outcomes included children's procedural pain (verbal Numerical Rating Scale, score range 0-10) and fear (Children's Fear Scale, score range 0-4).
Results:
Mean (SD) children age was 11.1 years (2.9) and 54% (45/82) were female. Mean (SD) preprocedural Observational Scale of Behavioral Distress-Revised scores were similarly low in both the VR [0.39 (0.70)] and SOC arms [0.18 (0.49)] (P = .16). Use of VR during IVI was not associated with lower mean (SD) total procedural distress [1.1 (1.5)] vs SOC [0.7 (1.4)] (P = .08), mean (SD) procedural pain intensity [3.0 (2.9)] vs SOC [2.1 (2.3)] (P = .14), or mean (SD) Children's Fear Scale score [0.97 (1.33)] vs SOC [0.97 (1.15)]. Technical issues with the VR equipment were reported in 26% (10/39) of cases.
Conclusions:
VR distraction therapy employing commercially available software was not associated with reduction in procedural distress, pain or fear, above that provided with SOC, for children undergoing IVI in the pediatric emergency department. Given no differences and frequency of technical issues, other forms of distraction may be more appropriate in this setting.
Trial Registration:
Clinicaltrials.gov Identifier: NCT04291404.
