Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
Burns. 2023 Nov;49(7):1643-1653. doi: 10.1016/j.burns.2023.05.017. Epub 2023 May 22.
Burns of the chest region constitute a common burn and develops skin contractures around the thorax region. Inhalation of toxic gases and chemical irritants during the fire leads to Acute Respiratory Distress Syndrome (ARDS). Breathing exercises are painful but are needed to help counteract contractures and increase lung capacity. These patients are usually in pain and extremely anxious about chest physiotherapy. Virtual reality distraction is one such technique that is gaining immense popularity when compared to other pain distraction techniques. However, studies examining the efficacy of the virtual reality distraction technique in this population are lacking.
To find and compare the effects of the virtual reality distraction technique as a pain alleviation tool for reducing pain during chest physiotherapy in chest burns patients with ARDS in middle-aged adults.
A randomized controlled study was conducted at the physiotherapy department between 1st Sep 2020 and 30th Dec 2022. The eligible sixty subjects were randomized into two groups: The virtual reality distraction group (n = 30) received virtual reality distraction technique and the control group (n = 30) received progressive relaxation technique before chest physiotherapy as a pain distraction technique. All the participants received chest physiotherapy as a common treatment (treatment as usual). Primary (Visual Analogue Scale - VAS) and secondary (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF), residual volume (RV), functional residual capacity (FRC), total lung capacity (TLC), RV/TLC, and diffusing capacity for carbon monoxide of the lungs (DLCO) outcome measures were measured at baseline, after four weeks, eight weeks and at six months follow up. The effects between the two groups were analyzed using the independent t-test and chi-square test. The intra-group effect was analyzed with a repeated measure ANOVA test.
Baseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following two different training protocols virtual reality distraction group shows more significant changes in pain intensity, FVC, FEV1, FEV1/FVC, PEF, RV, FRC, TLC, RV/TLC, and DLCO (p = 0.001) but not in RV (p = 0.541). The similar improvements were noted in the 8 weeks and 6 months follow up.
The reports of the study concluded that virtual reality distraction is an effective and useful technique in reducing pain and increasing lung capacity in chest burn patient with ARDS following smoke inhalation in community-dwelling middle-aged adults. In the virtual reality distraction group, the patients reported significantly less pain and clinically meaningful changes in pulmonary functions as compared to the control group (physiotherapy + relaxation).
胸部烧伤会导致胸部区域出现皮肤挛缩。火灾中吸入有毒气体和化学刺激物会导致急性呼吸窘迫综合征（ARDS）。呼吸练习虽然疼痛，但有助于对抗挛缩并增加肺活量。这些患者通常会感到疼痛，并对胸部物理治疗感到极度焦虑。虚拟现实分散注意力是一种正在获得广泛关注的技术，与其他疼痛分散技术相比。然而，目前缺乏研究检查虚拟现实分散注意力技术在该人群中的疗效。
寻找并比较虚拟现实分散注意力技术作为减轻 ARDS 中胸部烧伤患者胸部物理治疗期间疼痛的工具的效果，这些患者为中年成年人。
在 2020 年 9 月 1 日至 2022 年 12 月 30 日期间，在物理治疗部门进行了一项随机对照研究。将符合条件的 60 名受试者随机分为两组：虚拟现实分散注意力组（n=30）在接受胸部物理治疗前接受虚拟现实分散注意力技术，对照组（n=30）在接受胸部物理治疗前接受渐进性放松技术作为疼痛分散技术。所有参与者都接受胸部物理治疗作为常规治疗（常规治疗）。主要（视觉模拟量表-VAS）和次要（用力肺活量（FVC）、用力呼气 1 秒（FEV1）、FEV1/FVC、呼气峰流速（PEF）、残气量（RV）、功能残气量（FRC）、总肺容量（TLC）、RV/TLC、肺一氧化碳弥散量（DLCO））在基线、四周、八周和六个月随访时进行测量。使用独立 t 检验和卡方检验分析两组之间的效果。使用重复测量方差分析检验组内效果。
基线人口统计学特征和研究变量显示两组之间分布均匀（p>0.05）。在接受两种不同训练方案四周后，虚拟现实分散注意力组的疼痛强度、FVC、FEV1、FEV1/FVC、PEF、RV、FRC、TLC、RV/TLC 和 DLCO 有更显著的变化（p=0.001），但 RV 无显著变化（p=0.541）。在 8 周和 6 个月随访时也观察到类似的改善。
研究报告的结论是，在社区居住的中年成年人中，对于吸入烟雾后患有 ARDS 的胸部烧伤患者，虚拟现实分散注意力是一种有效且有用的减轻疼痛和增加肺活量的技术。与对照组（物理治疗+放松）相比，虚拟现实分散注意力组的患者报告疼痛明显减轻，肺功能有临床意义的改善。
