The beneficial impact of virtual reality in the burn wound care of pediatric patients: An updated systematic review and meta-analysis
Jiaqi Lou, Ziyi Xiang, Jiliang Li, Shengyong Cui, Neng Huang, Guoying Jin, Xin Le, Youfen Fan, Qionghui Sun
Abstract
OBJECTIVE: This systematic review and meta-analysis assesses the efficacy of virtual reality (VR) interventions in managing pain, anxiety, and physiological parameters in pediatric patients undergoing burn wound care. METHODS: We conducted a comprehensive literature search across PubMed, Embase, the Cochrane Library, and Web of Science to identify randomized controlled trials (RCTs) comparing VR interventions with standard care or non-VR alternatives in pediatric burn patients. Methodological quality was assessed using the Cochrane Risk of Bias tool. Primary outcomes included pain scores, anxiety levels, time spent thinking about pain, pleasure scores, heart rate, and oxygen saturation. Data were pooled using random-effects models to calculate standardized mean differences (SMD) and 95 % confidence intervals (CI). Analyses included funnel plots, Egger's regression tests, and sensitivity analyses to evaluate publication bias and robustness. RESULTS: Fifteen RCTs involving 622 pediatric burn patients were included. Meta-analysis indicated that VR was associated with reduced pain scores (SMD = -1.44, 95 % CI: -2.03 to -0.85; P < 0.001, I² = 81.1 %) and anxiety scores (SMD = -0.61, 95 % CI: -0.93 to -0.29; P < 0.001, I² = 77.1 %). VR interventions also appeared to decrease the time patients spent thinking about pain (SMD = -0.72, 95 % CI: -1.21 to -0.21; P < 0.001, I² = 85.2 %). Pleasure scores were numerically higher in the VR group (SMD = 0.47, 95 % CI: 0.23-0.71; P = 0.940, I² = 0.00 %), though this difference did not reach statistical significance. Furthermore, VR was associated with lower heart rate (SMD = -1.60, 95 % CI: -2.72 to -0.48; P = 0.007, I² = 86.4 %) without affecting oxygen saturation (SMD = 0.00, 95 % CI: -0.35-0.35; P = 0.651, I² = 86.4 %). Sensitivity analyses suggested relative stability of effect sizes, and funnel plots indicated limited evidence of publication bias. CONCLUSION: These findings suggest VR interventions may offer benefits in reducing pain and anxiety in pediatric burn patients during wound care. The evidence supports exploring VR as an adjunctive approach in burn care settings. Future research is needed to focus on optimizing VR content, delivery systems, and long-term outcomes to better understand its clinical utility.