Background & Aims

Burn wound care are painful and stressful procedures . Unfortunately, nonpharmacological methods such as virtual reality (VR) are rarely combined with pharmacological treatments despite evidence showing that distraction can serve as an effective method for pain and anxiety management and can potentially decrease analgesic requirements in other painful medical procedures. Considering the lack of optimal pain and anxiety management during burn wound care and the positive effect of an immersive distraction (VR) for painful procedures, using VR for burn wound care procedures may show promising results. This withing-subject-control trial aim to assess the efficacy of an immersive distraction (VR) compared to the standard treatment for pain and anxiety management in children undergoing burn wound care in an outpatient burn clinic.

Methods

This study used a within-subject randomized clinical trial design, where each child was serving as its own control. Participants, aged 6-17 years, with burn injuries requiring burn wound care were randomly assigned to receive both standard and experimental treatments in a randomized order of sequences. Pain (0-10; Verbal Numerical Rating Scale) and anxiety (0-4; Child Fear Scale) were measured before and after each treatment. Both children and nurses’ level of satisfaction were measured using tailored questionnaires. Paired t-test and Wilcoxon signed-rank tests (significance level at 0.05) were employed for statistical analysis.

Results

A total of 24 children, mean age of 10.2 ± 3.0 y.o., requiring burn wound care were recruited. No significant differences were observed in the mean (±SD) pain scores between the VR and control groups, respectively 4.2±3.6 and 2.6±3.0, (p=0.068). The mean anxiety score in the VR group (1.6 ±1.3) was significantly higher than in the control group (0.9±1.1) (p=0.013). Subgroup analysis on sex revealed that mean anxiety score and mean pain score were higher in girls in the VR group (p=0.021). Both children and nurses expressed high levels of satisfaction.

Conclusions

Results showed that VR is an acceptable and feasible intervention in this group of participants. Results revealed higher levels of anxiety and pain among participants in the VR group, particularly among girls. These findings may be attributed to the study’s design, which involved splitting the procedure into a randomized two-phases sequence (Control and Experimental). The sequence starting with the control phase involving the removal of the dressing, was usually less painful than the experimental phase (VR) involving wound cleansing, which was usually more painful. This sequence and splitting of the procedure could have influenced the scores reported by participants. In conclusion, it would have probably been more suitable to randomize by the clinic days and adopt a parallel-group randomized controlled trial (RCT) design rather than a within-subject design to provide a more balanced assessment of the effects of VR on pain and anxiety during burn wound care procedures.

References

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Presenting Author

Sylvie Le May

Poster Authors

Estelle Guingo

MSc

Université du Québec en Abitibi-Témiscamingue

Lead Author

Sylvie Le May

Université de Montréal, CA

Lead Author

Estelle Guingo

ing.

Université du Québec en Abitibi-Témiscamingue

Lead Author

Raissa Passos dos Santos

Université de Montréal

Lead Author

Kate St-Arneault

RN

Research Centre, CHU Sainte-Justine, Montreal, QC, Canada

Lead Author

Christine Genest

RN

Université de Montreal, Montreal, QC, Canada

Lead Author

Maxime Francoeur

BScN

Université de Montréal, CA

Lead Author

Nicole Hung

Université de Montréal

Lead Author

Christelle Khadra

PhD.

McGill University, Montreal, QC, Canada

Lead Author

Melanie N. Noel

PhD

Alberta Children’s Hospital Research Institute, Calgary, Alberta, Canada

Lead Author

Julie Paquette

Research Centre, CHU Sainte-Justine, Montreal, QC, Canada

Lead Author

Benedicte Grou

MSc.

Centre hospitalier de Ste Justine, Montreal, QC, Canada

Lead Author

Benedicte Therrien-Hogue

RN

Centre hospitalier de Ste Justine, Montreal, QC, Canada

Lead Author

Gwenaelle Trottet

Centre hospitalier de Ste Justine, Montreal, QC, Canada

Lead Author

Andrée-Anne Roy

MD

Centre hospitalier de Ste Justine, Montreal, QC, Canada

Lead Author

Topics

  • Treatment/Management: Complementary and Alternative therapies