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Immersive virtual reality for pediatric burn pain and early rehabilitation
Liping Lu1, Wenhui Li2, Shuangshuang Ye2
1Department of Burns and Plastic Surgery, No. 910 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force, Quanzhou, China.
Insights
Immersive virtual reality (VR) significantly reduced pain, fear, and distress in children undergoing repeated burn dressing changes by the third session. VR improved cooperation with later treatment and rehabilitation, offering a practical adjunct for pediatric burn care.
Area of Science:
- Pediatric Surgery
- Pain Management
- Virtual Reality Applications
Background:
- Repeated burn dressing changes cause significant procedural distress in children, impacting cooperation with wound care and rehabilitation.
- Current distraction methods may be insufficient for managing pain and distress during prolonged pediatric burn treatment.
Purpose of the Study:
- To evaluate the efficacy of immersive virtual reality (VR) in mitigating procedural distress and enhancing treatment cooperation during repeated burn dressing changes and early rehabilitation in pediatric patients.
- To assess the impact of VR on pain, fear, behavioral distress, and cooperation in children with burns.
Main Methods:
- Eighty pediatric burn patients were randomized into a control group (routine care) or an immersive VR group.
- The VR group received routine care plus immersive VR animation during dressing changes and rehabilitation sessions.
- Pain, fear, behavioral distress, cooperation, and rehabilitation completion were assessed using validated scales and recorded data.
Main Results:
- By the third dressing change, the VR group reported significantly less pain, fear, and behavioral distress compared to the control group.
- The VR group demonstrated improved cooperation with dressing changes and rehabilitation sessions from the second and third sessions onwards.
- No significant differences were observed in rehabilitation completion, dressing duration, or rescue analgesic use; no serious adverse events occurred.
Conclusions:
- Immersive virtual reality (VR) is a practical and effective adjunct for reducing distress and improving cooperation in children undergoing repeated burn care.
- VR may enhance patient tolerance and adherence to wound care protocols, contributing to better outcomes in pediatric burn management.
- Sex-stratified analysis indicated VR's benefits were observed in pain and fear for males, and pain and behavioral distress for females.
Abstract:
Burn dressing changes are painful and distressing for children, and repeated procedural discomfort can reduce cooperation with wound care and early rehabilitation. This study was conducted in the burn unit of No.910 Hospital of the Chinese People's Liberation Army Joint Logistic Support Force between January 2023 and March 2026 to evaluate the effects of immersive virtual reality (VR) on procedural distress and treatment cooperation during repeated dressing changes and early rehabilitation in children with burns. Eighty pediatric patients requiring repeated dressing changes were randomly assigned to a control group or a VR group, with 40 children in each group. Children in the control group received routine burn care and standard distraction, whereas those in the VR group received routine care plus immersive VR animation during dressing changes and early rehabilitation sessions. Procedural pain was assessed using the Faces Pain Scale-Revised, procedure-related fear using the Children's Fear Scale, and behavioral distress using the COMFORT-B scale; treatment cooperation, rehabilitation completion, dressing duration, rescue analgesic use, and adverse events were also recorded. Baseline demographic and burn-related characteristics were similar between groups. No significant differences were found in pain, fear, or behavioral distress during the first dressing change, and a similar pattern was observed during the second dressing change. By the third dressing change, children in the VR group reported less pain (p = 0.0009), less fear (p = 0.0116), and lower behavioral distress (p = 0.0048) than those receiving routine care. The VR group also showed better dressing cooperation at the third dressing change (p = 0.0024) and better rehabilitation cooperation during the second and third rehabilitation sessions (p = 0.0352 and p = 0.0106, respectively). Exploratory sex-stratified analysis showed that VR-related improvements were reflected mainly in pain and fear among male patients and in pain and behavioral distress among female patients. Rehabilitation completion, dressing duration, and rescue analgesic use did not differ significantly between groups, and no serious adverse events occurred. These findings suggest that immersive VR may be a practical adjunct for making repeated pediatric burn care less distressing and more tolerable while improving cooperation during later treatment sessions.