Introduction: Many children may experience anxiety in treatment settings, especially in situations such as before surgery, dentistry and radiology. Virtual reality technology can provide a platform for reducing children's anxiety by creating a sense of presence in an unreal world. The aim of this study was to investigate the effect of virtual reality technology on reducing anxiety in children.
Materials and Methods: A systematic review of randomized clinical trial studies was conducted in English without any time limit by searching for keywords in the reputable scientific databases PubMed, Scopus, EMBASE and Web of Science on September 12, 2021. Studies using virtual reality technology to reduce pediatric treatment anxiety were considered as inclusion criteria. Titles and abstracts were screened independently based on eligibility criteria. The quality of the studies was assessed using the Joanna Briggs institute (JBI) checklist. Studies that scored above 7 were included in this study.
Results: A total of 197 related articles were obtained, 10 of which were relevant to the objectives of the research. Input studies included children aged 4 to 12 years. In 7 studies, virtual reality has helped reduce children's anxiety during treatment (70%). In 3 of the studied studies, no improvement was seen in reducing children's anxiety (30%). In 7 of the studies found, children and parents were completely satisfied with the use of virtual reality.
Conclusion: The results of systematic review show that virtual reality can make the treatment process more satisfactory and help manage their behavior by creating calmness and distraction, while reducing anxiety in children.Han S-H, Park J-W, Choi SI, Kim JY, Lee H, Yoo H-J, et al. Effect of immersive virtual reality education before chest radiography on anxiety and distress among pediatric patients: A randomized clinical trial. JAMA Pediatr. 2019; 173(11): 1026-31. PMID: 31498380 DOI: 10.1001/jamapediatrics.2019.3000
Ryu J-H, Park J-W, Choi SI, Kim JY, Lee H, Yoo H-J, et al. Virtual reality vs. tablet video as an experiential education platform for pediatric patients undergoing chest radiography: A randomized clinical trial. J Clin Med. 2021; 10(11): 2486. PMID: 34199808 DOI: 10.3390/jcm10112486
Ran L, Zhao N, Fan L, Zhou P, Zhang C, Yu C. Application of virtual reality on non-drug behavioral management of short-term dental procedure in children. Trials. 2021; 22(1): 562. PMID: 34425901 DOI: 10.1186/s13063-021-05540-x
Meentken MG, van Beynum IM, Legerstee JS, Helbing WA, Utens EM. Medically related post-traumatic stress in children and adolescents with congenital heart defects. Front Pediatr. 2017; 5: 20. PMID: 28243582 DOI: 10.3389/fped.2017.00020
Wong M, Chia K, Yam W, Teodoro G, Lau K. Willingness to donate blood samples for genetic research: A survey from a community in Singapore. Clin Genet. 2004; 65(1): 45-51. PMID: 15032974 DOI: 10.1111/j..2004.00192.x
Kain ZN, Mayes LC, Caldwell-Andrews AA, Karas DE, McClain BC. Preoperative anxiety, postoperative pain, and behavioral recovery in young children undergoing surgery. Pediatrics. 2006; 118(2): 651-8. PMID: 16882820 DOI: 10.1542/peds.2005-2920
Perry JN, Hooper VD, Masiongale J. Reduction of preoperative anxiety in pediatric surgery patients using age-appropriate teaching interventions. J Perianesth Nurs. 2012; 27(2): 69-81. PMID: 22443919 DOI: 10.1016/j.jopan.2012.01.003
Namazi M, Akbari SAA, Mojab F, Talebi A, Majd HA, Jannesari S. Aromatherapy with citrus aurantium oil and anxiety during the first stage of labor. Iran Red Crescent Med J. 2014; 16(6): e18371. PMID: 25068058 DOI: 10.5812/ircmj.18371
Hockenberry MJ, Wilson D, Rentfro AR, McCampbell L. Study guide for wong's nursing care of infants and children. Mosby; 2018.
Inal S, Kelleci M. Distracting children during blood draw: Looking through distraction cards is effective in pain relief of children during blood draw. Int J Nurs Pract. 2012; 18(2): 210-9. PMID: 22435986 DOI: 10.1111/j.1440-172X.2012.02016.x
McCaul KD, Malott JM. Distraction and coping with pain. Psychol Bull. 1984; 95(3): 516-33. PMID: 6399756
Al-Khotani A, Bello LA, Christidis N. Effects of audiovisual distraction on children’s behavior during dental treatment: A randomized controlled clinical trial. Acta Odontol Scand. 2016; 74(6): 494-501. PMID: 27409593 DOI: 10.1080/00016357.2016.1206211
Mifflin KA, Hackmann T, Chorney JM. Streamed video clips to reduce anxiety in children during inhaled induction of anesthesia. Anesth Analg. 2012; 115(5): 1162-7. PMID: 23051880 DOI: 10.1213/ANE.0b013e31824d5224
Whitehead-Pleaux AM, Baryza MJ, Sheridan RL. The effects of music therapy on pediatric patients' pain and anxiety during donor site dressing change. J Music Ther. 2006; 43(2): 136-53. PMID: 16897906 DOI: 10.1093/jmt/43.2.136
Malloy KM, Milling LS. The effectiveness of virtual reality distraction for pain reduction: A systematic review. Clin Psychol Rev. 2010; 30(8): 1011-8. PMID: 20691523 DOI: 10.1016/j.cpr.2010.07.001
Liberati A, Altman DG, Tetzlaff J, Mulrow C, Gøtzsche PC, Ioannidis JP, et al. The PRISMA statement for reporting systematic reviews and meta-analyses of studies that evaluate health care interventions: Explanation and elaboration. J Clin Epidemiol. 2009; 62(10): e1-34. PMID: 19631507 DOI: 10.1016/j.jclinepi.2009.06.006
Moher D, Liberati A, Tetzlaff J, Altman DG, Altman D, Antes G, et al. Preferred reporting items for systematic reviews and meta-analyses: The PRISMA statement (Chinese edition). Journal of Chinese Integrative Medicine. 2009; 7(9): 889-96.
The Joanna Briggs Institute. Critical appraisal checklist for randomized controlled trials [Internet]. 2017 [cited: 1 Dec 2021]. Available from: https://jbi.global/sites/default/files/2019-05/JBI_RCTs_Appraisal_tool2017_0.pdf
CustÓdio NB, Cademartori MG, Azevedo MS, Mendes MdA, Schardozim LR, Sucasas da Costa LRdR, et al. Efficacy of audiovisual distraction using eyeglasses during dental care: A randomized clinical trial. Braz Oral Res. 2021; 35: e26. PMID: 33605356 DOI: 10.1590/1807-3107bor-2021.vol35.0026
Dehghan F, Jalali R, Bashiri H. The effect of virtual reality technology on preoperative anxiety in children: A Solomon four-group randomized clinical trial. Perioper Med (Lond). 2019; 8: 5. PMID: 31171963 DOI: 10.1186/s13741-019-0116-0
Eijlers R, Dierckx B, Staals LM, Berghmans JM, van der Schroeff MP, Strabbing EM, et al. Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial. Eur J Anaesthesiol. 2019; 36(10): 728-37. PMID: 31356373 DOI: 10.1097/EJA.0000000000001059
Felemban OM, Alshamrani RM, Aljeddawi DH, Bagher SM. Effect of virtual reality distraction on pain and anxiety during infiltration anesthesia in pediatric patients: A randomized clinical trial. BMC Oral Health. 2021; 21(1): 321. PMID: 34172032 DOI: 10.1186/s12903-021-01678-x
Gómez-Polo C, Vilches A-A, Ribas D, Castaño-Séiquer A, Montero J. Behaviour and anxiety management of paediatric dental patients through virtual reality: A randomised clinical trial. J Clin Med. 2021; 10(14): 3019. PMID: 34300185 DOI: 10.3390/jcm10143019
Ryu J-H, Park J-W, Nahm FS, Jeon Y-T, Oh A-Y, Lee HJ, et al. The effect of gamification through a virtual reality on preoperative anxiety in pediatric patients undergoing general anesthesia: A prospective, randomized, and controlled trial. J Clin Med. 2018; 7(9): 284. PMID: 30227602 DOI: 10.3390/jcm7090284
Ryu J, Park SJ, Park J, Kim J, Yoo HJ, Kim TW, et al. Randomized clinical trial of immersive virtual reality tour of the operating theatre in children before anaesthesia. Br J Surg. 2017; 104(12): 1628-33. PMID: 28975600 DOI: 10.1002/bjs.10684
Ioannou A, Papastavrou E, Avraamides MN, Charalambous A. Virtual reality and symptoms management of anxiety, depression, fatigue, and pain: A systematic review. SAGE Open Nurs. 2020; 6: 2377960820936163. PMID: 33415290 DOI: 10.1177/2377960820936163
Oing T, Prescott J. Implementations of virtual reality for anxiety-related disorders: Systematic review. JMIR Serious Games. 2018; 6(4): e10965. PMID: 30404770 DOI: 10.2196/10965
López-Valverde N, Muriel Fernández J, López-Valverde A, Valero Juan LF, Ramírez JM, Flores Fraile J, et al. Use of virtual reality for the Management of anxiety and pain in dental treatments: Systematic review and meta-analysis. J Clin Med. 2020; 9(10): 3086. PMID: 32987885 DOI: 10.3390/jcm9103086
Davidson AJ, Shrivastava PP, Jamsen K, Huang GH, Czarnecki C, Gibson MA, et al. Risk factors for anxiety at induction of anesthesia in children: A prospective cohort study. Paediatr Anaesth. 2006; 16(9): 919-27. PMID: 16918652 DOI: 10.1111/j.1460-9592.2006.01904.x
Lillard AS. Pretend play skills and the child's theory of mind. Child Dev. 1993; 64(2): 348-71. PMID: 8477622