EFFECTIVENESS OF VIRTUAL REALITY INTERVENTIONS IN REDUCING PREOPERATIVE ANXIETY AMONG CHILDREN: A SYSTEMATIC REVIEW AND META-ANALYSIS OF RANDOMISED CONTROLLED TRIALS

Abstract

Background: Preoperative anxiety is a highly prevalent issue among children and is associated with adverse postoperative outcomes, and poorer cooperation at the induction of anaesthesia. Virtual Reality (VR) is a new intervention which can potentially reduce preoperative anxiety. No prior systematic review has investigated the effectiveness of VR interventions in reducing preoperative anxiety among children. Aim: To examine the effectiveness of VR interventions in reducing preoperative anxiety among children undergoing elective surgery. Design: A systematic review and meta-analysis of randomised controlled trials Methods: Seven databases (PubMed, Cochrane, EMBASE, CINAHL, Web of Science, Scopus and ProQuest) were searched from 1 January 1980 to 31st December 2019. Quality of studies were assessed using the Cochrane Risk of bias tool. Meta-analysis was performed using RevMan, under the random-effect model. Overall effect was evaluated using effect size and Z-statistics with p-value set at 0.05. Heterogeneity was assessed using I2 and ?2 statistics. Results: A total of 2783 records were identified. Six studies were included in this review. Three of the six studies displayed low risk of bias. Five studies were pooled for meta-analysis and it reveal that VR interventions reduces preoperative anxiety on the modified Yale Preoperative Anxiety Scale (MD= -9.36, 95% CI: [-15.16, -3.56], p=0.002). Conclusion: Due to the limited number of studies and small sample sizes across the trials, the effectiveness of VR interventions in reducing preoperative anxiety is inconclusive. Nevertheless, there appears to be emerging evidence regarding the effectiveness of VR interventions as a preparatory tool in reducing preoperative anxiety. Implications: More high quality RCTs with larger sample sizes are needed to establish whether VR interventions are effective in reducing preoperative anxiety among children.