EFFECTIVENESS OF IMMERSIVE VIRTUAL REALITY ON PAIN DURING PROCEDURES IN PAEDIATRIC PATIENTS: A SYSTEMATIC REVIEW AND META-ANALYSIS

Abstract

Background: Pain during medical procedures in paediatric patients is often undermanaged or neglected, leading to undesirable consequences. Immersive virtual reality (IVR) is a novel distraction technique that has gained popularity and accessibility in recent years, with the potential to decrease acute pain during medical procedures. However, no existing reviews have explored its effectiveness in reducing procedural pain in paediatric patients. Aims: This review aimed to evaluate the effectiveness of IVR in reducing procedural pain in paediatric patients. Method: Seven databases (Pubmed, CINAHL, Cochrane, Embase, Proquest, Scopus and Web of Science) were sourced for English language studies from January 1999 till January 2019. Thereafter, two independent reviewers screened and retrieved the studies, extracted relevant data and assessed their risk of bias. Meta-analysis was conducted using the Revman 5.3 software, with the overall effect assessed using effect size Cohen’s d and heterogeneity was assessed using the Cochran’s Q and I2 statistic. Outcomes were also appraised for their overall quality of evidence. Results: A total of 52631 records were identified. Twelve studies (6 RCTs and 6 crossover trials) were included in this review. Meta-analysis revealed a large effect size (d=-1.76) favouring IVR interventions. IVR also showed a reduction of anxiety with a large effect size (d=-2.03). Using the GRADE framework, the overall quality of evidence was rated to be ‘low’ for pain both outcomes. Subgroup analysis revealed early evidence for the use of IVR in reducing pain during dressing change. Conclusion/Implications: IVR is effective in reducing pain over a range of medical procedures with a large effect size but suffered from considerable heterogeneity. Thus, results should be interpreted with caution. Since the overall quality of evidence was low, more high-quality RCTs are required to improve the evidence of IVR on paediatric pain during medical procedures.