A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns

Abstract

This randomized, controlled, within-subjects (crossover design) study examined the effects of immersive virtual reality as an adjunctive analgesic technique for hospitalized pediatric burn inpatients undergoing painful physical therapy. Fifty-four subjects (6-19 years old) performed range-of-motion exercises under a therapist's direction for 1-5 days. During each session, subjects spent equivalent time in both the virtual reality and the control conditions (treatment order randomized and counterbalanced). Graphic rating scale scores assessing the sensory, affective, and cognitive components of pain were obtained for each treatment condition. Secondary outcomes assessed subjects' perception of the virtual reality experience and maximum range-of-motion. Results showed that on study day one, subjects reported significant decreases (27-44%) in pain ratings during virtual reality. They also reported improved affect ("fun") during virtual reality. The analgesia and affect improvements were maintained with repeated virtual reality use over multiple therapy sessions. Maximum range-of-motion was not different between treatment conditions, but was significantly greater after the second treatment condition (regardless of treatment order). These results suggest that immersive virtual reality is an effective nonpharmacologic, adjunctive pain reduction technique in the pediatric burn population undergoing painful rehabilitation therapy. The magnitude of the analgesic effect is clinically meaningful and is maintained with repeated use.

Figure 1

CONSORT diagram for subject enrollment, allocation, and follow-up. The University of Washington IRB prohibits data collection on eligible research subjects who do not participate for any reason. Thus, information on potential subjects assessed, excluded, or who refused is not available.

Figure 2

Subjective pain and fun ratings (0 to 100 GRS assessment) during the control condition (standard pharmacologic therapy without virtual reality – white bars) and the virtual reality condition (standard pharmacologic therapy plus immersive virtual reality – black bars) on the first study day (* p < 0.05).

Figure 3

Subjective pain and fun ratings (0 to 100 GRS assessment) during the control condition (standard pharmacologic therapy without virtual reality – white bars) and the virtual reality condition (standard pharmacologic therapy plus immersive virtual reality – black bars) on multiple study days. Virtual reality results in a persistent decrease in “worst pain” (panel A), “time spent thinking about pain” (panel B), and “pain unpleasantness” (panel C) over several days of therapy (* p < 0.05). Virtual reality also results in a persistent increase in “fun” (panel D) over several days of therapy (* p < 0.05).