Virtual Reality MObility for Burn Patients (VR-MOBILE): A Pilot Randomized Clinical Trial

BACKGROUND

Pediatric burn care procedures in hydrotherapy have been known to generate severe pain intensity as well as moderate to high levels of anxiety. In the acute phase, burn patients undergo several painful procedures including wound debridement, passive range-of-motion (ROM) exercises and dressing change treatments. These procedures are important for proper rehabilitation as they prevent contractures, muscle spasms and limited joint mobility. These possible complications result from the normal healing process following a burn injury and are mainly due to scarring and loss of skin elasticity .1,2

Hydrotherapy in burn care is done with the use of opioids and benzodiazepines, since regular analgesics, such as acetaminophen alone, are often inadequate for pain and anxiety management.3,4 As hydrotherapy treatments cause a great deal of pain compared to standard burn care, high dose of narcotics is required to reach an acceptable level of pain relief. The delicate balance between pain relief and opioid requirements is often at the limit of respiratory depression and the occurrence of side effects such as nausea and vomiting. Unfortunately, non-pharmacological methods are rarely combined with the pharmacological treatments used to relieve pain during hydrotherapy even if they could decrease the necessary dose of analgesics and benzodiazepines.

Virtual Reality (VR) is a method that uses distraction to interact within a virtual environnement.3 Flexibility and variety of content make of VR a promising tool for pain reduction, able to be adapted to procedures and to different patient.5-8 Other positive effects including reduction of anxiety for painful procedures have been reported by children and adults. 9-12 Furthermore, recent randomized-controlled trials 9,10 comparing VR and standard distraction in children during painful procedures demonstrated a significant effect on pain and anxiety which enhanced patients', caregivers' and phlebotomist's satisfaction. Also, Gold and Maher 10 concluded that children with higher anxiety sensitivity had better results, adding support for the adoption of this new technology in children's health care. However, VR is also associated with certain side effects such as an increased nausea and the feeling of cybersickness. 13,14

Only a few authors have studied the effect of VR on procedural pain and anxiety management in burn children older than 6 years old. Indeed, a review of the literature has yielded only three studies who used VR with burn children.1,3,15 A study compared the efficacy of VR with standard pharmacological care in an RCT on 54 children (6 to 19 years) suffering from burn-related injuries with TBSA (Total Body Surface Area) varying from 1% to >50%.1 Results showed better pain control and maximum ROM in children in the VR group.1 Another study combined participants from three studies (to increase power) to compare the use of VR with standard pharmacological care with children undergoing physical therapy following a major burn.15 Results on 110 children also showed that VR significantly decreased pain and unpleasantness related to pain in children with burns.15