Projector-based virtual reality dome environment for procedural pain and anxiety in young children with burn injuries: a pilot study

Abstract

Christelle Khadra,1,2 Ariane Ballard,1,2 Johanne Déry,1,3 David Paquin,4 Jean-Simon Fortin,5 Isabelle Perreault,6 David R Labbe,7 Hunter G Hoffman,8 Stéphane Bouchard,9 Sylvie LeMay1,2 1Faculty of Nursing, University of Montreal, Montreal, QC, Canada; 2Research Center, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada; 3Direction of Nursing, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada; 4Department in Creation and New Media, Université du Québec en Abitibi-Témiscamingue, Rouyn-Noranda, QC, Canada; 5Emergency Department, Hôpital de Granby, Granby, QC, Canada; 6Department of Surgery, Centre Hospitalier Universitaire (CHU) Sainte-Justine, Montreal, QC, Canada; 7Department of Software and IT Engineering, École de Technologie Supérieure, Montreal, QC, Canada; 8Department of Mechanical Engineering, University of Washington, Seattle, WA, USA; 9Department of Psychoeducation and Psychology, Université du Québec en Outaouais, Gatineau, QC, Canada Background: Virtual reality (VR) is a non-pharmacological method to distract from pain during painful procedures. However, it was never tested in young children with burn injuries undergoing wound care.Aim: We aimed to assess the feasibility and acceptability of the study process and the use of VR for procedural pain management.Methods: From June 2016 to January 2017, we recruited children from 2 months to 10 years of age with burn injuries requiring a hydrotherapy session in a pediatric university teaching hospital in Montreal. Each child received the projector-based VR intervention in addition to the standard pharmacological treatment. Data on intervention and study feasibility and acceptability in addition to measures on pain (Face, Legs, Activity, Cry, Consolability scale), baseline (Modified Smith Scale) and procedural (Procedure Behavior Check List) anxiety, comfort (OCCEB-BECCO [behavioral observational scale of comfort level for child burn victims]), and sedation (Ramsay Sedation Scale) were collected before, during, and after the procedure. Data analyses included descriptive and non-parametric inferential statistics.Results: We recruited 15 children with a mean age of 2.2±2.1 years and a mean total body surface area of 5% (±4). Mean pain score during the procedure was low (2.9/10, ±3), as was the discomfort level (2.9/10, ±2.8). Most children were cooperative, oriented, and calm. Assessing anxiety was not feasible with our sample of participants. The prototype did not interfere with the procedure and was considered useful for procedural pain management by most health care professionals.Conclusion: The projector-based VR is a feasible and acceptable intervention for procedural pain management in young children with burn injuries. A larger trial with a control group is required to assess its efficacy. Keywords: pain, virtual reality, distraction, burns, preschool children, wound care

Keywords

• Pain
• Virtual Reality
• Distraction
• Burns
• Preschool children
• Wound Care