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Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomised controlled trial.

Small C, Stone R, Pilsbury J, Bowden M, Bion J - Trials (2015)

Bottom Line: The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli.Conventional analgesics alone.The study accrual rate is currently slower than predicted by previous audits of admission data.

View Article: PubMed Central - PubMed

Affiliation: School of Clinical and Experimental Medicine, The Medical School, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK. c.l.flutter@talk21.com.

ABSTRACT

Background: The pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients' psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system.

Methods/design: The present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system's impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions: 1. Interactive VRET plus conventional analgesics. 2. Passive VRET with conventional analgesics. 3. Conventional analgesics alone. Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes.

Discussion: The study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable.

Trial registration: Current Controlled Trials ISRCTN23330756 . Date of Registration 25 February 2014.

No MeSH data available.


Related in: MedlinePlus

Virtual restorative environment therapy (VRET) system in situ, viewed from the rear
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Fig1: Virtual restorative environment therapy (VRET) system in situ, viewed from the rear

Mentions: The prototype has been constructed using low-cost, commercial, off-the-shelf components (Fig. 1). Wound care is carried out in the patient bed space; thus, each prototype is fully mobile and can be placed at the end or side of each bed on the burns unit. The prototype consists of a high definition, 32-inch screen, headphones and hand controller (chosen for single-hand use and equipped with a thumb-operated joystick). The use of a head-mounted display [28] was considered but deemed to be unacceptable due to potential discomfort [29], hygiene issues and the inability of patients with facial or scalp burns to use such a device. The authors are aware that previous research has suggested that the use of head mounted displays may improve immersion and presence (Box 1) [30] in the virtual world. Thus, the study design includes the assessment of immersion for each patient following the VRET interventions. During passive video VRET, participants look at a static image of a virtual seascape. In the active VRET treatment participants are able to navigate the virtual world, traveling in a speed boat (Fig. 2). The activity will have multiple sensory inputs, encouraging maximum attention, yet be simple enough to be undertaken by those with impairment due to physical limitations and performance limitations such as opiates, pain and sleep deprivation.Fig. 1


Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes: study protocol for a randomised controlled trial.

Small C, Stone R, Pilsbury J, Bowden M, Bion J - Trials (2015)

Virtual restorative environment therapy (VRET) system in situ, viewed from the rear
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4526294&req=5

Fig1: Virtual restorative environment therapy (VRET) system in situ, viewed from the rear
Mentions: The prototype has been constructed using low-cost, commercial, off-the-shelf components (Fig. 1). Wound care is carried out in the patient bed space; thus, each prototype is fully mobile and can be placed at the end or side of each bed on the burns unit. The prototype consists of a high definition, 32-inch screen, headphones and hand controller (chosen for single-hand use and equipped with a thumb-operated joystick). The use of a head-mounted display [28] was considered but deemed to be unacceptable due to potential discomfort [29], hygiene issues and the inability of patients with facial or scalp burns to use such a device. The authors are aware that previous research has suggested that the use of head mounted displays may improve immersion and presence (Box 1) [30] in the virtual world. Thus, the study design includes the assessment of immersion for each patient following the VRET interventions. During passive video VRET, participants look at a static image of a virtual seascape. In the active VRET treatment participants are able to navigate the virtual world, traveling in a speed boat (Fig. 2). The activity will have multiple sensory inputs, encouraging maximum attention, yet be simple enough to be undertaken by those with impairment due to physical limitations and performance limitations such as opiates, pain and sleep deprivation.Fig. 1

Bottom Line: The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli.Conventional analgesics alone.The study accrual rate is currently slower than predicted by previous audits of admission data.

View Article: PubMed Central - PubMed

Affiliation: School of Clinical and Experimental Medicine, The Medical School, Vincent Drive, University of Birmingham, Birmingham, B15 2TT, UK. c.l.flutter@talk21.com.

ABSTRACT

Background: The pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients' psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system.

Methods/design: The present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system's impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions: 1. Interactive VRET plus conventional analgesics. 2. Passive VRET with conventional analgesics. 3. Conventional analgesics alone. Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes.

Discussion: The study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable.

Trial registration: Current Controlled Trials ISRCTN23330756 . Date of Registration 25 February 2014.

No MeSH data available.


Related in: MedlinePlus