There were nine eligible, consenting child subjects (6 boys and 3 girls) in the sample. The average age for both boys and girls was 10.0 years (SD 3.7 and 4.1 respectively), age ranging between 5 to 16 years. The average percent of body surface area burnt was 5.3% (SD 3.4%) and there was no significant gender or age difference in body area burnt.
For boys, two had burns from contact with a silencer (muffler) on a four wheeled motor bike, two were burnt from a hot water bag bursting, one was burnt while playing with petrol and fire, and the remaining boy was burnt with hot oil from a BBQ. For the girls, all three were burnt by overturned fluids. All participants were experiencing burns for the first time, and when enrolled into the study, their burns were at either second or third dressing change. Every participants' pain, prior to enrolling in this study, had been managed either with no pain relief, or by pharmacological means.
For every child participant, one parent or guardian with one exception (was not available to observe the dressing change) provided data on the effectiveness of the VR for every post-session interview. One key nurse involved in the burns management was also interviewed following each session.
Overall, 13 trials were undertaken from nine children (one subject participating in three trials, two subjects in two trials, and the remainder in one trial each). The results of two subjects were withdrawn for further analysis as the respective participants were too drowsy from the effects of analgesia to participate appropriately in the VR section of the session. Thus the remaining seven child subjects were included for analysis, with a total of 11 useable trials (an average of 1.6 trials per subject). The seven participants in the included trials had an average age of 11.1 years (SD 3.5).
There was no significant difference (p <0.05) in time taken in the two treatment halves (removal and application of fresh dressing). The average difference in administering the two treatment halves was approximately 2 minutes (Figure ).
Per trial comparison of time taken to complete each treatment half
With pharmacological analgesia only, the mean pain score (using the Faces Scale), over all included trials was 4.1 (SD 2.9), whilst for VR coupled with pharmacological analgesia, the average pain score was 1.3 (SD 1.8). Because of the small number of child subjects in the study, the data was considered per child, and per trial. Over all included trials, the mean pain score difference between administrations was 3.2 (SD 2.1), which was significant using paired t-tests (p < 0.01). This indicated the importance of the effect of using VR (coupled with analgesia) in reducing pain experiences during burns dressing changes. The per trial pain responses to VR and analgesia, and analgesia alone, compared with the average trial response per administration is shown in Figure .
Per trial differences in pain scores compared with average administration scores
For each child subject who completed an eligible trial, the average per-child difference in pain scores between administrations of VR & Pharmacological Analgesia, or Pharmacological Analgesia alone, suggested that every child but one obtained an improvement in pain scoring of at least 2 points on the Faces Scale, attributable to VR, as demonstrated in Figure .
Per child differences in pain response attributable to VR
Comments made by nurses, parent/s and child subject
All nurses or parents agreed that VR helped distract the children and was helpful in reducing pain and there were no negative comments regarding the application of VR. (note - delete 'interestingly')
The overwhelming response from the nursing staff was that VR administration was helpful to the child. Comments from the interviews are provided below as evidence of this.
"... probably VR helped to take concentration off ... probably helped take away a lot of the anticipation away from the treatment".
"... from my past experience, I can tell that it (changing burns dressing) can be a real problem. It was not a problem today. He did not even flinch while the dressing was being taken off."
"... communication was good – he understood what I asked him to do. I did not find it invasive or intrusive..."
"... it was great to do the changing (of dressing) without dumping him with medication."
"... no (communication was not effected) ... he responded well to the requests and commands."
"yes (pain was significantly less)... he had lot more pain with cleaning (of the wound) than taking the dressing off... He seemed to cope better with VR than without."
"... cleaning the dressing in the bathroom made him more anxious, when he saw the wound – felt more pain."
"Yes, he was more anxious when VR was not on."
"... he felt worse when he was looking at it (the wound) compared to when he was not."
"... was more relaxed and concentrated on the game. You could tell that he could feel the pain, but focussed on the game."
The perception of the assisting nurses were the children were more cooperative and distracted from the administration of VR, which helped reduce the difficulty in changing the burns dressing compared to when routine analgesia was used by itself. There appeared to be no problem in physically using VR within the environmental constraints of the burns dressing area, and in no instance did VR impede communication with the child.
All parents agreed with the positive effects of VR in pain management for their child. They all commented that the child's anxiety level was perceptibly less when using VR, and the child looked forward to playing the VR game. Comments below from the parent interviews support the positive VR effects:
"... was a lot calmer and enjoyed the VR."
"...absolutely, she did not remember about the last dressing that was taken off. She had to be prompted, to remind her of the game and change of dressing."
"... much happier than usual. He reckoned he felt it but I think he did not. He did not show any of the same signs."
"...she was not as anxious. Was afraid before hand, but she was all right after the game was switched on. It took her mind, off the pain."
"...was smiling while playing the game."
"... compared to the medication which left him groggy, disoriented, lost track of time and anxious, I think this (VR) allows the continuity of time and reduces anxiety."
"Yes (pain was significantly less) ... probably judging it from yesterday – medication made him worse – uncooperative and pig-headed, compared to when he was playing the game."
"Yesterday he was whinging thinking about the dressing change, this morning, when I told him that you were coming; he had a grin on his face..."
Comments from child participants on the VR game
However, the current game appeared to have a reasonable level of complexity and engaged the participating children of different age groups.
The above comments were randomly selected from the questionnaire deployed at the completion of each trial (to interview the nurses, parents and children participating in the study).