Departments of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences, Keck School of Medicine, University of Southern California, Los Angeles, CA, United States.
Department of Anesthesiology Critical Care Medicine, The Saban Research Institute, Children's Hospital Los Angeles, Los Angeles, CA, United States.
J Med Internet Res. 2024 Jul 1;26:e53196. doi: 10.2196/53196.
Virtual reality (VR) is a well-researched digital intervention that has been used for managing acute pain and anxiety in pediatric patients undergoing various medical procedures. This study focuses on investigating the role of unique patient characteristics and VR immersion level on the effectiveness of VR for managing pediatric pain and anxiety during venipuncture.
The purpose of this study is to determine how specific patient characteristics and level of immersion during a VR intervention impact anxiety and pain levels for pediatric patients undergoing venipuncture procedures.
This study is a secondary data analysis of 2 combined, previously published randomized control trials on 252 pediatric patients aged 10-21 years observed at Children's Hospital Los Angeles from April 12, 2017, to July 24, 2019. One randomized clinical trial was conducted in 3 clinical environments examining peripheral intravenous catheter placement (radiology and an infusion center) and blood draw (phlebotomy). Conditional process analysis was used to conduct moderation and mediation analyses to assess the impact of immersion level during the VR intervention.
Significant moderation was found between the level of immersion and anxiety sensitivity when predicting postprocedural anxiety (P=.01). Patients exhibiting the highest anxiety sensitivity within the standard of care yielded a 1.9 (95% CI 0.9-2.8; P<.001)-point elevation in postprocedural anxiety relative to individuals with high immersion levels. No other significant factors were found to mediate or moderate the effect of immersion on either postprocedural anxiety or pain.
VR is most effective for patients with higher anxiety sensitivity who report feeling highly immersed. Age, location of the procedure, and gender of the patient were not found to significantly impact VR's success in managing levels of postprocedural pain or anxiety, suggesting that immersive VR may be a beneficial intervention for a broad pediatric population.
ClinicalTrials.gov NCT04268901; https://clinicaltrials.gov/study/NCT04268901.
虚拟现实（VR）是一种经过充分研究的数字干预手段，已被用于管理接受各种医疗程序的儿科患者的急性疼痛和焦虑。本研究重点研究了患者特征和 VR 沉浸水平的独特性对 VR 在管理儿科患者静脉穿刺过程中的疼痛和焦虑的有效性的影响。
本研究旨在确定特定的患者特征和 VR 干预期间的沉浸程度如何影响接受静脉穿刺程序的儿科患者的焦虑和疼痛水平。
这是对 2017 年 4 月 12 日至 2019 年 7 月 24 日期间在洛杉矶儿童医院观察到的 252 名 10-21 岁儿科患者的 2 项已发表的随机对照试验的二次数据分析。一项随机临床试验在 3 个临床环境中进行，研究外周静脉导管放置（放射科和输液中心）和采血（采血）。条件过程分析用于进行调节和中介分析，以评估 VR 干预期间沉浸水平的影响。
在预测术后焦虑时，发现沉浸水平与焦虑敏感之间存在显著的调节作用（P=.01）。与高沉浸度的个体相比，在标准护理中表现出最高焦虑敏感性的患者在术后焦虑中升高了 1.9 分（95%CI 0.9-2.8；P<.001）。没有发现其他显著因素可以调解或调节沉浸对术后焦虑或疼痛的影响。
对于报告感觉高度沉浸的焦虑敏感性较高的患者，VR 最有效。患者的年龄、手术地点和性别均未发现对 VR 成功管理术后疼痛或焦虑水平有重大影响，这表明沉浸式 VR 可能对广泛的儿科人群有益。
ClinicalTrials.gov NCT04268901；https://clinicaltrials.gov/study/NCT04268901。
