106 - A randomized controlled trial of virtual reality-based distraction for intravenous cannulation-related distress in children

Publication Number: 106.3663

Summer Hudson, University of Alberta, Edmonton, AB, Canada; Samina Ali, University of Alberta, Edmonton, AB, Canada; Manasi Rajagopal, University of Alberta Faculty of Medicine and Dentistry, Scottsdale, AZ, United States; Jennifer Stinson, The Hospital for Sick Children, Toronto, ON, Canada; Katie Gourlay, The University of Calgary, Calgary, AB, Canada; Ben W. Vandermeer, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Keon Ma, University of Calgary, Calgary, AB, Canada; Bailey Felkar, Childrens Hospital London, LHSC, Thorndale, ON, Canada; Kurt Schreiner, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada; Amanda Proctor, Stollery Children's Hospital, Edmonton, AB, Canada; Lisa Hartling, University of Alberta Faculty of Medicine and Dentistry, Edmonton, AB, Canada

Background: Virtual reality (VR) has emerged as a promising tool to ameliorate procedure-related distress in the pediatric healthcare setting; however, existing evidence has largely employed custom VR software, which can be expensive and inaccessible.

Objective: To assess the effectiveness of commercially available VR-based distraction when added to standard of care (SOC, which included topical anesthetic cream), in reducing distress in children undergoing intravenous insertion (IVI) in the pediatric emergency department (PED).

Design/Methods: Children aged 6 to 17 years requiring IVI at the Stollery Children’s Hospital were recruited for a two-arm randomized controlled trial. The primary outcome was child distress, measured using the Observational Scale of Behavioural Distress – Revised (OSBD-R, score range 0-23.5). Secondary outcomes included child pain intensity (measured with the Faces Pain Scale-Revised, score range 0-10) and child fear [measured by the Children's Fear Scale (CFS), score range 0-4] during the procedure. Trial registration number: NCT04291404C.

Results: 82 children and their caregivers were included. Mean (SD) child age was 11.1 years (2.9) and 54% (45/82) were female; 72% (55/76) had experienced a previous IVI. There was no difference in mean (SD) pre-procedural OSBD-R scores in the VR arm [0.39 (0.70)] compared to SOC arm [0.18 (0.49)] (p = 0.16). Post-procedure OSBD-R mean (SD) scores were also similar across VR [0.16 (0.30)] vs SOC [0.19 (0.48)] arms (p = 0.45). There was no difference between measured mean (SD) total OSBD-R scores in the VR arm [1.1 (1.5)] compared to SOC [0.7 (1.4)] (p = 0.08). There was no reduction in mean (SD) procedural pain intensity in the VR group [4.2 (3.1)] compared to the SOC group [4.1 (3.2)] (p = 0.85). There was no difference in mean (SD) child CFS score during IVI in the VR arm [0.97 (1.33)] versus SOC [0.97 (1.15)]. Notably, technical issues with the VR equipment were reported in 26% (10/39) of cases.

Conclusion(s): VR distraction therapy employing commercially available software was not associated with reduction in procedural distress, pain, or fear, above that provided with SOC, for children undergoing IVI in the PED. This result highlights the need for more accessible custom VR distraction software, created to meet the unique psychological needs of children undergoing medical procedures in the high stress ED setting. Further study is needed to directly compare custom versus commercially available VR software, and other distraction techniques, for use in the healthcare setting.