Desai Bhumit, Newcomb Nicholas, Plost Brielle, Waldron Sean, Sarkar Korak, Haber Lawrence
Ochsner Medical Center, New Orleans, LA, USA.
University of Queensland, Ochsner Clinical School, New Orleans, LA, USA.
J Child Orthop. 2024 May 26;18(4):414-420. doi: 10.1177/18632521241254707. eCollection 2024 Aug.
Distraction therapy use such as virtual reality is novel in the pediatric orthopedic field. In this study, we use subjective and objective metrics to evaluate virtual reality efficacy to reduce anxiety and pain in a pediatric orthopedic cohort.
A prospective randomized controlled trial included patients between age 5 and 17 years, presenting to a tertiary care pediatric orthopedic clinic. Parallel groups underwent orthopedic procedures in clinic, utilizing immersive and interactive virtual reality distraction therapies versus standard of care. Procedures included cast application, cast removal, bone pin removal, and fracture reduction. All preprocedure parameters were similar between the groups. Primary outcome was the difference between maximum procedural heart rate and baseline. Secondary outcomes included Wong Baker FACES Rating Scale (Wong & Baker, 1988, Oklahoma, USA) for pain and Visual Analog Scale scores for anxiety.
Ninety-five patients (66 M, 29 F) underwent 59 cast removals, 26 cast applications, 7 percutaneous pin removals, and 3 fracture reductions. Average patient age in the virtual reality and control cohorts was 10.1 (5-17) and 10.6 (5-17), respectively. Average change in maximum heart rate in the virtual reality and control groups was 10.6 ± 10.1 versus 18.4 ± 11.0 (p = 0.00048). The virtual reality group demonstrated trends toward lower perceived anxiety (1.7 ± 2.8 versus 2.9 ± 3.6, = 0.0666) when compared to controls.
This level 1 study is the first to utilize objective biometric measurements to evaluate use of interactive virtual reality during multiple types of pediatric orthopedic procedures in the clinical setting. The findings suggest that an interactive and immersive virtual reality experience can be effective in reducing pain and anxiety.
Level 1, Randomized Controlled Trial.
诸如虚拟现实之类的分散注意力疗法在小儿骨科领域尚属新颖。在本研究中，我们使用主观和客观指标来评估虚拟现实在减轻小儿骨科队列焦虑和疼痛方面的疗效。
一项前瞻性随机对照试验纳入了5至17岁到三级护理小儿骨科诊所就诊的患者。平行组在诊所接受骨科手术，一组采用沉浸式交互式虚拟现实分散注意力疗法，另一组采用标准护理。手术包括打石膏、拆石膏、取骨钉和骨折复位。两组术前所有参数相似。主要结局是手术期间最高心率与基线之间的差异。次要结局包括用于评估疼痛的面部表情疼痛评分量表（Wong & Baker，1988年，美国俄克拉荷马州）和用于评估焦虑的视觉模拟量表评分。
95名患者（66名男性，29名女性）接受了59次拆石膏、26次打石膏、7次经皮取钉和3次骨折复位。虚拟现实组和对照组的平均患者年龄分别为10.1岁（5至17岁）和10.6岁（5至17岁）。虚拟现实组和对照组最高心率的平均变化分别为10.6±10.1和18.4±11.0（p = 0.00048）。与对照组相比，虚拟现实组的感知焦虑有降低趋势（1.7±2.8对2.9±3.6，p = 0.0666）。
这项1级研究首次利用客观生物特征测量来评估在临床环境中多种小儿骨科手术期间交互式虚拟现实的应用。研究结果表明，交互式沉浸式虚拟现实体验可有效减轻疼痛和焦虑。
1级，随机对照试验。
