Cambridge University Press



Appendix 1: Additional details on Methods and ResultsMethodsData Sources and Searches (Search date: June 16th, 2018)1) Search string Pubmed: #1 virtual [Title/Abstract] AND (reality [Title/Abstract] OR game*[Title/Abstract] OR gaming [Title/Abstract] OR interface [Title/Abstract] OR immers*[Title/Abstract]) #2 Virtual Reality Exposure Therapy [MeSH Terms]#3 (pain*[Title/Abstract] OR burn*[Title/Abstract] OR wound*[Title/Abstract] OR injur*[Title/Abstract])#4 (pain [MeSH Terms] OR burns [MeSH Terms] OR (wounds and injuries [MeSH Terms])(#1 or #2) and (#3 or #4)Hits: 930 records2) Search string Cochrane Central Registrar of Clinical Trials: #1 virtual and (reality or game or interface or immersion or immersive) (Word variations have been searched)#2 Virtual Reality Exposure Therapy (MeSH)#3 wounds and injuries (MeSH)#4 burns (MeSH)#5 pain (MeSH)#6 pain or burn or wound or injury (Word variations have been searched)#7 (#1 or #2) and (#3 or #4 or #5 or #6) in TrialsHits: 333 records3) Search string EMBASE: ((('virtual' NEAR/4 'reality'):ti,ab,kw) OR (('virtual' NEAR/4 'interface'):ti,ab,kw) OR (('virtual' NEAR/4 'game'):ti,ab,kw) OR (('virtual' NEAR/4 'gaming'):ti,ab,kw) OR (('virtual' NEAR/4 'immers*'):ti,ab,kw) OR 'virtual reality'/exp) AND ('pain'/exp OR 'burn'/exp OR 'injury'/exp OR 'pain*':ti,ab,kw OR 'burn*':ti,ab,kw OR 'wound':ti,ab,kw OR 'injur*':ti,ab,kw) AND ([embase]/lim OR [embase classic]/lim)Hits: 1697 records4) Search string PsycInfo (through ProQuest): #1 MJMAINSUBJECT.EXACT. EXPLODE("Pain") OR MJMAINSUBJECT.EXACT. EXPLODE("Burns") OR MJMAINSUBJECT.EXACT. EXPLODE("Wounds")#2 pain* or burn* or wound* or injur*#3 MJMAINSUBJECT.EXACT. EXPLODE ("Virtual Reality")#4 (virtual NEAR reality) or (virtual NEAR interface) or (virtual NEAR game) or (virtual NEAR gaming) or (virtual NEAR immers*)(#1 OR #2) and (#3 or #4)(MJMAINSUBJECT.EXACT.EXPLODE("Pain") OR MJMAINSUBJECT.EXACT.EXPLODE("Burns") OR MJMAINSUBJECT.EXACT.EXPLODE("Wounds") OR ab(pain* or burn* or wound* or injur*)) AND (MJMAINSUBJECT.EXACT.EXPLODE("Virtual Reality") OR ab((virtual NEAR/4 reality) OR (virtual NEAR/4 interface) OR (virtual NEAR/4 game) OR (virtual NEAR/4 gaming) OR (virtual NEAR/4 immers*)))Scholarly journals (Exclude books and Dissertations & Theses)Hits: 421 recordsResultsStudy selectionWe also contacted authors for two trials where we suspected overlap between samples ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"6VumGSjL","properties":{"formattedCitation":"(Schneider {\\i{}et al.} 2003, 2004)","plainCitation":"(Schneider et al. 2003, 2004)","noteIndex":0},"citationItems":[{"id":13,"uris":[""],"uri":[""],"itemData":{"id":13,"type":"article-journal","title":"Virtual reality intervention for older women with breast cancer","container-title":"Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society","page":"301-307","volume":"6","issue":"3","source":"PubMed","abstract":"This study examined the effects of a virtual reality distraction intervention on chemotherapy-related symptom distress levels in 16 women aged 50 and older. A cross-over design was used to answer the following research questions: (1) Is virtual reality an effective distraction intervention for reducing chemotherapy-related symptom distress levels in older women with breast cancer? (2) Does virtual reality have a lasting effect? Chemotherapy treatments are intensive and difficult to endure. One way to cope with chemotherapy-related symptom distress is through the use of distraction. For this study, a head-mounted display (Sony PC Glasstron PLM - S700) was used to display encompassing images and block competing stimuli during chemotherapy infusions. The Symptom Distress Scale (SDS), Revised Piper Fatigue Scale (PFS), and the State Anxiety Inventory (SAI) were used to measure symptom distress. For two matched chemotherapy treatments, one pre-test and two post-test measures were employed. Participants were randomly assigned to receive the VR distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. Analysis using paired t-tests demonstrated a significant decrease in the SAI (p = 0.10) scores immediately following chemotherapy treatments when participants used VR. No significant changes were found in SDS or PFS values. There was a consistent trend toward improved symptoms on all measures 48 h following completion of chemotherapy. Evaluation of the intervention indicated that women thought the head mounted device was easy to use, they experienced no cybersickness, and 100% would use VR again.","DOI":"10.1089/109493103322011605","ISSN":"1094-9313","note":"PMID: 12855087\nPMCID: PMC3645300","journalAbbreviation":"Cyberpsychol Behav","language":"eng","author":[{"family":"Schneider","given":"Susan M."},{"family":"Ellis","given":"Mathew"},{"family":"Coombs","given":"William T."},{"family":"Shonkwiler","given":"Erin L."},{"family":"Folsom","given":"Linda C."}],"issued":{"date-parts":[["2003",6]]}}},{"id":105,"uris":[""],"uri":[""],"itemData":{"id":105,"type":"article-journal","title":"Virtual reality as a distraction intervention for women receiving chemotherapy","container-title":"Oncology Nursing Forum","page":"81-88","volume":"31","issue":"1","source":"PubMed","abstract":"PURPOSE/OBJECTIVES: To explore the use of virtual reality as a distraction intervention to relieve symptom distress in women receiving chemotherapy for breast cancer.\nDESIGN: Crossover study.\nSETTING: The outpatient clinic of a midwestern comprehensive cancer center.\nSAMPLE: 20 women 18-55 years of age.\nMETHODS: Using a crossover design, 20 subjects served as their own controls. For two matched chemotherapy treatments, one pretest and two post-test measures were employed. Participants were assigned randomly to receive the virtual reality distraction intervention during one chemotherapy treatment and received no distraction intervention (control condition) during an alternate chemotherapy treatment. An open-ended questionnaire elicited each subject's evaluation of the intervention.\nMAIN RESEARCH VARIABLES: Symptom distress, fatigue, anxiety.\nFINDINGS: Significant decreases in symptom distress and fatigue occurred immediately following chemotherapy treatments when women used the virtual reality intervention.\nCONCLUSIONS: The distraction intervention decreased symptom distress, was well received, and was easy to implement in the clinical setting.\nIMPLICATIONS FOR NURSING: Nursing interventions to manage chemotherapy-related symptom distress can improve patient quality of life and increase chances for survival by reducing treatment-related symptom distress and enhancing patients' ability to adhere to treatment regimens and cope with their disease.","DOI":"10.1188/04.ONF.81-88","ISSN":"1538-0688","note":"PMID: 14722591","journalAbbreviation":"Oncol Nurs Forum","language":"eng","author":[{"family":"Schneider","given":"Susan M."},{"family":"Prince-Paul","given":"Maryjo"},{"family":"Allen","given":"Mary Jo"},{"family":"Silverman","given":"Paula"},{"family":"Talaba","given":"Deborah"}],"issued":{"date-parts":[["2004",2]]}}}],"schema":""} (Schneider et al. 2003, 2004) and for another trial where values presented alongside means were not labeled as SEs or SDs ADDIN ZOTERO_ITEM CSL_CITATION {"citationID":"3L08mrrP","properties":{"formattedCitation":"(Miller {\\i{}et al.} 2010)","plainCitation":"(Miller et al. 2010)","noteIndex":0},"citationItems":[{"id":167,"uris":[""],"uri":[""],"itemData":{"id":167,"type":"webpage","title":"Multi-modal distraction. Using technology to combat pain in young children with burn injuries - Burns","abstract":"Background: The use of non-pharmacological pain management remains adhoc within\nacute paediatric burns pain management protocols despite ongoing acknowledgement of\nits role. Advancements in adult based pain services including the integration of virtual\nreality has been adapted to meet the needs of children in pain, as exemplified by the\ndevelopment of multi-modal distraction (MMD). This easy to use, hand held interactive\ndevice uses customised programs designed to inform the child about the procedure he/she\nis about to experience and to distract the child during dressing changes.\nAim: (1) To investigate if either MMD procedural preparation (MMD-PP) or distraction (MMDD) has a greater impact on child pain reduction compared to standard distraction (SD) or\nhand held video game distraction (VG), (2) to understand the impact of MMD-PP and MMD-D\non clinic efficiency by measuring length of treatment across groups, and lastly, (3) to assess\nthe efficacy of distraction techniques over three dressing change procedures.\nMethods: A prospective randomised control trial was completed in a paediatric tertiary\nhospital Burns Outpatient Clinic. Eighty participants were recruited and studied over their\nfirst three dressing changes. Pain was assessed using validated child report, caregiver report,\nnursing observation and physiological measures.\nResults: MMD-D and MMD-PP were both shown to significantly relieve reported pain\n( p 0.05) and reduce the time taken for dressings ( p 0.05) compared to SD and VG.\nThe positive effects of both MMD-D and MMD-PP were sustained with subsequent dressing\nchanges.\nConclusions: The use of MMD as a preparatory or a distraction tool in an outpatient burns\nclinic offered superior pain reduction across three dressing changes to children when\ncompared to standard practices or hand held video games. This device has the potential\nto improve clinic efficiency with reductions in treatment lengths.","URL":"(09)00403-3/abstract","author":[{"family":"Miller","given":"Kate"},{"family":"Rodger","given":"Sylvia"},{"family":"Bucolo","given":"Sam"},{"family":"Greer","given":"Ristan"},{"family":"Kimble","given":"Roy M."}],"issued":{"date-parts":[["2010"]]},"accessed":{"date-parts":[["2018",2,7]]}}}],"schema":""} (Miller et al. 2010). The authors did not reply in the last case but given that values were very small compared to the means, we opted for considering them as standard errors.List of eligible trials Sufficient data for effect size calculation (included in the meta-analysis) ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Bentsen B, Svensson P, Wenzel A (2001). Evaluation of effect of 3D video glasses on perceived pain and unpleasantness induced by restorative dental treatment. European Journal of Pain (London, England) 5, 373–378.Brown NJ, Kimble RM, Rodger S, Ware RS, Cuttle L (2014). Play and heal: randomized controlled trial of DittoTM intervention efficacy on improving re-epithelialization in pediatric burns. Burns: Journal of the International Society for Burn Injuries 40, 204–213.Carrougher GJ, Hoffman HG, Nakamura D, Lezotte D, Soltani M, Leahy L, Engrav LH, Patterson DR (2009). The Effect of Virtual Reality on Pain and Range of Motion in Adults With Burn Injuries. Journal of burn care & research: official publication of the American Burn Association 30, 785–791.Chan EA, Chung JW, Wong TK, Lien AS, Yang JY (2007). Application of a virtual reality prototype for pain relief of pediatric burn in Taiwan. Journal of Clinical Nursing 16, 786–793.Frere CL, Crout R, Yorty J, McNeil DW (2001). Effects of audiovisual distraction during dental prophylaxis. Journal of the American Dental Association (1939) 132, 1031–1038.Ger?eker G?, Binay ?, Bilsin E, Kahraman A, Y?lmaz HB (2018). Effects of Virtual Reality and External Cold and Vibration on Pain in 7- to 12-Year-Old Children During Phlebotomy: A Randomized Controlled Trial. Journal of Perianesthesia Nursing: Official Journal of the American Society of PeriAnesthesia NursesGershon J, Zimand E, Lemos R, Rothbaum BO, Hodges L (2003). Use of virtual reality as a distractor for painful procedures in a patient with pediatric cancer: a case study. Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society 6, 657–661.Gold JI, Kim SH, Kant AJ, Joseph MH, Rizzo AS (2006). Effectiveness of virtual reality for pediatric pain distraction during i.v. placement. Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society 9, 207–212.Gold JI, Mahrer NE (2018). Is Virtual Reality Ready for Prime Time in the Medical Space? A Randomized Control Trial of Pediatric Virtual Reality for Acute Procedural Pain Management. Journal of Pediatric Psychology 43, 266–275.Guo C, Deng H, Yang J (2015). Effect of virtual reality distraction on pain among patients with hand injury undergoing dressing change. Journal of Clinical Nursing 24, 115–120.Hoffman HG, Patterson DR, Carrougher GJ (2000). Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. The Clinical Journal of Pain 16, 244–250.Hoffman HG, Patterson DR, Carrougher GJ, Sharar SR (2001). Effectiveness of virtual reality-based pain control with multiple treatments. The Clinical Journal of Pain 17, 229–235.Hoffman HG, Patterson DR, Seibel E, Soltani M, Jewett-Leahy L, Sharar SR (2008). Virtual reality pain control during burn wound debridement in the hydrotank. The Clinical Journal of Pain 24, 299–304.Hua Y, Qiu R, Yao W-Y, Zhang Q, Chen X-L (2015). The Effect of Virtual Reality Distraction on Pain Relief During Dressing Changes in Children with Chronic Wounds on Lower Limbs. Pain Management Nursing: Official Journal of the American Society of Pain Management Nurses 16, 685–691.JahaniShoorab N, Ebrahimzadeh Zagami S, Nahvi A, Mazluom SR, Golmakani N, Talebi M, Pabarja F (2015). The Effect of Virtual Reality on Pain in Primiparity Women during Episiotomy Repair: A Randomize Clinical Trial. Iranian Journal of Medical Sciences 40, 219–224.Jeffs D, Dorman D, Brown S, Files A, Graves T, Kirk E, Meredith-Neve S, Sanders J, White B, Swearingen CJ (2014). Effect of virtual reality on adolescent pain during burn wound care. Journal of Burn Care & Research: Official Publication of the American Burn Association 35, 395–408.Kipping B, Rodger S, Miller K, Kimble RM (2012). Virtual reality for acute pain reduction in adolescents undergoing burn wound care: a prospective randomized controlled trial. Burns: Journal of the International Society for Burn Injuries 38, 650–657.Konstantatos AH, Angliss M, Costello V, Cleland H, Stafrace S (2009). Predicting the effectiveness of virtual reality relaxation on pain and anxiety when added to PCA morphine in patients having burns dressings changes. Burns: Journal of the International Society for Burn Injuries 35, 491–499.Maani CV, Hoffman HG, Morrow M, Maiers A, Gaylord K, McGhee LL, DeSocio PA (2011). Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. The Journal of Trauma 71, S125-130.Miller K, Rodger S, Bucolo S, Greer R, Kimble RM (2010). Multi-modal distraction. Using technology to combat pain in young children with burn injuries. Burns: Journal of the International Society for Burn Injuries 36, 647–658.Miller K, Rodger S, Kipping B, Kimble RM (2011). A novel technology approach to pain management in children with burns: A prospective randomized controlled trial. Burns: Journal of the International Society for Burn Injuries 37, 395–405.Morris LD, Louw QA, Grimmer-Somers K (2009). The Effectiveness of Virtual Reality on Reducing Pain and Anxiety in Burn Injury Patients: A Systematic Review. The Clinical Journal of Pain 25, 815–826.Schmitt YS, Hoffman HG, Blough DK, Patterson DR, Jensen MP, Soltani M, Carrougher GJ, Nakamura D, Sharar SR (2011). A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. Burns: Journal of the International Society for Burn Injuries 37, 61–68.Schneider SM, Ellis M, Coombs WT, Shonkwiler EL, Folsom LC (2003). Virtual reality intervention for older women with breast cancer. Cyberpsychology & Behavior: The Impact of the Internet, Multimedia and Virtual Reality on Behavior and Society 6, 301–307.Schneider SM, Prince-Paul M, Allen MJ, Silverman P, Talaba D (2004). Virtual reality as a distraction intervention for women receiving chemotherapy. Oncology Nursing Forum 31, 81–88.van Twillert B, Bremer M, Faber AW (2007). Computer-generated virtual reality to control pain and anxiety in pediatric and adult burn patients during wound dressing changes. Journal of Burn Care & Research: Official Publication of the American Burn Association 28, 694–702.Wolitzky K, Fivush R, Zimand E, Hodges L, PhD BOR (2005). Effectiveness of virtual reality distraction during a painful medical procedure in pediatric oncology patients. Psychology & Health 20, 817–824. Insufficient data for effect size calculation (not included) ADDIN ZOTERO_BIBL {"uncited":[],"omitted":[],"custom":[]} CSL_BIBLIOGRAPHY Asl Aminabadi N, Erfanparast L, Sohrabi A, Ghertasi Oskouei S, Naghili A (2012). The Impact of Virtual Reality Distraction on Pain and Anxiety during Dental Treatment in 4-6-Year-Old Children: a Randomized Controlled Clinical Trial. Journal of Dental Research, Dental Clinics, Dental Prospects 6, 117–124.Cacau L de AP, Oliveira GU, Maynard LG, Araújo Filho AA de, Silva WM da, Cerqueria Neto ML, Antoniolli AR, Santana-Filho VJ (2013). The use of the virtual reality as intervention tool in the postoperative of cardiac surgery. Revista Brasileira De Cirurgia Cardiovascular: Orgao Oficial Da Sociedade Brasileira De Cirurgia Cardiovascular 28, 281–289.Das DA, Grimmer KA, Sparnon AL, McRae SE, Thomas BH (2005). The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial [ISRCTN87413556]. BMC Pediatrics 5, 1.McSherry T, Atterbury M, Gartner S, Helmold E, Searles DM, Schulman C (2018). Randomized, Crossover Study of Immersive Virtual Reality to Decrease Opioid Use During Painful Wound Care Procedures in Adults. Journal of Burn Care & Research: Official Publication of the American Burn Association 39, 278–285.Mosso JL, Gorini A, De La Cerda G, Obrador T, Almazan A, Mosso D, Nieto JJ, Riva G (2009). Virtual reality on mobile phones to reduce anxiety in outpatient surgery. Studies in Health Technology and Informatics 142, 195–200.Oyama H, Kaneda M, Katsumata N, Akechi T, Ohsuga M (2000). Using the bedside wellness system during chemotherapy decreases fatigue and emesis in cancer patients. Journal of Medical Systems 24, 173–182.Schneider SM Hood LE (2007). Virtual Reality: A Distraction Intervention for Chemotherapy. Oncology nursing forum 34, 39–46.Walker MR, Kallingal GJS, Musser JE, Folen R, Stetz MC, Clark JY (2014). Treatment efficacy of virtual reality distraction in the reduction of pain and anxiety during cystoscopy. Military Medicine 179, 891–896.Wint SS, Eshelman D, Steele J, Guzzetta CE (2002). Effects of Distraction Using Virtual Reality Glasses During Lumbar Punctures in Adolescents With Cancer. Oncology Nursing Forum 29, E8–E15.Interaction with the virtual environment (Table S1)Presence in the virtual environment was assessed in ten trials and immersion in one. Generally, participants rated the virtual environment as engaging and interactive (average above 5 on a 1 to 10 scale). The number of interactive elements ranged from 1 to 5, with most studies using visual feedback, sound, and mouse navigation.Table S1. Characteristics of the virtual reality environment and experienceStudyVR systemaVR interaction toolsNumber of toolsImmersion measurePresence measureAdverse events measureNo drop VRbVR AucBentsen, 2001VGvisual feedback1NRNRNR0NBrown, 2014MMDvisual feedback, navigation, character insertion and touch screen, tactile feedback (vibration)4NRNRNR3NCarrougher, 2009VGvisual feedback, sound, navigation through mouse3NRVAS 15% report nausea (on GRS)2YChan, 2007HMDvisual feedback, sound, navigation through mouse3NRPQNR0YFrere, 2001VGvisual feedback, sound2VAS NRNR0N/AGerceker, 2018HMDvisual feedback, sound2NRNRNR0NGershon, 2004HMDvisual feedback, sound, navigation through joystick, feedback interaction 4NRNRNR0YGold, 2006HMDvisual feedback, sound, navigation, interactive avatar4NRCPQ0% report nausea (at CSSQ)0NGold, 2018VGvisual feedback, sound, navigation through rumble pad, tactile feedback4NRCPQ8 % report mild to moderate nausea on Malaise Scale0NGuo,20143d GLvisual feedback, sound2NRNRNR0NHoffman, 2000VGvisual feedback, sound, navigation through the mouse, tactile feedback4NRVAS mean of nausea < 1% (on VAS)0YHoffman, 2001VGvisual feedback, sound, navigation through mouse3NRVAS mean of nausea = 2.7% (on VAS)0YHoffman, 2008HMDvisual feedback, sound, navigation through the joystick3NRVAS mean of nausea < 1% (on VAS)0YHua, 2015HMDvisual feedback, sound2NRNRNR0NJahanishoorab, 2015VGvisual feedback, sound, navigation through mouse3NRNRNR1NJeffs, 2014HMDvisual feedback, sound2NRNR0% report nausea or simulator sickness1NKipping, 2012HMDvisual feedback, sound, joystick hand control3NRVAS No significant differences in nausea between VR and control 0NKonstantatos, 2009VGvisual feedback, sound, hypnotic suggestion3NRNRNR2YMaani, 2011HMDvisual feedback, sound, joystick hand control3NRVAS 0 % report nausea (on VAS)0YMiller,2010MMDvisual feedback, navigation, character insertion and touch screen, tactile feedback (vibration)4NRNRNR0YMiller,2011MMDvisual feedback, navigation, character insertion and touch screen, tactile feedback (vibration)4NRNRNR0YMorris, 2010HMDvisual feedback, sound, joystick hand control3NRNRNR0NSchmitt, 2011HMDvisual feedback, sound, navigation through mouse3NRVAS Mean of nausea = 3.46 (on VAS) 0YSchneider, 2003HMDvisual feedback, sound, navigation through mouse3NRNR0% experienced cybersickness0NSchneider, 2004HMDvisual feedback, sound, navigation through mouse3NRNR0% report nausea, dizziness or visual disturbances1Nvan Twillert, 2007 HMDvisual feedback, sound, navigation through mouse3NRNR0% report side effects0NWolitzky, 2005VGvisual feedback, sound, navigation through joystick, feedback interaction4NRNRNR0NNote:Abbreviations: VG= video glasses; HMD= head-mounted display; MMD= multi model design; 3d GL = 3d glasses; VR GL= VR glasses; NR = not reported; VAS = Visual Analog Scale; CPQ = Child Presence Questionnaire; PQ = Presence Questionnaire; CSSQ= Child Simulator Sickness Questionnaire; Au = authors. a VR system = types of VR equipment used in interventions. b No drop VR = Number of participants that dropped out c VR AU = the VR environment author where among the study’s author pool.0000Figure S1. Risk of bias summary: review authors' judgments about each risk of bias item for each included study.0000Figure S2. Funnel plots for comparison between VR-based intervention and treatment as usual: A. Funnel plot (black circles, observed studies); B. Contour-enhanced funnel plot ................
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