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Virtual reality reduced measured levels of pain, fear and anxiety scores during venepuncture for children aged 5–12 years compared to control
  1. Eva Louise Wooding1,2
  1. 1Department of Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
  2. 2Child Health, University of Exeter Medical School, Exeter, UK
  1. Correspondence to Dr Eva Louise Wooding, Royal Devon and Exeter Hospital, Exeter EX2 5DW, UK; evawooding{at}nhs.net

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Review of: Gerçeker GÖ, Ayar D, Özdemir EZ, et al. Effects of virtual reality on pain, fear and anxiety during blood draw in children aged 5–12 years old: a randomised controlled study. J Clin Nurs 2020;29:1151–61.

Study question: What is the effect of two different virtual reality modalities on venepuncture-related pain, fear and anxiety levels in children during blood sample collection?

Study design

Setting: Specialist hospital venepuncture clinic in Izmir, Turkey.

Patients: 136 patients aged 5–12 years.

Design: Prospective randomised controlled trial (RCT).

Randomisation: Random allocation to one of two virtual reality (VR) themes or usual care control in 1:1:1 ratio. Randomised into blocks according to gender and age using a computer-generated number table.

Blinding: Unblinded (blinding not possible due to nature of intervention). Research nurse blinded to VR theme in intervention groups.

Intervention: VR video watched on clinic mobile phone with headset following one of two themes (rollercoaster or ocean rift). Usual care not described.

Outcomes: Primary outcome was pain score after venepuncture assessed by patient report and observed report by carer, researcher and nurse performing procedure. Secondary outcome measures were fear and anxiety scores prevenepuncture/postvenepuncture using face and ordinal measurement scales applied by patient, carer and observing researcher.

Main results: There were no significant demographic differences between the groups, although a slightly higher number of patients in the control group had a recent unsuccessful venepuncture attempt (p=0.04).

Pain scores were lower in both VR groups compared with control, but there was no significant difference between the two VR groups. Pain score difference data were not presented. However, before and after fear, pain and anxiety scores were collected using validated scales. The Wong-Baker Faces Pain Rating Scale and the Children’s Anxiety Metre are ordinal scales from 0 to 10 where 10 is maximum pain/anxiety. The Child Fear Scale is a 0–5 self-reporting scale where 5 is extreme fear and 0 is absence thereof. A mean of the after scores from patients is summarised in table 1.

Table 1

Comparison between pain, fear and anxiety scores attributed by patients after blood sampling in each group according to Bonferroni correction

Conclusions: This study supports the use of VR during paediatric venepuncture, leading to a reduction in pain, fear and anxiety.

Commentary

Medical procedures such as venepuncture are commonly associated with pain, distress and fear in children. Distraction techniques to reduce perceived pain are supported by strong evidence on meta-analysis.1 Gerçeker et al previously demonstrated reduced pain scores in children aged 7–12 years receiving VR or external cold and vibration during phlebotomy, compared with control.2 This study builds on their previous findings but comparing VR modalities to routine care with an adequately powered sample, randomisation and appropriate statistical analysis. The authors state that randomisation was blocked by age and gender using a computer-generated number table. Analysis of variance testing across groups suggested the groups were broadly similar in terms of age and sex of participant, time since last episode of venepuncture, parent present, number of siblings and parental education level. Other demographics such as ethnicity were absent. This may affect the applicability of findings in light of known disparities in the assessment and recognition of pain by healthcare professionals by patient ethnicity.

The study excluded children with chronic or genetic diseases, and those with visual problems, including wearing glasses. Ways to be inclusive in the use of VR should be explored. Little detail is given on the ‘routine care’ for patients and whether, for example, it includes use of topical anaesthetic cream. In areas where these are widely used, it may limit the applicability of findings. The authors assure us that the technology is affordable, but previous demonstration of similar pain score reductions with cold and vibration questions its necessity. Its novelty may bolster its appeal with patients presently, but this may lessen in future if this seemingly affordable technology becomes widely used by all. That being said, previous RCTs report that VR is popular with patients, caregivers and healthcare professionals alike,3 and merits consideration for non-pharmacological pain reduction for procedures in the clinical environment, and whether different VR themes or patient-selected VR themes elicit superior effects.

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References

Footnotes

  • Twitter @paedsdr

  • Contributors Abstracted and commentary by ELW.

  • Provenance and peer review Not commissioned; internally peer reviewed.