Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes : study protocol for a randomised controlled trial

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Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes : study protocol for a randomised controlled trial. / Small, Charlotte; Stone, Robert; Pilsbury, Jane; Bowden, Michael; Bion, Julian.

In: Trials, Vol. 16, No. 1, 329, 05.08.2015.

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@article{b451d76491734dde9de31402e9cb3dcb,
title = "Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes : study protocol for a randomised controlled trial",
abstract = "BackgroundThe pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients{\textquoteright} psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system.Methods/DesignThe present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system{\textquoteright}s impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions:1. Interactive VRET plus conventional analgesics.2. Passive VRET with conventional analgesics.3. Conventional analgesics alone.Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes.DiscussionThe study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable.Trial registrationCurrent Controlled Trials ISRCTN23330756. Date of Registration 25 February 2014.",
keywords = "procedure-related pain, distraction, virtual reality, burns, pilot study, randomised controlled trial",
author = "Charlotte Small and Robert Stone and Jane Pilsbury and Michael Bowden and Julian Bion",
year = "2015",
month = aug
day = "5",
doi = "10.1186/s13063-015-0878-8",
language = "English",
volume = "16",
journal = "Trials",
issn = "1745-6215",
publisher = "Springer",
number = "1",

}

RIS

TY - JOUR

T1 - Virtual restorative environment therapy as an adjunct to pain control during burn dressing changes : study protocol for a randomised controlled trial

AU - Small, Charlotte

AU - Stone, Robert

AU - Pilsbury, Jane

AU - Bowden, Michael

AU - Bion, Julian

PY - 2015/8/5

Y1 - 2015/8/5

N2 - BackgroundThe pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients’ psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system.Methods/DesignThe present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system’s impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions:1. Interactive VRET plus conventional analgesics.2. Passive VRET with conventional analgesics.3. Conventional analgesics alone.Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes.DiscussionThe study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable.Trial registrationCurrent Controlled Trials ISRCTN23330756. Date of Registration 25 February 2014.

AB - BackgroundThe pain of a severe burn injury is often characterised by intense background pain, coupled with severe exacerbations associated with essential procedures such as dressing changes. The experience of pain is affected by patients’ psychological state and can be enhanced by the anxiety, fear and distress caused by environmental and visual inputs. Virtual Reality (VR) distraction has been used with success in areas such as burns, paediatrics and oncology. The underlying principle of VR is that attention is diverted from the painful stimulus by the use of engaging, dynamic 3D visual content and associated auditory stimuli. Functional magnetic resonance imaging (fMRI) studies undertaken during VR distraction from experimental pain have demonstrated enhancement of the descending cortical pain-control system.Methods/DesignThe present study will evaluate the feasibility of introducing a novel VR system to the Burns Unit at the Queen Elizabeth Hospital Birmingham for dressing changes: virtual restorative environment therapy (VRET). The study will also explore the system’s impact on pain during and after the dressing changes compared to conventional analgesia for ward-based burn dressing changes. A within-subject crossover design will be used to compare the following three conditions:1. Interactive VRET plus conventional analgesics.2. Passive VRET with conventional analgesics.3. Conventional analgesics alone.Using the Monte Carlo method, and on the basis of previous local audit data, a sample size of 25 will detect a clinically significant 33 % reduction in worst pain scores experienced during dressing changes.DiscussionThe study accrual rate is currently slower than predicted by previous audits of admission data. A review of the screening log has found that recruitment has been limited by the nature of burn care, the ability of burn inpatients to provide informed consent and the ability of patients to use the VR equipment. Prior to the introduction of novel interactive technologies for patient use, the characteristics and capabilities of the target population needs to be evaluated, to ensure that the interface devices and simulations are usable.Trial registrationCurrent Controlled Trials ISRCTN23330756. Date of Registration 25 February 2014.

KW - procedure-related pain

KW - distraction

KW - virtual reality

KW - burns

KW - pilot study

KW - randomised controlled trial

U2 - 10.1186/s13063-015-0878-8

DO - 10.1186/s13063-015-0878-8

M3 - Article

C2 - 26242401

VL - 16

JO - Trials

JF - Trials

SN - 1745-6215

IS - 1

M1 - 329

ER -