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Original Investigation
September 9, 2019

Effect of Immersive Virtual Reality Education Before Chest Radiography on Anxiety and Distress Among Pediatric Patients: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Anesthesiology and Pain Medicine, Medical Virtual Reality Research Group, Seoul National University College of Medicine, Gwanak-gu, Seoul, Republic of Korea
  • 2Department of Anesthesiology and Pain Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Republic of Korea
  • 3Department of Radiology, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Republic of Korea
  • 4Department of Pediatrics, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Republic of Korea
  • 5Department of Psychiatry, Medical Virtual Reality Research Group, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Bundang-gu, Seongnam, Republic of Korea
JAMA Pediatr. Published online September 9, 2019. doi:10.1001/jamapediatrics.2019.3000
Key Points

Question  What is the effect of virtual reality education for pediatric patients on anxiety during chest radiography?

Findings  In this randomized clinical trial with 99 children, children assigned to receive virtual reality education before chest radiography had significantly lower anxiety and distress scores during the procedure compared with those assigned to a control group.

Meaning  Virtual reality education effectively relieves the distress of the radiography experience among pediatric patients.

Abstract

Importance  Pediatric patients often encounter anxiety and distress in hospital settings, and virtual reality education, providing a vivid, immersive, and realistic experience, has been introduced to mitigate these anxiety responses.

Objective  To evaluate whether virtual reality education for pediatric patients before chest radiography could reduce anxiety and distress in children and improve the radiographic process.

Design, Setting, and Participants  This prospective randomized clinical trial was conducted in a tertiary academic hospital in Seongnam, Republic of Korea. Participants (n = 112) were children aged 4 to 8 years who underwent chest radiography between July 20, 2018, and September 11, 2018. Analysis was performed from October 2, 2018, to April 23, 2019.

Interventions  Children were randomized to simple verbal instruction (control group) or 3-minute virtual reality education explaining the process of chest radiography in detail and leading to appropriate cooperation (virtual reality group).

Main Outcomes and Measures  The primary outcome was anxiety and distress among pediatric patients based on behavioral observations using the amended version of the Observational Scale of Behavioral Distress scale for radiology procedures (total score of 30, with a score <5 indicating less distressed and a score ≥5 indicating more distressed). Secondary outcomes were the need of parental presence, parental satisfaction score, procedure time, number of repeated images, and process difficulty score.

Results  Of 99 children included in the final analysis, 50 (50.5%) were allocated to the control group (mean [SD] age, 5.6 [1.2] years; 26 boys [52.0%]) and 49 (49.5%) to the virtual reality group (mean [SD] age, 5.8 [1.3] years; 32 boys [65.3%]). The mean (SD) score for anxiety and distress (2.0 [3.7] vs 5.0 [6.1]; mean difference, 3.0 [95% CI, 1.0-5.0]; P = .004), need for parental presence (8 cases with parents present [16.3%] vs 18 cases with parents present [36.0%]), and mean (SD) procedure time (55.1 [21.6] seconds vs 75.0 [42.0] seconds) were lower in the virtual reality group than in the control group. The mean (SD) score for parental satisfaction (9.4 [1.4] vs 8.6 [2.0]) was higher in the virtual reality group than in the control group.

Conclusions and Relevance  Virtual reality education before chest radiography improved the radiography experience among pediatric patients by reducing anxiety, distress, and procedure time while increasing parents’ satisfaction.

Trial Registration  UMIN Clinical Trials Registry: UMIN000030663

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