Patients with burn trauma could better cope with the pain and anxiety of dressing changes with a non-pharmacological approach – virtual reality (VR). This has been confirmed by the results of research unique in Europe, which involved psychologists from the Palacký University Faculty of Arts.
There are hundreds of published studies on reducing pain and anxiety in burn trauma patients during dressing changes. However, most of these studies were conducted in the USA, whereas there have been only four in Europe – one in Germany, one in the Netherlands, and two in the UK. Thus, the current study conducted on Czech patients is in the European top ten, and some of its features are totally unique in the world.
By means of 3D glasses and a specially developed application called Cold River, Czech experts tried to influence a select group of burn trauma patients to focus on something other than their pain while their dressings were applied. The efforts were successful, and the results are more than promising. Patients who underwent the study subjectively experienced significantly less pain and anxiety, in some cases as much as forty percent less. Although experts are still in the early stages of analysis, it appears that interactive, highly immersive virtual reality can distract patients more effectively than passive viewing of static images.
“Although we’ve had indications that influencing pain or anxiety with virtual reality is possible, to date there has been a lack of adequate data from Czech burn trauma patients to make such a claim. No one before us has paid attention to the effect of the use of presence, immersion, and interactivity,” said Jan Šmahaj from the Department of Psychology at the UP Faculty of Arts, who participated in the unique research with his colleague Daniel Dostál. They were joined by other experts and specialists from the Second Faculty of Medicine of Charles University, doctors and medical staff of the University Hospital Královské Vinohrady, and experts from SPACE, a company that has been developing modern technologies and VR applications for a long time.
Over sixty selected patients participated in the research; they were divided into two groups, experiment and control, and kept unaware which group they were assigned to. During a painful dressing change, the patients in the experiment group wore a helmet with 3D glasses, while the experts used a newly developed app to distract them from their pain and anxiety. The patients were drawn into the sensation of floating a boat down a chilly river. During the bandage change, it was possible to float freely or even be more active on the journey and use the gaming potential of the app. This was controlled via the eye-tracker embedded in the 3D glasses, so only by moving their eyes. Whenever the patients decided to collect points in the game, such as by feeding animals or throwing snowballs, etc., they simply made an eye movement. The software contained enough elements for the patient to play something different during each dressing.
Virtual reality has been used as a treatment aid by researchers in the USA before, in patients with post-traumatic stress disorders from war events and in patients with war injuries when changing their dressings. The first-ever studies related to the use of VR in burn trauma were also conducted in the USA. However, until now, there has been no research on this topic with Czech patients.
Compared to normal, somewhat outdated VR applications (in use for about 20 years), the newly developed Cold River application offers a unique solution. According to Šmahaj, it is the very first app in this area that uses an eye camera to interact and deepen distraction. As a result, healthcare professionals can focus on changing bandages, even on burns located on the patients’ hands, without hindrance. Another unique feature of the project is the possibility during the VR game to position the patient without affecting them significantly. In the development of the app, many more detailed features were handled by an interdisciplinary team of experts, and although they may not be noticed by patients during the procedure, they are essential for more effective distraction and enhancing the effect of virtual reality to counteract the pain and anxiety associated with burn trauma.
Patients in the control group, also wearing a helmet with 3D glasses, differed from those in the experiment group in that they only viewed static images of a snowy landscape from the Cold River app. To eliminate the expectancy effect, patients did not know which group (control or experiment) they were in. The 3D glasses were also put on them in the same stages of dressing change and wound care (i.e., in the first or second half of the procedure).
“Our goal was to draw the patient into the highly immersive environment of Cold River as much as possible during the dressing, to keep them as occupied as possible, and to distract them from their flow of thoughts about pain or anxiety. Each patient underwent at least two dressing changes on different dates, and we monitored the effect of distraction –i.e., presence, immersiveness, and interactivity – on the perception of procedural pain. We found that patients in both the experiment and control groups perceived a decrease in both pain and anxiety. In addition, positive results were demonstrated regardless of which part of the procedure the app was used,” said cyberpsychologist and therapist Šmahaj.
Although the researchers are still analysing the results of the research, it is clear from the available data that the use of VR in the treatment of burns would be beneficial. Possibly in the sense that the patient would need less accompanying medication while changing dressings, and that their time spent in hospital would be reduced. Experts believe that such a patient would also be in a better mental state, which has a significant impact on both physical and psychological recovery from burn trauma.
The development of the special Cold River application and the methodology for its use, with regard to the needs determined by the health care system, was carried out by experts from SPACE in cooperation with physicians and psychologists, and according to Šmahaj, the new software and data prepared by the scientists could open up the possibility of its wider use.
“There are ongoing discussions about whether and how virtual reality could be used in other treatments, such as medical procedures that do not require general anaesthesia. It is estimated that we could also prospectively use VR in diagnostics and rehabilitation. In the future, we’d also like to focus on paediatric patients, on the education and training of medics, and on the simulation of certain processes in medicine,” added Šmahaj.
The results of the project – Virtual Reality and Coping with Procedural Pain in Burn Patients, supported by the Technology Agency of the Czech Republic within the ÉTA programme with approximately €560,000 – are now in the stage focused on the possible transfer of this technology.
Project name: Virtual Reality and Coping with Procedural Pain in Burn Patients
Supported by the Technology Agency of the Czech Republic within the ÉTA programme, with the amount of €560,000.
Period: May 2020 to December 2023
Principal Investigator: 2nd Faculty of Medicine, Charles University in Prague
Co-investigators: University Hospital Královské Vinohrady, Palacký University Olomouc Faculty of Arts, and SPACE, s. r. o.
More about the project is here. More about the VR laboratory at the Department of Psychology can be found here and here.