Features of virtual reality impact effectiveness of VR pain alleviation therapeutics in pediatric burn patients: A randomized clinical trial.
Features of virtual reality impact effectiveness of VR pain alleviation therapeutics in pediatric burn patients: A randomized clinical trial.
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DOI：
10.1371/journal.pdig.0000440
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发表时间：
2024-01
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影响疼痛减轻效果的虚拟现实（VR）的关键特征仍然未知。我们假设VR体验的特定特征显著影响VR在儿科烧伤敷料护理期间减轻疼痛的有效性。我们的随机对照试验包括6至17岁（含）的儿童，他们在美国烧伤协会认证的儿科烧伤中心的门诊接受治疗。参与者被随机分配（1：1：1）到主动VR（播放VR），被动VR（沉浸在相同的VR环境中，没有交互）或标准护理。在从0到100的范围内，参与者对整体疼痛（主要结局）和VR体验的特征（游戏真实性，乐趣和参与度）进行评分。路径分析评估了这些VR关键特征之间的相互关系及其对自我报告疼痛评分的影响。从2016年12月至2019年1月，共筛选了412例患者，随机分配了90例患者（主动VR组31例，被动VR组30例，标准治疗组29例）。目前的研究仅包括VR组。VR特征的中位评分在活动组和非活动组之间的差异无统计学意义。（现实主义，77.5 [IQR：50-100];乐趣，100 [IQR：81-100];参与，90 [IQR：70-100]）和被动（现实主义，72 [IQR：29-99];乐趣，93.5 [IQR：68-100];参与，95 [IQR：50-100]）VR分心类型。VR参与对自我报告的疼痛评分有显著的直接（-0.39）和总（-0.44）影响（p<0.05）。关键的VR功能会显著影响其减轻疼痛的效果。路径模型提出了一种超越分心的镇痛机制。VR特征评分的差异部分解释了主动VR比被动VR更显著的镇痛效果。试用注册：ClinicalTrials.gov标识符：NCT 04544631。在这项随机对照试验中，90名6-17岁（含）的儿童烧伤患者在儿科医疗中心接受了烧伤敷料更换，虚拟现实（VR）的三个关键特征（游戏真实性，乐趣和参与）显著影响烧伤敷料更换期间自我报告的疼痛评分。这些发现提供了VR影响疼痛感知的潜在机制的见解，支持分心作为VR镇痛的关键机制，并强调了一个潜在的神经生理机制，而不仅仅是分心。未来的研究应采用纵向设计，开发VR功能的客观测量方法，开发操作VR功能的方法，考虑清晰和具体的术语来描述数字体验，并进一步测试VR游戏的关键功能，这些功能可以在各种医疗过程中有效影响VR疼痛缓解疗法。
Key features of virtual reality (VR) that impact the effectiveness of pain reduction remain unknown. We hypothesized that specific features of the VR experience significantly impact VR’s effectiveness in reducing pain during pediatric burn dressing care. Our randomized controlled trial included children 6 to 17 years (inclusive) who were treated in the outpatient clinic of an American Burn Association–verified pediatric burn center. Participants were randomly assigned (1:1:1) to active VR (playing the VR), passive VR (immersed in the same VR environment without interactions), or standard-of-care. On a scale from 0 to 100, participants rated overall pain (primary outcome) and features of the VR experience (game realism, fun, and engagement). Path analysis assessed the interrelationships among these VR key features and their impact on self-reported pain scores. From December 2016 to January 2019, a total of 412 patients were screened for eligibility, and 90 were randomly assigned (31 in the active VR group, 30 in the passive VR group, and 29 in the standard-of-care group). The current study only included those in the VR groups. The difference in median scores of VR features was not statistically significant between the active (realism, 77.5 [IQR: 50–100]; fun, 100 [IQR: 81–100]; engagement, 90 [IQR: 70–100]) and passive (realism, 72 [IQR: 29–99]; fun, 93.5 [IQR: 68–100]; engagement, 95 [IQR: 50–100]) VR distraction types. VR engagement had a significant direct (-0.39) and total (-0.44) effect on self-reported pain score (p<0.05). Key VR features significantly impact its effectiveness in pain reduction. The path model suggested an analgesic mechanism beyond distraction. Differences in VR feature scores partly explain active VR’s more significant analgesic effect than passive VR. Trial Registration: ClinicalTrials.gov Identifier: NCT04544631. In this randomized controlled trial of 90 pediatric burn patients aged 6–17 years (inclusive) who received burn dressing changes at a pediatric medical center, three key features of virtual reality (VR) (game realism, fun, and engagement) significantly influence self-reported pain scores during burn dressing changes. These findings provide insight into the potential mechanisms through which VR affects pain perception, supporting distraction as a key mechanism of VR analgesia and highlighting a potential neurophysiological mechanism beyond mere distraction. Future studies should employ longitudinal designs, develop objective measures of VR features, develop methods to manipulate VR features, consider clear and specific terminology to describe digital experiences, and further test key features of VR games that could effectively impact the VR pain alleviation therapeutics during a variety of medical procedures.