A Novel Clinician-Orchestrated Virtual Reality Platform for Distraction During Pediatric Intravenous Procedures in Children With Hemophilia: Randomized Controlled Trial

Abstract

Background: Needles are frequently required for routine medical procedures. Children with severe hemophilia require intensive intravenous (IV) therapy to treat and prevent life-threatening bleeding and undergo hundreds of IV procedures. Fear of needle-related procedures may lead to avoidance of future health care and poor clinical outcomes. Virtual reality (VR) is a promising distraction technique during procedures, but barriers to commercially available VR platforms for pediatric health care purposes have prevented widespread use.

Objective: We hypothesized that we could create a VR platform that would be used for pediatric hemophilia care, allow clinician orchestration, and be safe and feasible to use for distraction during IV procedures performed as part of complex health care.

Methods: We created a VR platform comprising wireless, adjustable, disposable headsets and a suite of remotely orchestrated VR games. The platform was customized for a pediatric hemophilia population that required hands-free navigation to allow access to a child's hands or arms for procedures. A hemophilia nurse observing the procedure performed orchestration. The primary endpoint of the trial was safety. Preliminary feasibility and usability of the platform were assessed in a single-center, randomized clinical trial from June to December 2016. Participants were children with hemophilia aged 6-18 years. After obtaining informed consent, 25 patients were enrolled and randomized. Each subject, 1 caregiver, and 1 hemophilia nurse orchestrator assessed the degree of preprocedural nervousness or anxiety with an anchored, combined modified visual analog (VAS)/FACES scale. Each participant then underwent a timed IV procedure with either VR or standard of care (SOC) distraction. Each rater assessed the distraction methods using the VAS/FACES scale at the completion of the IV procedure, with questions targeting usability, engagement, impact on procedural anxiety, impact on procedural pain, and likability of the distraction technique. Participants, caregivers, and nurses also rated how much they would like to use VR for future procedures. To compare the length of procedure time between the groups, Mann-Whitney test was used.

Results: Of the 25 enrolled children, 24 were included in the primary analysis. No safety concerns or VR sickness occurred. The median procedure time was 10 (range 1-31) minutes in the VR group and was comparable to 9 (range 3-20) minutes in the SOC group (P=.76). Patients in both the groups reported a positive influence of distraction on procedural anxiety and pain. Overall, in 80% (34/45) of the VR evaluations, children, caregivers, and nurses reported that they would like to use VR for future procedures.

Conclusions: We demonstrated that an orchestrated, VR environment could be developed and safely used during pediatric hemophilia care for distraction during IV interventions. This platform has the potential to improve patient experience during medical procedures.

Trial registration: Clinical Trials.gov NCT03507582; https://ichgcp.net/clinical-trials-registry/NCT03507582 (Archived by WebCite at http://www.webcitation.org/73G75upA3).

Keywords: anxiety; distraction; hemophilia; intravenous; mobile phone; needle; pediatric; virtual reality.

Conflict of interest statement

Conflicts of Interest: AD reports grants, personal fees, and nonfinancial support from Bayer, CSL Behring, Pfizer, Shire, and Hema Biologics; grants and personal fees from Bioverativ; personal fees and nonfinancial support from Medscape and NovoNordisk; and grants from Alnylam and Octapharma during the conduct of the study, and other from Little Seed Inc outside the submitted work. JP reports grants from The Ohio State University, outside the submitted work. JL reports grants from The Ohio State University, during the conduct of the study. CFB reports personal fees from Shire. JRS, AG, and RS have no conflict of interest to declare.

©Amy Dunn, Jeremy Patterson, Charmaine F Biega, Alice Grishchenko, John Luna, Joseph R Stanek, Robert Strouse. Originally published in JMIR Serious Games (http://games.jmir.org), 09.01.2019.

Figures

Figure 1

Manual orchestration of child engaging events in a virtual reality environment from a connected virtual digital interface from an embedded viewpoint.

Figure 2

An example of the modified visual analog/FACES scale. VR: virtual reality.

Figure 3

Trial flow diagram. VR: virtual reality.