Comparing a Virtual Reality-Based Simulation App (VR-MRI) With a Standard Preparatory Manual and Child Life Program for Improving Success and Reducing Anxiety During Pediatric Medical Imaging: Randomized Clinical Trial

Chelsea Stunden, Kirsten Stratton, Sima Zakani, John Jacob, Chelsea Stunden, Kirsten Stratton, Sima Zakani, John Jacob

Abstract

Background: The experience of undergoing magnetic resonance imaging (MRI) can be anxiety provoking, particularly for pediatric patients and their families. Alternative methods to improve success and experiences without the use of sedation are needed.

Objective: This study aims to compare the effectiveness of a virtual reality (VR)-based simulation app (VR-MRI) with a standard preparatory manual (SPM) and a hospital-based Child Life Program (CLP) on success and anxiety during a simulated pediatric MRI scan. Our secondary aim is to compare caregivers' reported anxiety, procedural data, caregiver usability, child satisfaction, and fun.

Methods: This unblinded, randomized, triple-arm clinical trial involved 92 children aged 4-13 years and their caregivers. Recruitment was conducted through posters, public libraries, community centers, and social media. At a 2-hour session, participants were instructed to prepare for a simulated MRI head scan using one of three randomly assigned preparation materials: the VR-MRI app, SPM, or the CLP. Data were collected before preparation, during a simulated MRI head scan, and after the simulated scan. The primary outcomes were the success of the simulated MRI scan (MoTrak head motion tracking system), and child-reported anxiety (Venham picture test). We secondarily measured caregivers' reported anxiety (short State-Trait Anxiety Inventory), procedural data (minutes), usability (Usefulness, Satisfaction, and Ease of Use Questionnaire), and child-reported satisfaction and fun (visual analog scales).

Results: A total of 84 participants were included in the final analysis (VR-MRI: 30/84, 36%; SPM: 24/84, 29%; and CLP: 30/84, 36%). There were no clinically significant differences between the groups in terms of success during the MRI simulation (P=.27) or the children's reported anxiety at any timepoint (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). Caregivers reported being significantly more anxious after preparing with the manual than caregivers in the other 2 groups (P<.001). Child and caregiver anxiety had a significant relationship, increasing together with moderate effect (r84=0.421; P<.001). Participants using VR-MRI took the most time to prepare (P<.001) and participants using the manual took the least time (P<.001). No statistically significant relationships were found between time preparing and time completing the simulated assessment (P=.13). There were no differences found in ease of use (P=.99), ease of learning (P=.48), and usefulness (P=.11) between the groups; however, caregivers reported being significantly more satisfied with the VR-MRI app and CLP than SPM (P<.001). Children reported the most satisfaction with the CLP (P<.001). There were no differences in how much fun the preparation materials were perceived to be (P=.37).

Conclusions: Digital preparation experiences using VR-based media could be a viable solution to improve the success of nonsedated MRI scans, with outcomes comparable with hospital-based in-person preparatory programs. Future research should focus on validating the results in a real MRI setting.

Trial registration: Clinicaltrials.gov NCT03931382; https://ichgcp.net/clinical-trials-registry/NCT03931382.

Keywords: alternatives to sedation; certified child life specialists; magnetic resonance imaging procedures; magnetic resonance imaging simulation; pediatrics; preparing children for MRI; virtual reality.

Conflict of interest statement

Conflicts of Interest: None declared.

©Chelsea Stunden, Kirsten Stratton, Sima Zakani, John Jacob. Originally published in the Journal of Medical Internet Research (https://www.jmir.org), 22.09.2021.

Figures

Figure 1
Figure 1
A screenshot of the virtual reality magnetic resonance imaging tutorial.
Figure 2
Figure 2
A screenshot of the introduction to hospital staff and a peer in the reception area.
Figure 3
Figure 3
A screenshot of the interactive hotspots used to transition through rooms and sequences.
Figure 4
Figure 4
A screenshot of the sequence focusing the user’s attention on the head coil.
Figure 5
Figure 5
A screenshot of narrative elements used to describe the magnetic resonance imaging sounds.
Figure 6
Figure 6
A screenshot of putting in earplugs during the user’s virtual imaging experience.
Figure 7
Figure 7
A screenshot of putting on the head coil during the user’s virtual imaging experience.
Figure 8
Figure 8
A screenshot of the real-time feedback during movement, measured using the mobile phone gyroscope.
Figure 9
Figure 9
Screenshots of the levels where feedback mechanisms are eliminated and presence in the bore is reintroduced through sounds and visual cues.
Figure 10
Figure 10
Flow diagram for virtual reality magnetic resonance imaging study. MRI: magnetic resonance imaging; VR-MRI: virtual reality magnetic resonance imaging.
Figure 11
Figure 11
The magnetic resonance imaging simulation room.
Figure 12
Figure 12
Comparison of self-reported child anxiety across groups and timepoints, measured by the Venham picture test (the circles denote outliers and the asterisks denote extreme outliers). No clinically significant results were indicated (timepoint 1, P=.99; timepoint 2, P=.008; timepoint 3, P=.10). MRI: magnetic resonance imaging; VR-MRI: virtual reality magnetic resonance imaging.
Figure 13
Figure 13
Comparison of change in self-reported caregiver anxiety between timepoints and across groups, measured with the short State-Trait Anxiety Inventory (the circles denote outliers and the asterisks denote extreme outliers). Clinically significant differences were found between the manual group in comparison with the virtual reality magnetic resonance imaging (Dunnett P<.001) and the Child Life Program (Dunnett P=.004). MRI: magnetic resonance imaging; VR-MRI: virtual reality magnetic resonance imaging.
Figure 14
Figure 14
Comparison of preparation and assessment times across groups, measured in minutes. No significant relationship was found (r=0.148; P=.18). VR-MRI: virtual reality magnetic resonance imaging.
Figure 15
Figure 15
Comparison of median usability metrics collected across groups, adjusted to total scores of 100. Significant differences were found for caregiver satisfaction when comparing the manual with the virtual reality magnetic resonance imaging and Child Life Program (Bonferroni P<.001). VR-MRI: virtual reality magnetic resonance imaging.

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