L'effetto della realtà virtuale sul dolore procedurale e sull'ansia anticipatoria nei bambini ricoverati al pronto soccorso: revisione sistematica e meta-analisi.
DOI:
https://doi.org/10.54103/dn/20520Parole chiave:
Realtà Virtuale, dolore, ansia anticipatoria, bambini, pronto soccorsoAbstract
BACKGROUND:
Negli ultimi anni si sta diffondendo l’utilizzo della realtà virtuale (RV) come tecnica di distrazione per il controllo del dolore in ambito pediatrico. Nonostante la presenza in letteratura di diverse revisioni sistematiche dedicate, nessuna si focalizza sull’efficacia dell’intervento in pronto soccorso, setting che per i bambini e i caregivers è motivo di grande stress.
OBIETTIVO:
Valutare l’effetto della RV sul dolore dei bambini sottoposti a procedure mediche in Pronto Soccorso.
METODI:
Revisione sistematica con meta-analisi di trial clinici controllati randomizzati a gruppi paralleli. Il reperimento degli studi è avvenuto tramite interrogazione di database biomedici, risorse online e registri di trial. La RV è stata posta a confronto con lo standard of care. L'esito primario è stato il dolore a seguito della procedura. Il rischio di bias è stato valutato con RoB 2. La dimensione d'effetto complessiva è stata calcolata con un modello a effetti casuali. La certezza/qualità dei risultati è stata valutata con l’approccio GRADE.
RISULTATI:
Sei studi con 433 pazienti sono stati inclusi. Il rischio di bias è alto per quattro studi e solleva alcune preoccupazioni per due. Rispetto allo standard of care, l’uso della RV ha avuto un effetto piccolo ma statisticamente significativo sul dolore (SMD: -0.32, IC 95%: -0.56, -0.09). L'eterogeneità tra gli studi è bassa.
CONCLUSIONE:
La realtà virtuale per il dolore nei bambini sottoposti a procedure mediche in pronto soccorso sembra efficace, ma occorrono ulteriori studi a conferma dei risultati.
Riferimenti bibliografici
Birnie KA, Chambers CT. Fernandez CV, Forgeron PA, Latimer MA, McGrath PJ, Cummings EA, Finley GA. (2014). Hospitalized children continue to report undertreated and preventable pain. Pain Res Manag 2014;19(4): 198-204. doi: 10.1155/2014/614784.
Friedrichsdorf SJ, Eull D, Weidner CA. A Children’s comfort promise: how can we do everything possible to prevent and treat pain in children using quality improvement strategies. Pediatr Pain Letter 2016;18(3):26-30.
http://ppl.childpain.org/issues/v18n3_2016/v18n3_friedrichsdorf.pdf
Olsen K, Weinberg E. Pain-less practice: techniques to reduce procedural pain and anxiety in pediatric acute care. Clin Ped Emerg Med 2017;18(1):32-41. doi: 10.1016/j.cpem.2017.01.007.
Cooke MW. UK Ambulance Service Clinical Practice Guidelines (2006). 2021.
http://www.ambo.com.au/download/uk_guidelines_2006.pdf
Birnie KA, Noel M, Chambers CT, Uman LS, Parker JA. Psychological interventions for needle‐related procedural pain and distress in children and adolescents. Cochrane Database of Systematic Reviews 2018; 10(10):CD005179. doi: 10.1002/14651858.CD005179.pub4.
Ali S, McGrath T, Drendel AL. (2016). An evidence-based approach to minimizing acute procedural pain in the emergency department and beyond. Ped Emerg Care 2016;32(1):36-42. doi: 10.1097/PEC.0000000000000669.
Czech O, Wrzeciono A, Rutkowska A, Guzik A, Kiper P, Rutkowski S. (2021). Virtual reality interventions for needle-related procedural pain, fear and anxiety—A systematic review and meta-analysis. J Clin Med 2021;10(15): 3248. doi: 10.3390/jcm10153248.
Vessey JA, Carlson KL, McGill J. (1994). Use of distraction with children during an acute pain experience. Nurs Res 1994;43(6):369-72. PMID: 7971302.
Hoffman HG. Virtual-reality therapy. Sci Am 2004a;291(2):58-65. doi: 10.1038/scientificamerican0804-58.
Gold JI, Kim SH, Kant AJ, Joseph MH, Rizzo AS. (2006). Effectiveness of virtual reality for pediatric pain distraction during iv placement. CyberPsychol Behav 2006;9(2):207-12. doi: 10.1089/cpb.2006.9.207
Lambert V, Boylan P, Boran L, Hicks P, Kirubakaran R, Devane D, Matthews A. (2020). Virtual reality distraction for acute pain in children. Cochrane Database Syst Rev 2020; 10(10):CD010686. doi: 10.1002/14651858.CD010686.pub2.
Carrougher GJ, Hoffman HG, Nakamura D, Lezotte D, Soltani M, Leahy L, Engrav LH, Patterson DR. The effect of virtual reality on pain and range of motion in adults with burn injuries. J Burn Care Res 2009;30(5):785-91. doi: 10.1097/BCR.0b013e3181b485d3.
Markus LA, Willems KE, Maruna CC, Schmitz CL, Pellino TA, Wish JR, Faucher LD, Schurr MJ. Virtual reality: feasibility of implementation in a regional burn center. Burns 2009;35(7):967-9. doi: 10.1016/j.burns.2009.01.013.
Spiegel BM. Virtual medicine: how virtual reality is easing pain, calming nerves and improving health. Med J Aust 2018;209(6):245-7. doi: 10.5694/mja17.00540.
Hoffman HG, Chambers GT, Meyer WJ, Arceneaux LL, Russell WJ, Seibel EJ, Richards TL, Sharar SR, Patterson DR. Virtual reality as an adjunctive non-pharmacologic analgesic for acute burn pain during medical procedures. Ann Behav Med 2011;41(2):183-91. doi: 10.1007/s12160-010-9248-7.
Hoffman HG, Richards TL, Coda B, Bills AR, Blough D, Richards AL, Sharar SR. Modulation of thermal pain-related brain activity with virtual reality: evidence from fMRI. Neuroreport, 2004b;15(8):1245-8. doi: 10.1097/01.wnr.0000127826.73576.91.
Sharar SR, Carrougher GJ, Nakamura D, Hoffman HG, Blough DK, Patterson DR. Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. Arch Phys Med Rehabil 2007;88(12):S43-9. doi: 10.1016/j.apmr.2007.09.004.
Hoffman HG, Richards TL, Van Oostrom T, Coda BA, Jensen MP, Blough DK, Sharar SR. (2007). The analgesic effects of opioids and immersive virtual reality distraction: evidence from subjective and functional brain imaging assessments. Anesth Analg 2007;105(6):1776-83. doi: 10.1213/01.ane.0000270205.45146.db.
Rutter CE, Dahlquist LM, Weiss KE. Sustained efficacy of virtual reality distraction. J Pain 2009;10(4):391-7. doi: 10.1016/j.jpain.2008.09.016.
Eijlers R, Utens EM, Staals LM, de Nijs PF, Berghmans JM, Wijnen RM, Hillegers MHJ, Dierckx B, Legerstee JS. Systematic review and meta-analysis of virtual reality in pediatrics: effects on pain and anxiety. Anesth Analg 2019;129(5):1344. doi: 10.1213/ANE.0000000000004165.
Gates M, Hartling, L, Shulhan-Kilroy J, MacGregor T, Guitard S, Wingert A, Featherstone R, Vandermeer B, Poonai N, Kircher J, Perry S, Graham T, Scott SD, Ali S. (2020). Digital Technology Distraction for Acute Pain in Children: A Meta-analysis. Pediatrics 2020;145(2):e20191139. doi: 10.1542/peds.2019-1139.
Huang Q, Lin J, Han R, Peng C, Huang A. Using virtual reality exposure therapy in pain management: A systematic review and meta-analysis of randomized controlled trials. Value Health 2021;25(2):288-301. doi: 10.1016/j.jval.2021.04.1285
Iannicelli AM, Vito D, Dodaro CA, De Matteo P, Nocerino R, Sepe R, Raia V. (2019). Does virtual reality reduce pain in pediatric patients? A systematic review. Ital J Pediatr 2019;45(1):1-6. doi: 10.1186/s13052-019-0757-0.
Li T, Fu Y, Yang Y, Zhou YE. Control effect of virtual reality technology on procedural pain in children’s wound: A meta-analysis. Medicine 2022:101(40):e30961. doi: 10.1097/MD.0000000000030961.
Lluesma-Vidal M, González RC, García-Garcés L, Sánchez-López MI, Peyro L, Ruiz-Zaldibar C. Effect of Virtual Reality on Pediatric Pain and Fear During Procedures Involving Needles: Systematic Review and Meta-analysis. JMIR Serious Games 2022;10(3):e35008. doi: 10.2196/35008.
Saliba T, Schmartz D, Fils JF, Van Der Linden P. The use of virtual reality in children undergoing vascular access procedures: a systematic review and meta-analysis. J Clin Monit Comput 2022;36(4):1003-12. doi: 10.1007/s10877-021-00725-w.
Pancekauskaitė G, Jankauskaitė L. Paediatric pain medicine: pain differences, recognition and coping acute procedural pain in paediatric emergency room. Medicina 2018 54(6):94. doi: 10.3390/medicina54060094.
Sterne JAC, Savović J, Page MJ, Elbers RG, Blencowe NS, Boutron I, Cates CJ, Cheng H-Y, Corbett MS, Eldridge SM, Emberson JR, Hernán MA, Hopewell S, Hróbjartsson A, Junqueira DR, Peter Jüni P, Kirkham JJ, Lasserson T, Li T, McAleenan A, Reeves BC, Shepperd S, Shrier I, Stewart LA, Tilling K, White IR, Whiting PF, Higgins JPT RoB 2: a revised tool for assessing risk of bias in randomised trials BMJ 2019;366. doi: https://doi.org/10.1136/bmj.l4898.
Cohen J. Statistical power analysis for the behavioral sciences, 2nd edn. Lawrence Erlbaum Associates, Hillsdale1998.
Cochran WG. (1950). The comparison of percentages in matched samples. Biometrika 1950;37(3/4):256-66. PMID: 14801052.
Higgins JP, Thompson SG, Deeks, JJ, Altman DG. Measuring inconsistency in meta-analyses. BMJ 2003;327(7414):557-60. doi: 10.1136/bmj.327.7414.557.
Calderón MA, Boyle RJ, Penagos M, Sheikh A (2011) Immunotherapy: the meta-analyses. What have we learned? Immunol Allergy Clin North Am 2011;31(2):159-73. doi: 10. 1016/j. iac.2011.02.002.
Sterne JA, Egger M. Funnel plots for detecting bias in meta-analysis: guidelines on choice of axis. J Clin Epidemiol 2001;54(10):1046-55. doi: 10.1016/s0895-4356(01)00377-8.
Duval S, Tweedie R. Trim and fill: a simple funnel‐plot–based method of testing and adjusting for publication bias in meta‐analysis. Biometrics 2000;56(2):455-63. doi: 10.1111/j.0006-341x.2000.00455.x.
Egger M, Smith GD, Schneider M, Minder C. Bias in meta-analysis detected by a simple, graphical test. BMJ 1997;315(7109):629-34. doi: 10.1136/bmj.315.7109.629.
Begg CB, Mazumdar M. Operating characteristics of a rank correlation test for publication bias. Biometrics 1994;50(4):1088-101. PMID: 7786990.
Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ 2021;372:n71. doi: 10.1136/bmj.n71.
Balshem H, Helfand M, Schünemann HJ, Oxman AD, Kunz R, Brozek J, Gunn EV, Falck-Ytter Y, Meerpohl J, Norris S, Guyatt GH. GRADE guidelines: 3. Rating the quality of evidence. J Clin Epidemiol 2011;64(4):401-6. doi: 10.1016/j.jclinepi.2010.07.015.
Canares T, Parrish C, Santos C, Badawi A, Stewart A, Kleinman, K, Psoter K, McGuire J. (2021). Pediatric coping during venipuncture with virtual reality: Pilot randomized controlled trial. JMIR Pediatr Parent 2021;4(3):e26040. doi: 10.2196/26040.
Chan E, Hovenden M, Ramage E, Ling N, Pham JH, Rahim A, Lam C, Liu L, Foster S, Sambell R, Jeyachanthiran K, Crock C, Stock A, Hopper AM, Cohen S, Davidson A, Plummer K, Mills E, Craig SS, Deng G, Leong P. Virtual reality for pediatric needle procedural pain: two randomized clinical trials. J Pediatr 2019;209:160-7. 10.1016/j.jpeds.2019.02.034.
Schlechter AK, Whitaker W, Iyer S, Gabriele G, Wilkinson, M. Virtual reality distraction during pediatric intravenous line placement in the emergency department: A prospective randomized comparison study. Am J Emerg Med 2021;44:296-9. doi: 10.1016/j.ajem.2020.04.009.
Lee HN, Bae W, Park JW, Jung JY, Hwang S, Kim DK, Kwak YH. Virtual reality environment using a dome screen for procedural pain in young children during intravenous placement: A pilot randomized controlled trial. PloS One 2021;16(8):e0256489. doi: 10.1371/journal.pone.0256489.
Ferraz-Torres M, Martín-Rodríguez S, García-Vivar C, Soto-Ruiz N, Escalada-Hernández P. Passive or interactive virtual reality? The effectiveness for pain and anxiety reduction in pediatric patients. Virtual Reality 2022;26: 1307-16. 10.1007/s10055-022-00633-7.
Chen YJ, Cheng SF, Lee PC, Lai CH, Hou IC, Chen CW. Distraction using virtual reality for children during intravenous injections in an emergency department: A randomised trial. J Clin Nurs 2020;29(3-4), 503-10.
Dumoulin S, Bouchard S, Ellis J, Lavoie KL, Vézina 1 M-P, Charbonneau P, Tardif J, Hajjar A. A randomized controlled trial on the use of virtual reality for needle-related procedures in children and adolescents in the emergency department. Games Health J 2019;8(4), 285-93. doi: 10.1089/g4h.2018.0111.
Goldman RD, Behboudi A. (2021a). Virtual reality for intravenous placement in the emergency department—a randomized controlled trial. Eur J Pediatr 2021A;180(3), 725-731. doi: 10.1089/g4h.2018.0111.
Goldman RD, Behboudi A. Pilot randomized controlled trial of virtual reality vs. standard-of-care during pediatric laceration repair. J Child Adolescent trauma 14(2), 295-298. doi: 10.1089/g4h.2018.0111.
Litwin SP, Nguyen C, Hundert A, Stuart S, Liu D, Maguire B, Matava C, Stinson J. Virtual reality to reduce procedural pain during IV insertion in the pediatric emergency department: a pilot randomized controlled trial. Clin J Pain 2021;37(2):94-101. doi: 10.1097/AJP.0000000000000894.
Osmanlliu E, Trottier ED,Bailey B , Maryse Lagacé , Certain M, Khadra C, Marisol Sanchez , Thériault C, Paquin D, Côtes-Turpin C, Le May S. Distraction in the emergency department using virtual reality for intravenous procedures in children to improve comfort (DEVINCI): a pilot pragmatic randomized controlled trial. Can J Emerg Med 2021;23(1):94-102. doi: 10.1007/s43678-020-00006-6.
Hicks CL, von Baeyer CL, Spafford PA, van Korlaar I, & Goodenough B. The Faces Pain Scale–Revised: toward a common metric in pediatric pain measurement. Pain 2001;93(2):173-83. doi: 10.1016/S0304-3959(01)00314-1.
Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediat Nurs 1988;14(1):9–17.
McMurtry CM, Noel M, Chambers CT, McGrath PJ.
Children's fear during procedural pain: preliminary investigation of the Children's Fear Scale. Health Psychol 2011;30(6):780. doi: 10.1037/a0024817.
Venham LL, Gaulin-Kremer E. (1979). A self-report measure of situational anxiety for young children. Pediatr Dent 1979;1(2):91-6. PMID: 399677.
Luo D, Wan X, Liu J, Tong T. Optimally estimating the sample mean from the sample size, median, mid-range, and/or mid-quartile range. Stati Methods Med Res 2018;27(6):1785-805. doi: 10.1177/0962280216669183.
Wan X, Wang W, Liu J, Tong T. Estimating the sample mean and standard deviation from the sample size, median, range and/or interquartile range. BMC Med Res Methodol 2014;14(1):1-13. doi: 10.1186/1471-2288-14-135.
Koller D, Goldman RD. Distraction techniques for children undergoing procedures: a critical review of pediatric research. J Pediatr Nurs 2012;27(6):652-81. doi: 10.1016/j.pedn.2011.08.001.
Scheffler M, Koranyi S, Meissner W, Strauss B, Rosendahl J. Efficacy of non-pharmacological interventions for procedural pain relief in adults undergoing burn wound care: A systematic review and meta-analysis of randomized controlled trials. Burns 2018;44(7):1709-20. doi: 10.1016/j.burns.2017.11.019.
Ang SP, Montuori M, Trimba Y, Maldari N, Patel D, Chen . QC. Recent applications of virtual reality for the management of pain in burn and pediatric patients. Curr Pain Headache Rep 2021;25(1):1-8. doi: 10.1007/s11916-020-00917-0.
McGrath PJ, Walco GA, Turk DC, Dworkin RH, Brown MT, Davidson K, Eccleston C, Finley GA, Goldschneider K, Haverkos L, Hertz SH, Ljungman G, Palermo T, Rappaport BA, Rhodes T, Schechter N, Scott J, Sethna N, Svensson OK, Stinson J, von Baeyer CL, Walker L, Weisman S, White RE, Zajicek A, Zeltzer L; PedIMMPACT. Core outcome domains and measures for pediatric acute and chronic/recurrent pain clinical trials: PedIMMPACT recommendations. J Pain 2008;9(9):771-83. doi: 10.1016/j.jpain.2008.04.007.
Manne SL, Jacobsen PB, Redd WH. Assessment of acute pediatric pain: do child self-report, parent ratings, and nurse ratings measure the same phenomenon?. Pain 1992;48(1):45-52. doi: 10.1016/0304-3959(92)90130-4.
Simons LE, Sieberg CB, Carpino E, Logan D, Berde C. The Fear of Pain Questionnaire (FOPQ): assessment of pain-related fear among children and adolescents with chronic pain. J Pain 2011;12(6):677-86. doi: 10.1016/j.jpain.2010.12.008.
Taddio A, Ipp M, Thivakaran S, Jamal A, Parikh C, Smart S, Sovran J, Stephens D, Katz J. Survey of the prevalence of immunization non-compliance due to needle fears in children and adults. Vaccine 2012;30(32):4807-12. doi: 10.1016/j.vaccine.2012.05.011.
Won AS, Bailey J, Bailenson J, Tataru C, Yoon IA, Golianu B. Immersive Virtual Reality for Pediatric Pain. Children (Basel, Switzerland) 2017;4(7):52. doi: 10.3390/children4070052.
Almeida A, Rebelo F, Noriega P, Vilar E. Virtual reality self induced cybersickness: an exploratory study. In International conference on applied human factors and ergonomics 2017;26-33. Springer, Cham.
LaViola Jr JJ. A discussion of cybersickness in virtual environments. ACM Sigchi Bull 2000;32(1):47-56. doi: 10.1145/333329.333344.
Shafer DM, Carbonara CP, Korpi MF. Modern virtual reality technology: cybersickness, sense of presence, and gender. Media Psychol Rev 2017; 11(2):1. https://www.researchgate.net/profile/DanielShafer-/publication/322202078_Modern_Virtual_Reality_Technology_Cybersickness_Sense_of_Presence_and_Gender/links/5a5395c20f7e9bbc1056fbd7/Modern-Virtual-Reality-Technology-Cybersickness-Sense-of-Presence-and-Gender.pdf
Gorini A, Riva G. Virtual reality in anxiety disorders: the past and the future. Expert Rev Neurother 2008;8(2):215-33. doi: 10.1586/14737175.8.2.215.
Dowloads
Pubblicato
Come citare
Fascicolo
Sezione
Licenza
Copyright (c) 2024 Luca Giuseppe Re, Viviana Fusetti, Silvia Cilluffo, Laura Zoppini
Questo lavoro è fornito con la licenza Creative Commons Attribuzione - Non commerciale - Non opere derivate 4.0 Internazionale.
Accettato 2023-11-09
Pubblicato 2024-01-31
