Child Health Evaluative Sciences.
Department of Anesthesiology, Perioperative and Pain Medicine, University of Calgary, Alberta Children's Hospital Research Institute, Calgary, AB, Canada.
Clin J Pain. 2021 Dec 30;38(3):189-196. doi: 10.1097/AJP.0000000000001017.
We aimed to determine the feasibility of virtual reality (VR) distraction for children with cancer undergoing subcutaneous port (SCP) access. We also aimed to estimate preliminary treatment effects of VR compared with an active distraction control (iPad).
A single-site pilot randomized controlled trial comparing VR to iPad distraction was conducted. Eligible children and adolescents were aged 8 to 18 years undergoing treatment for cancer with upcoming SCP needle insertions. Intervention acceptability was evaluated by child, parent, and nurse self-report. Preliminary effectiveness outcomes included child-reported pain intensity, distress, and fear. Preliminary effectiveness was determined using logistic regression models with outcomes compared between groups using preprocedure scores as covariates.
Twenty participants (mean age 12 y) were randomized to each group. The most common diagnosis was acute lymphocytic leukemia (n=23, 58%). Most eligible children and adolescents (62%) participated, and 1 withdrew after randomization to the iPad group. Nurses, parents, and children reported the interventions in both groups to be acceptable, with the VR participants reporting significantly higher immersion in the distraction environment (P=0.0318). Although not statistically significant, more VR group participants indicated no pain (65% vs. 45%) and no distress (80% vs. 47%) during the procedure compared with the iPad group. Fear was similar across groups, with ~60% of the sample indicating no fear.
VR was feasible and acceptable to implement as an intervention during SCP access. Preliminary effectiveness results indicate that VR may reduce distress and distress compared with iPad distraction. These data will inform design of a future full-scale randomized controlled trial.
我们旨在确定虚拟现实（VR）分散注意力对接受皮下端口（SCP）接入的癌症儿童的可行性。我们还旨在估计 VR 与主动分散注意力对照（iPad）相比的初步治疗效果。
进行了一项单站点先导随机对照试验，比较 VR 与 iPad 分散注意力。合格的儿童和青少年年龄在 8 至 18 岁之间，正在接受癌症治疗，并即将进行 SCP 针插入。通过儿童，父母和护士的自我报告评估干预的可接受性。初步有效性结果包括儿童报告的疼痛强度，痛苦和恐惧。使用逻辑回归模型确定初步效果，使用预程序评分作为协变量比较组间结果。
每组随机分配 20 名参与者（平均年龄 12 岁）。最常见的诊断是急性淋巴细胞白血病（n=23，58％）。大多数合格的儿童和青少年（62％）参与了研究，1 名参与者在随机分配到 iPad 组后退出。护士，父母和儿童报告说两组的干预措施都可以接受，VR 参与者报告说他们在分散注意力的环境中的沉浸感明显更高（P=0.0318）。尽管没有统计学意义，但与 iPad 组相比，更多的 VR 组参与者在手术过程中表示没有疼痛（65％对 45％）和没有痛苦（80％对 47％）。恐惧在两组之间相似，约有 60％的样本表示没有恐惧。
VR 作为 SCP 接入期间的干预措施是可行且可接受的。初步有效性结果表明，与 iPad 分散注意力相比，VR 可能会减轻痛苦和痛苦。这些数据将为未来的全面随机对照试验设计提供信息。
