Table 4 – Results' synthesis Study
characteristics
Aim Participants:
Control Group (CG) and Experimental Group (EG)
Intervention Findings
Piskorz and Czub (2018), Poland
Evaluate the effectiveness of VR in minimizing stress and pain associated with venipuncture.
N= 38, ages 7 to 17 years hospitalized children.
CG: n= 19 EG: n= 19
Quasi-experimental study with inclusion criteria: children hospitalized with blood draw procedure scheduled for the same or next day after recruitment.
VR equipment used were goggles. Game’s difficulty level was manipulated and adjusted to the age and cognitive development of the child.
Control group did not had any distraction technique during procedure. Experimental group used VR during procedure.
After procedure, children self-evaluated pain intensity using VAS scale.
Children immersed in the VR reported 59%
less pain intensity than the control group. No discomfort was reported because of exposure.
No relationship was found between the intensity of the pain experienced and the age or sex of the children, nor with the number of previous blood draw procedure.
The fact that it is possible to control VR game with only head movements, allowed active participation of the child and avoided movements that could interfere with the performance of the procedure.
Chad, Emaan and Jillian (2018), United States of America
Determine the rationale, feasibility and effectiveness of utilizing a VR headset for fear reduction and pain distraction during pediatric
immunization.
N= 15, ages 6 to 18 years children undergoing vaccine administration and their caregiver.
VR equipment used were headphones and goggles, and all the children could choose one of the three available game scenarios.
The intensity of the pain was simultaneously self-assessed by the children using the WBFS scale, before and after the procedure and according to the expectation of pain and the pain felt during puncture.
Child's pain was 77% lower than they expected to feel, and 94.1% of the children reported a desire to use VR in a next needle procedure.
Birnie, Kulandaivelu, Jibb, Hroch, Positano, Robertson,
Assess the usability (ease of use and understanding, acceptability) of a custom VR
N= 17, ages 8 to 18 years children with oncological disease.
Group 1: n=5
Study with a mixed method approach with inclusion criteria: children submitted to treatment and with access to IVAD during the outpatient visit. The exclusion criteria were children with visual, auditory or
Before using VR, 29% of children reported mild to moderate pain or discomfort and 70% did not report any pain. During VR use, no child reported any adverse effects.
Campbell, Abla and Stinson (2018), Canada
intervention for children with cancer undergoing IVAD needle insertion.
Group 2: n=6 Group 3: n=6
cognitive alterations, in terminal phase or with signs or symptoms of infection.
The study used three interactive VR cycles.
Each cycle was performed at three different times, involving three different groups.
Children were asked about the rate of dizziness, nausea, pain and stress before the use of the VR and the beginning of
procedure. The children had previous contact with the VR equipment (goggles and headset) and were encouraged to report potential problems related to it.
After the procedure, the acceptability of using the VR and the pain intensity were evaluated using a numerical scale.
Regarding problems with the VR equipment, 11% of the children reported that the goggles were oversized, 9.1% reported that the game was boring, 82% stated that VR equipment was easy to use and 76% appreciated its use during the procedure.
VR allowed a better communication between the child and the nurse in which both
observed benefits in its use, since it increased the distraction and decreased stress. In the end, 94% of children showed interest in using this device in future procedures involving the use of needles.
Castillo, Torres, Sánchez, Castellanos, Fernández, Sánchez and Fernández (2019), Spain
Assess whether the use of VR, both in isolation or
combined with the use of a
lidocaine/prilocaine cream, reduced pain and anxiety during invasive procedures in patients
hospitalized in the paediatric ward without producing clinically relevant
N= 58, ages 4 to 15 years hospitalized children.
CG: n=18
EG with VR: n=16 EG with VR and lidocaine/prilocaine:
n=22
Observational, analytical, prospective and cohort study, which inclusion criteria were children capable of using VR and applying validated scales; and exclusion criteria were clinically unstable children, who needed other types of analgesia during the procedure.
The children were divided in three groups and underwent different procedures involving the use of a needle as a lumbar puncture, insertion of a PVC and blood draw.
The equipment used were goggles and headset, and each child chose the VR scenario according to their age and preferences.
Groups that used VR showed lower pain intensity compared to control group, reported by children, caregiver and health
professionals. The group that used VR associated with topical anesthetic reported a lower intensity compared to the other groups.
Regarding the self-evaluation of pain, 85.7% of children reported that pain felt was lower than the expected with the use of analgesic methods. 95.5% wished the use of this techniques in future procedures involving needles.
74.1% of the caregivers assumed that the child felt less pain and 96.3% requested the use of the same techniques in future procedures. In
adverse effects. For the self-assessment of pain, children between four and six years used the WBFS scale and children over seven years used VAS scale. Simultaneously, caregivers and
professionals evaluated child's pain through the numerical scale.
addition, 86.8% believed that VR facilitated the procedure.
It was verified a strong correlation between the pain perceived by the children and the one described by the family.
The survey of health professionals showed that 92% considered that the use of these analgesic interventions facilitated their performance during the procedure.
Aydın and Özyazıcıoğlu (2019), Turkey
Determine the effect of using a virtual reality headset on
decreasing the pain felt during a venipuncture procedure in children.
N= 120, ages 9 to 12 years children undergoing blood draw.
CG: n=60 EG: n=60
Prospective randomized experimental study, whose inclusion criteria were children who do not wear glasses, do not manifest pain before the intervention, do not have a chronic disease, causing pain and do not have a peripheral venous catheter in the antecubital area.
Experimental group used VR during the procedure.
The equipment used were VR googles and headset and the scenario were the same for all children. VR device was placed one minute before the procedure and removed after that.
Children evaluated the pain using the WBFS and VAS scales.
No significant differences were found in pain intensity in both groups, depending on the age or sex of the children.
After the application of both scales, it was funded that the control group had higher pain intensities than the experimental group.
Gerçeker, Ayar, Özdemir and Bektaş (2020), Turkey
Evaluate the effects of two different VR methods on procedure related pain, fear and anxiety of children
N= 136, ages 5 to 12 years children undergoing blood draw.
CG: n=46
Prospective randomized study, whose inclusion criteria were children submitted to blood collection, with no chronic or genetic diseases and no visual problems or glasses.
Participants were divided into three groups.
Control group did not benefit from any non-
The groups that used VR had lower pain scores than the control group. There were no
significant differences in the level of pain reported between the two experimental groups.
aged 5-12 years old during blood draw.
EG with Ocean Rift:
n=45 EG with
Rollercoaster: n=45
pharmacological strategy. Ocean Rift VR was a more relaxing environment and
Rollercoaster VR was more distracting.
After the blood draw, the child indicated the intensity of the pain felt, using the WBFS scale.
