TABLE 2 |.
Descriptive information from the studies on the effect of VR on pediatric burn pain.
| References | Participants | Sample age range (years) | Sample size | Study design | Intervention | Control Group(s) | Self-reported pain | Caregivers observational pain report | Effect size for self-reported pain intensity outcome (Cohen’s d)a | Level and quality rating of evidence |
|---|---|---|---|---|---|---|---|---|---|---|
| Brown et al. (2014) | Children with burn injuries in Australian pediatric burn clinic | 4 to 13 | n = 75, 35 for Ditto, 40 for standard distraction | Between-subjects | Ditto | Standard passive distraction (TV, videos, books, toys, parental soothing) (random assignment) | Pain intensity measured by the Faces Pain Scale-Revised (FPS-R) | Nurses observational pain measured by the Faces, Legs, Arms, Cry. Consolability (FLACC) scale | 0.4 | Level: I Quality: A |
| Hoffman et al. (2019) | Children with extensive, severe injuries in Latin American intensive care hospital unit | 6 to 17 | n = 48 | Within-subjects | VR Snow World | Standard pain medication (order counterbalanced) | “Worst” (sensory) pain intensity, “unpleasantness” (affective) pain, and “time spent thinking about” (cognitive) pain measured by the Graphic Rating Scale (GRS) | - | 1.03 | Level: I Quality: A |
| Hoffman et al. (2020) | Large severe burn injuries children | 6 to 17 | n = 50, 25 for VR, 25 for standard pain medication | Between-subjects | VR Snow World | Standard pain medication | Worst pain intensity, pain unpleasantness, and time spent thinking about pain measured by the Graphic Rating Scale (GRS) | - | 0.59 | Level: I Quality: A |
| Jeffs et al. (2014) | Adolescents with burn injuries | 10 to 17 | n = 28; 8 for VR, 10 for passive distraction, and 10 for Standard care | Between-subjects | VR | Passive distraction, Standard care | Pain intensity, sensory, affective, and evaluative qualities of pain measured by the Adolescent Pediatric Pain Tool (APPT) | - | 0.54 | Level: I Quality: B |
| Khadra et al. (2018) | Children with burn injuries undergoing inpatient and outpatient hydrotherapy | 0.2 to 10 | n = 15 | Within-subjects | Projector-based VR | Standard care (order counterbalanced) | - | Nurses observational pain measured by the Faces, Legs, Arms, Cry. Consolability (FLACC) scale | - | Level: II Quality: C |
| Khadra et al. (2020) | Burn injuries children | 0.5 to 7 | n = 38 | Within-subjects | Projector-based VR | Standard care (order counterbalanced) | - | Nurses observational pain measured by the Faces, Legs, Arms, Cry. Consolability (FLACC) scale, and Numerical Rating Scale-obs (NRS-obs) | - | Level: II Quality: B |
| Kipping et al. (2012) | Adolescents with burn injuries in outpatient burn clinic | 11 to 17 | n = 41,20 for VR, 21 for Standard distraction | Between-subjects | VR | Standard distraction (TV, stories, music available) | Pain intensity measured by the Visual Analog Scale (VAS) | Nurses observational pain measured by the Faces, Legs, Arms, Cry. Consolability (FLACC) scale, and adolescent pain (VAS) | 0.46 | Level: I Quality: B |
| Le May et al. (2021) | Burn and fracture injuries children | 7 to 17 | n = 20 | Within-subjects | VR | Standard care | Pain intensity measured by the Numerical Rating Scale (NRS) | Nurses observational comfort measured by OCCEB-BECCO | 0.31 | Level: II Quality: A |
| Miller et al. (2011) | Children with burn injuries | 3 to 10 | n = 40, 20 for Multi-modal distraction, 20 for standard distraction | Between-subjects | Multi-modal Distraction Ditto | Standard distraction (TV, stories, age-appropriate toys, nursing staff soothing) (randomization | Pain intensity measured by Wong Baker Faces Scale (FACES) | Nurses observational pain measured by the Faces, Legs, Arms, Cry. Consolability (FLACC) scale | 1.72 | Level: I Quality: A |
| Xiang et al. (2021) | Burn injuries children | 6 to 17 | n = 90, 31 for active VR, 30 for passive VR, 29 for standard care | Between-subjects | Active VR | Passive VR, Standard care | Pain intensity measured by Visual Analog Scale (VAS) | Researcher observational pain measured by the FLACC-revised | 0.39 | Level: I Quality: A |
a
Effect sizes were calculated for the self-reported pain only. Positive values for Cohen’s d indicate a higher value in the control group than in the treatment group. For measures evaluating pain, a positive Cohen’s d reflects a decrease in pain in the treatment group compared to the control.
Cohen’s d: | 0.2 | = small effect size | 0.5 | = medium effect size | 0.8 | = large effect size.