Relaxation-VR: Implementation of Virtual Reality for Children in Hospital
Condition: Anxiety; Pain; Stress
Study type: Observational

Summary: 
      Although on an international level, accumulating evidence supports the feasibility and
      effectiveness of VR for pain and anxiety management, in Belgium, adoption of VR in clinical
      practice is limited and local trials are scarce. In order to improve translation from
      research to practice, the current study will focus on the feasibility, acceptability,
      tolerability and preliminary effectiveness of 'Relaxation-VR', a VR application aiming to
      reduce anxiety and pain for children admitted to hospital, as experienced by both patients
      and clinical staff. This study will take place at the paediatric wards of two hospitals
      interested in adopting this innovative technology for improving both patient care (e.g.,
      anxiety and pain reduction) and staff workload (e.g., shorter procedure times), UZ Brussel
      and AZ Sint-Maarten.
    

Detailed description: 
      Current pain and anxiety management for children in hospital includes pharmacological
      analgesia (e.g. opioid therapy) with potential negative side effects. In addition, a
      non-pharmacological approach involves various distraction techniques, either passive (e.g.,
      music, movies) or active (e.g., interactive toys, electronic games, storytelling by the
      nursing staff). However, these distraction techniques can often be time consuming for the
      already busy and even over-demanded nursing staff.

      A combination of distraction, extinction learning, cognitive-behavioral principles, mindful
      meditation, stress reduction, gate-control theory, and the spotlight theory of attention is
      believed to be the mechanism behind VR's effectiveness in pain management. Accumulating
      evidence supports VR as a feasible and effective method to alleviate anxiety and pain for
      paediatric patients during lumbar punctures, intravenous injections, burn wound care and
      rehabilitation. In particular, a recent meta-analysis reported that the use of VR was
      significantly more effective in reducing pain (14 studies) and anxiety (7 studies) than care
      as usual (CAU), with large effect size. Moreover, for chest radiography, the use of VR has
      also significantly reduced procedure time, while increasing patient satisfaction. As such,
      adding the use of VR to standard pain and anxiety management methods might improve both
      effectiveness and efficiency of current practice.

      Although on an international level, accumulating evidence supports the feasibility and
      effectiveness of VR for pain and anxiety management, in Belgium, adoption of VR in clinical
      practice is limited and local trials are scarce. In order to improve translation from
      research to practice, the current study will focus on the feasibility, acceptability,
      tolerability and preliminary effectiveness of 'Relaxation-VR', a VR application aiming to
      reduce anxiety and pain for children admitted to hospital, as experienced by both patients
      and clinical staff. This study will take place at the paediatric wards of two hospitals
      interested in adopting this innovative technology for improving both patient care (e.g.,
      anxiety and pain reduction) and staff workload (e.g., shorter procedure times), UZ Brussel
      and AZ Sint-Maarten.
    

Intervention name(s): Virtual reality
Intervention type(s): Other
Intervention description(s): The VR intervention, Relaxation-VR, is a VR application developed by Psylaris aiming to reduce anxiety/stress and pain by distracting the patient in a relaxing environment. Relaxation-VR will be administered via a commercially available VR headset (Oculus Go). The VR headset is a piece of equipment that a person wears over their eyes that allows them to experience images and sounds produced by a computer as if they were part of real life (Cambridge Dictionary, 2020). As such, the patient is immersed in a novel, calming and distracting environment where the he/she is asked to perform tasks that will help the patients to relax when distressed before and/or during a medical procedure or during their stay in hospital.
The Relaxation-VR application consists of three modules: two modules make use of relaxation principles (i.e. breathing exercises, meditation) and one module presents a scene with different interactive animations and objects (i.e. popping bubbles, playing fetch with a dog).
Other intervention name(s): Relaxation-VR
Observational model: Other
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Inpatient or outpatient in one of the study sites (UZ Brussel or AZ Sint-Maarten): each
        paediatric patient who will undergo a medical (nursing) procedure during the study period
        (1-01-2021 and 30-09-2021) and/or is in need of relaxation or distraction, as assessed by
        the clinical expertise of the involved clinical staff. Note that in this study no specific
        medical procedure, treatment or patient population is chosen to increase the ecological
        validity of the study.
      
Keywords: Virtual reality; VR; paediatric; distraction; pain; anxiety; relaxation