Background: Surgery, hospitalization and painful procedures are a source of great stress and anxiety for children. Anxiety caused by the unknown exacerbates the pain, slows the recovery down and could result in a low adherence to future medical treatment. According to current evidence, pain that is not efficiently treated can have negative impact on patient, especially in perioperative period. The good management of preoperative anxiety seems to reduce the pain and the risk of complications which reflects in shorter hospital stays, reduces healthcare costs and increases the quality of care. Recent studies suggest a certain effectiveness of virtual reality (VR) as a non-pharmacological technique for the management of acute anxiety and pain related to painful medical procedures. First used in the 1990s to treat post-traumatic syndrome in the military, its use has expanded more and more and currently includes psychiatric therapy, rehabilitation and physiotherapy, health education, oncology. Thanks to its distraction and playful potential, VR is particularly delightful for pediatric patients. The use of game design elements in non-game contexts (gamification) encourages learning and processing of new information, adding involvement, motivation and fun. Object: This review aims to summarize the evidences on the efficacy of VR in the treatment of anxiety and pain in children during the perioperative period, allowing them greater compliance. Materials and methods: Systematic review of the literature, includes primary studies on the efficacy of VR in the treatment of perioperative anxiety and postoperative pain in children between 0 and 18 years of age undergoing elective surgery in general anesthesia. After research made on Pubmed, Scopus and Web of Science databases, 1365 studies were found, 24 of which defined as eligible. 7 randomized controlled trials (RCTs) were included in the final analysis. Results: Analysis of the studies shows that virtual reality is an effective non-pharmacological method for reducing preoperative anxiety, and it also seems that VR increases compliance during general anesthesia induction. However, VR does not seem to have an effect in reducing post-operative negative outcomes such as emergence delirium. Furthermore, there is insufficient evidence that this technique reduces postoperative pain and parental anxiety. Conclusions: Virtual reality can be considered as an efficient method for reducing preoperative anxiety. Analysis of the studies shows that VR is suitable for children aged between 4 and 12 years. It would therefore be desirable to conduct studies that include subjects of different age groups. Further investigations are needed in order to better define the effectiveness of VR in reducing anxiety caused by interventions that require hospitalization for more than one day and not in election, as prolonged hospitalization increases the level of general stress.
Background: L’intervento chirurgico, l’ospedalizzazione e le procedure dolorose sono fonte di forte stress ed ansia per il bambino. L’ansia scaturita dall’ignoto esacerba il dolore, rallenta il recupero e può compromettere i futuri rapporti del bambino con il sistema sanitario. Secondo le attuali evidenze, il dolore non adeguatamente trattato può impattare negativamente sulla sfera psichica e fisica dell’assistito, soprattutto nel periodo perioperatorio. L’efficace gestione dell’ansia preoperatoria sembra avere benefici sul dolore, riducendo le complicanze e la degenza ospedaliera, aumentando la qualità delle cure e riducendo la spesa sanitaria. Studi recenti suggeriscono una certa efficacia della realtà virtuale (VR) come tecnica non farmacologica per la gestione dell’ansia e del dolore acuti legati a procedure mediche dolorose. Utilizzata per prima negli anni ‘90 per trattare la sindrome post traumatica nei militari, il campo della sua applicazione si è esteso sempre di più ed attualmente include la terapia psichiatrica, la riabilitazione e la fisioterapia, l’educazione sanitaria, l’oncologia. Grazie alle sue potenzialità di distrazione e ludiche, la VR è particolarmente allietante per la pediatria. L’inserimento di elementi di gioco in contesti educativi (gamification) facilita l’apprendimento e l’elaborazione di nuove informazioni, aggiungendovi coinvolgimento, motivazione e divertimento. Obiettivo: L’obiettivo della revisione è quello di riassumere le principali evidenze sull’efficacia della VR nella gestione dell’ansia e del dolore nei bambini durante il periodo perioperatorio, consentendo loro una maggiore compliance. Materiali e metodi: Revisione sistematica della letteratura, che include gli studi primari sull’efficacia della VR nella gestione dell’ansia perioperatoria e il dolore postoperatorio nei bambini tra 0 e 18 anni sottoposti ad anestesia generale per intervento chirurgico in elezione. Dalla ricerca effettuata sui database Pubmed, Scopus e Web of Science sono stati rilevati 1365 studi, dei quali 24 definiti come eleggibili. Nella ricerca finale sono stati inclusi 7 trial controllati randomizzati (RCT). Risultati: I sette studi analizzati dimostrano che la realtà virtuale è un efficace metodo non farmacologico per la riduzione dell’ansia preoperatoria, inoltre sembra che la VR aumenti la compliance durante l’induzione dell’anestesia generale. Tuttavia, la VR non sembra avere effetto nella riduzione degli esiti negativi postoperatori come l’emergence delirium. Inoltre, non ci sono prove sufficienti che questa tecnica riduca il dolore postoperatorio e l’ansia dei genitori. Conclusioni: La realtà virtuale può essere considerata un valido metodo per la riduzione dell’ansia preoperatoria. Dall’analisi degli studi esaminati, emerge che è adatta per i bambini di età tra 4 e 12 anni. Sarebbe dunque auspicabile la conduzione di studi che includano soggetti di differenti fasce di età. Inoltre, sono necessari ulteriori indagini per poter definire meglio l’efficacia della VR nella riduzione dell’ansia anche per gli interventi che prevedono il ricovero per più di un giorno e non in elezione, considerato che l’ospedalizzazione prolungata aumenta il livello dello stress generale.
La realtà virtuale nella gestione dell'ansia e del dolore nel bambino sottoposto a intervento chirurgico: revisione della letteratura
VANKOVA, NADEZHDA
2019/2020
Abstract
Background: Surgery, hospitalization and painful procedures are a source of great stress and anxiety for children. Anxiety caused by the unknown exacerbates the pain, slows the recovery down and could result in a low adherence to future medical treatment. According to current evidence, pain that is not efficiently treated can have negative impact on patient, especially in perioperative period. The good management of preoperative anxiety seems to reduce the pain and the risk of complications which reflects in shorter hospital stays, reduces healthcare costs and increases the quality of care. Recent studies suggest a certain effectiveness of virtual reality (VR) as a non-pharmacological technique for the management of acute anxiety and pain related to painful medical procedures. First used in the 1990s to treat post-traumatic syndrome in the military, its use has expanded more and more and currently includes psychiatric therapy, rehabilitation and physiotherapy, health education, oncology. Thanks to its distraction and playful potential, VR is particularly delightful for pediatric patients. The use of game design elements in non-game contexts (gamification) encourages learning and processing of new information, adding involvement, motivation and fun. Object: This review aims to summarize the evidences on the efficacy of VR in the treatment of anxiety and pain in children during the perioperative period, allowing them greater compliance. Materials and methods: Systematic review of the literature, includes primary studies on the efficacy of VR in the treatment of perioperative anxiety and postoperative pain in children between 0 and 18 years of age undergoing elective surgery in general anesthesia. After research made on Pubmed, Scopus and Web of Science databases, 1365 studies were found, 24 of which defined as eligible. 7 randomized controlled trials (RCTs) were included in the final analysis. Results: Analysis of the studies shows that virtual reality is an effective non-pharmacological method for reducing preoperative anxiety, and it also seems that VR increases compliance during general anesthesia induction. However, VR does not seem to have an effect in reducing post-operative negative outcomes such as emergence delirium. Furthermore, there is insufficient evidence that this technique reduces postoperative pain and parental anxiety. Conclusions: Virtual reality can be considered as an efficient method for reducing preoperative anxiety. Analysis of the studies shows that VR is suitable for children aged between 4 and 12 years. It would therefore be desirable to conduct studies that include subjects of different age groups. Further investigations are needed in order to better define the effectiveness of VR in reducing anxiety caused by interventions that require hospitalization for more than one day and not in election, as prolonged hospitalization increases the level of general stress.| File | Dimensione | Formato | |
|---|---|---|---|
|
Tesi Nadia pdfa.pdf
Open Access dal 28/11/2023
Dimensione
1.01 MB
Formato
Adobe PDF
|
1.01 MB | Adobe PDF | Visualizza/Apri |
I documenti in UNITESI sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
https://hdl.handle.net/20.500.12075/2898