Virtual Reality Analgesia for Burn Joint Flexibility: A Randomized Controlled Trial

• Published in: Rehabilitation psychology 2018-11, Vol.63 (4), p.487-494
• Main Authors: Soltani, Maryam, Drever, Sydney A., Hoffman, Hunter G., Sharar, Sam R., Wiechman, Shelley A., Jensen, Mark P., Patterson, David R.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Analgesia; Analgesia - methods; Burns; Burns - rehabilitation; Distraction; Exercise; Female; Human; Humans; Injuries; Inpatient; Joints (Anatomy); Male; Middle Aged; Pain; Pain Management - methods; Physical Therapy; Physical Therapy Modalities; Range of Motion; Range of Motion, Articular; Virtual Reality; Young Adult
• ISSN: 0090-5550; 1939-1544
• DOI: 10.1037/rep0000239

Objective: We conducted a randomized controlled study to determine the effects of virtual reality (VR) distraction on pain and range of motion (ROM) in patients hospitalized for burn care during active physical therapy exercises. Method: Thirty-nine participants aged 15 to 66 (M = 36) years with significant burn injuries (mean burn size = 14% TBSA) participated. Under therapist supervision, using a within-subjects design, participants performed unassisted active ROM exercises both with and without VR distraction in a randomized order. Therapists provided participants with instructions but did not physically assist with stretches. Maximum active ROM was measured using a goniometer. A 0-100 Graphic Rating Scale (GRS) was used to assess the cognitive, affective, and sensory components of pain. A GRS rating of the amount of "fun" during stretching served as a measure of positive experience. Results: Participants reported lower mean GRS ratings during VR, relative to No VR, for worst pain, pain unpleasantness, and time spent thinking about pain. They also reported having a more positive experience during VR than during No VR. However, patients did not show greater ROM during VR. Conclusion: Immersive VR reduced pain during ROM exercises that were under the control of the patient. Impact and Implications With current advancements in technology, the availability and potential health applications have exploded over the past few years. The current project is one of the early randomized trials done in the area of applying VR to rehabilitation medicine, much less any form of health care. We were able to demonstrate that VR decreased pain ratings when patients were exercising a limb that had been burned in a way that affected range of motion. Although our study did not demonstrate that VR increased limb range of motion during physical therapy, the fact that the patients reported less pain and found therapy more enjoyable has potential positive implications. With greater emphasis on home health care, interventions that result in patients participating more in their own care and being more motivated to exercise are particularly important. Given the popularity and advancements in technology, the melding of it with health care is particularly compelling.