The feasibility, clinical utility, tolerability and initial clinical efficacy of virtual reality distraction with children undergoing medical procedures at a specialized pediatric orthopedic hospital
Bibliographic record
Abstract
Healthcare technologies have innovated the quality and delivery of care to patients driving the promotion of safe and cost-effective care. Virtual reality (VR) technology has been leveraged in the healthcare setting as a distraction tool to manage undertreated and preventable procedural pain and anxiety. Our integrative review found 56 studies of varying methodological quality have been conducted testing the use of VR during various medical procedures received by children, including burn wound care (n = 12), post-burn injury physiotherapy (n = 5), dental (n = 7), cancer-related (n = 19), needle-related (n = 17), and pre-operative (n = 2) procedures. However, a gap remains and VR efficacy warrants investigation in children with chronic and complex musculoskeletal condition. These under-researched children remain at heightened risk of repeated exposure to painful and anxiety-inducing medical procedures as part of their long-term care. Before integration into clinical practice, hospitals must secure clinical buy-in with end-users, who will integrate the use of innovative tools into practice. Herein lies our interest in introducing VR distraction at the Shriners Hospitals for Children®-Canada for use by children undergoing painful or anxiety- inducing medical procedures. A mixed-methods study, concurrent triangulation design, guided by the VR-CORE methodological framework, was piloted across various clinics to test the feasibility, clinical utility, tolerability, and initial clinical efficacy of virtual reality as a distraction tool. Quantitative and qualitative data derived from children (n = 44), their parents (n = 26), and healthcare professionals (n = 11) were collected using validated questionnaires, fieldnotes, semi-structured interviews, and focus group. This thesis presents a rich and rigorous account of a triad perspective on the use of VR during intravenous insertion (n = 30), pin/wire removal (n = 7), Botox injections (n = 2), blood-draw (n = 3), dressing change (n = 1), and urodynamic test (n = 1). Findings reveal that VR use: (1) is feasible as VR is easily implemented in the current clinical workflow, (2) is clinically useful as VR is easy to use and accepted by stakeholders, (3) is tolerable as VR does not cause physical or emotional adversities, and (4) supports VR analgesic and anxiolytic benefit in procedural pain and anxiety management. These results will inform the creation of policies and procedures for VR use in practice and a sustainable implementation across the Shriners Healthcare network. Finally, a larger comprehensive clinical trial may ensue to test clinically relevant outcomes
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.010 | 0.024 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.002 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.000 | 0.001 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.002 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".