Virtual Reality

Virtual Reality

PEP Topic 
Anxiety
Description 

Virtual reality refers to a computer-simulated environment with sensual stimuli and interactive software and hardware that can create the feeling of physical presence in an imaginary environment. Virtual reality was evaluated as a distractive intervention to prevent chemotherapy-induced nausea and vomiting in patients with cancer during chemotherapy administration, and has been studied for its effect in anxiety, depression, and fatigue.

Effectiveness Not Established

Research Evidence Summaries

Li, W.H., Chung, J.O., & Ho, E.K. (2011). The effectiveness of therapeutic play, using virtual reality computer games, in promoting the psychological well-being of children hospitalised with cancer. Journal of Clinical Nursing, 20, 2135–2143.

doi: 10.1111/j.1365-2702.2011.03733.x
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Study Purpose:

To examine the effectiveness of play, consisting of virtual reality computer games, in reducing anxiety and symptoms of depression in children hospitalized for cancer treatment

Intervention Characteristics/Basic Study Process:

Children hospitalized for cancer treatment were invited to participate in the study. Patients received 30 minutes of a play intervention, consisting of virtual reality gaming, five days per week. Play was in a small-group setting that included no more than four patients. A historical comparison group was used in the study. Study measures were obtained at hospital admission and at day 7.

Sample Characteristics:

  • The study reported on a sample of 122 pediatric patients.
  • Patient age range was 8–16 years.
  • The sample was 53% male and 47% female.
  • Most patients had leukemia or lymphoma and were undergoing inpatient treatment.
  • At baseline, patients had high anxiety and depression scores.

Setting:

  • Single site
  • Inpatient setting
  • China

Phase of Care and Clinical Applications:

  • Phase of care: active antitumor treatment
  • Clinical application: pediatrics

Study Design:

 Prospective, single-blind trial with historical control comparison

Measurement Instruments/Methods:

  • State-Trait Anxiety Inventory for Children
  • Center for Epidemiological Studies Depression Scale for Children

Results:

ANOVA showed a main effect for time, suggesting significantly lower anxiety and depression symptoms in the group that participated in the play intervention. There were no significant differences in baseline scores between groups. In both groups, anxiety scores declined between baseline and day 7.

Conclusions:

Play involving virtual reality may reduce symptoms of depression in children hospitalized for cancer treatment.

Limitations:

  • The study had risk of bias due to no random assignment and no appropriate attentional control condition.
  • Several age groups were involved. The study did not include subgroup analysis, to see if effects varied in different age and education groups.

Nursing Implications:

Findings suggest that use of virtual reality play may help pediatric inpatients being treated for cancer. Further well-designed research in this area is warranted. It is unclear if virtual reality is more effective than other means of distraction.

Schneider, S.M., & Hood, L.E. (2007). Virtual reality: A distraction intervention for chemotherapy. Oncology Nursing Forum, 34, 39–46.

doi: 10.1188/07.ONF.39-46
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Intervention Characteristics/Basic Study Process:

This intervention was a computer-simulated visual and auditory intervention (virtual reality, or VR) with headset and choice of four scenarios during chemotherapy. Patients were randomized to receive VR during their first or second chemotherapy session.

Sample Characteristics:

The study reported on a sample of 123 patients receiving chemotherapy for breast, colon, and lung cancers.

Setting:

One U.S. hospital

Study Design:

A crossover design was used.

Measurement Instruments/Methods:

  • State Anxiety Inventory (SAI)
  • Revised Piper Fatigue Scale (PFS)
  • Presence Questionnaire
  • Evaluation of virtual reality intervention
  • Adapted Symptom Distress Scale–2 (ASDS-2)
  • ASDS-2, SAI, and PFS after chemotherapy, before leaving clinic, and 48 hours after chemotherapy

Results:

There was no statistical difference (main effect) in symptom distress or anxiety (p = 0.15). There was significant crossover effect at time 2, suggesting that VR may be more effective in decreasing distress during the first visit. Significant altered time perception equated to distraction effect of VR.

Limitations:

  • The study sample was older and included multiple diagnoses.
  • The one-time intervention consisted of a single session of VR and was conducted at a single site.
  • No baseline measures were reported.

Systematic Review/Meta-Analysis

Thrane, S. (2013). Effectiveness of integrative modalities for pain and anxiety in children and adolescents with cancer: A systematic review. Journal of Pediatric Oncology Nursing, 30, 320–332.  

doi: 10.1177/1043454213511538
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Purpose:

STUDY PURPOSE: To systematically review the effect of integrative modalities (e.g., hypnosis, acupuncture, massage, virtual reality, folk healing, prayer) on pain and anxiety in children with cancer
 
TYPE OF STUDY:  Systematic review

Search Strategy:

DATABASES USED: PubMed, CINAHL, MedLine, PsycInfo, Web of Science, integrative medicine journals
 
KEYWORDS: pain, anxiety, pediatric, child, oncology, cancer, neoplasm, complementary, integrative, nonconventional, unconventional
 
INCLUSION CRITERIA: Ages 1–18; randomization; use of control group; published in peer-reviewed journals; use of integrative modality except natural products (e.g., herbs, vitamins, supplements); measuring pain and anxiety
 
EXCLUSION CRITERIA: Review article; informational papers

Literature Evaluated:

TOTAL REFERENCES RETRIEVED: 164 articles were retrieved, 25 underwent full-text review using a systematic approach, and 12 met the criteria.
 

Sample Characteristics:

  • FINAL NUMBER STUDIES INCLUDED =  12
  • TOTAL PATIENTS INCLUDED IN REVIEW = 358
  • KEY SAMPLE CHARACTERISTICS:  Mean age of 8.4 years, age ranged from 1–19 years; 55% male participants; 120 participants from Greece; 62% Caucasian; majority had hematologic cancer; many studies were conducted during painful procedures such as lumbar puncture and venipuncture.

Phase of Care and Clinical Applications:

PHASE OF CARE: Mutliple phases of care
APPLICATIONS: Pediatrics 

Results:

Five studies used hypnosis; one study used mind–body therapy; one used distraction and breathing techniques; one used behavioral intervention; one used virtual reality; one used creative-arts therapy; one used massage; and one used music therapy. Sample size for each study was very small, ranging from 8–59. All studies in this review had at least one statistically significant finding except for one study that examined distraction and breathing techniques. Cohen's d calculations show medium (d = 0.70) to extremely large (8.57) effect sizes for overall integrative intervention. Hypnosis was consistently significantly effective for reduction of pain and anxiety with invasive procedures. Distraction and breathing techniques did not demonstrate effectiveness. Virtual reality in one study did not reduce anxiety. Creative arts therapy in one study of 16 children reduced pain during chemotherapy. Massage showed inconsistent results. Music reduced pain and anxiety before and after lumbar puncture. 

Conclusions:

Integrative interventions may be very effective for pain and anxiety in children undergoing cancer treatment. Integrative modalities, however, warrant further study with larger sample sizes to better determine their effectiveness in this population.

Limitations:

  • No description existed of the time window during which data were extracted.
  • Various interventions were combined and analyzed as a unit.
  • Only included randomized controlled trials and thus reduced literature sample size
  • The sample size for each intervention was small.
  • The effect of each intervention is not clear.

Nursing Implications:

This study provided some evidence that complementary modalities can help children undergoing cancer treatment or painful procedures. The usefulness of a particular method should be further examined.


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