Virtual Reality Interventions for Needle-Related Procedural Pain, Fear and Anxiety-A Systematic Review and Meta-Analysis

Oliver Czech, Adam Wrzeciono, Anna Rutkowska, Agnieszka Guzik, Paweł Kiper, Sebastian Rutkowski, Oliver Czech, Adam Wrzeciono, Anna Rutkowska, Agnieszka Guzik, Paweł Kiper, Sebastian Rutkowski

Abstract

Needle-related procedures are often a source of pain, anxiety and fear in young patients. This systematic review aimed to investigate the effectiveness of virtual reality (VR) on reducing pain, fear and anxiety in pediatric patients undergoing needle-related procedures. Pain, anxiety, fear, changes in blood pressure and heart rate as well as satisfaction were evaluated as outcomes during needle-related procedures in VR compared with standard care conditions. A meta-analysis was performed, taking into account online databases. Two authors independently conducted literature searches in December 2020. The last search was conducted in March 2021 from a total of 106 records, 7 met our inclusion criteria. One study was excluded from the meta-analysis due to insufficient data. VR was applied as a distractor during venous access. Statistically significant benefits of using VR were shown in children's pain scores, where VR significantly decreased symptoms (n = 3204 patients, MD = -2.85; 95% CI -3.57, -2.14, for the Wong-Baker Faces Pain Rating Scale and n = 2240 patients, MD = -0.19; 95% CI -0.58, 0.20, for the Faces Pain Scale-Revised). The analysis of fear, anxiety and satisfaction scores revealed no significant differences between the conditions, as the studies were too heterogeneous to be pooled. Distraction using virtual reality may be an effective intervention for reducing pain in children undergoing needle-related medical procedures. However, further research in the implementation of VR as a distractor for children and adolescents is required, due to the limited research into this field.

Keywords: VR; anxiety; fear; invasive procedures; needle; pain; virtual reality.

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Flow diagram of the studies.
Figure 2
Figure 2
Risk of bias summary. + (green): low risk; ? (yellow): unclear risk; − (red): high risk.
Figure 3
Figure 3
Comparison of VR treatment and standard care, pain (WBS). SD: standard deviation; 95% CI: 95% confidence interval; green square: mean difference; black rhombus: pooled effect.
Figure 4
Figure 4
Comparison of VR treatment and standard care, pain (FPS-R). SD: standard deviation; 95% CI: 95% confidence interval; green square: mean difference; black rhombus: pooled effect.
Figure 5
Figure 5
Comparison of VR treatment and standard care, fear. SD: standard deviation; 95% CI: 95% confidence interval. Without pooling due to heterogeneity (I2 = 94%).
Figure 6
Figure 6
Comparison of VR treatment and standard care, anxiety (CAM). SD: standard deviation; 95% CI: 95% confidence interval. Without pooling due to heterogeneity (I2 = 93%).
Figure 7
Figure 7
Comparison of VR treatment and standard care, satisfaction. SD: standard deviation; 95% CI: 95% confidence interval. Without pooling due to heterogeneity (I2 = 83%).

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