The Usability of Virtual Reality as a Complimentary Pain Management Therapy in a Pediatric Population Undergoing Urodynamic Testing: A PILOT Study

Abstract

Research Question: The research question we are posing is, ¿In pediatric patients undergoing urodynamic testing, is the use of virtual reality feasible as a complementary pain management therapy in comparison to standard care?

Background and Significance: Urodynamics testing is an invasive procedure commonly used to assess the function of the lower urinary tract and bladder. The testing requires urethral and rectal catherization, and often needle electrodes for sphincter EMG. Patients are typically kept awake and receive local anesthetic gel. As a result, children receiving this type of evaluation often undergo physical and emotional discomfort. There is emerging evidence that virtual reality (VR) therapy offers an alternative noninvasive approach to reduce procedural pain and anxiety in patients. However, less is known about the use of this technology in the field of pediatric urology, specifically related to urodynamic testing.

Materials and Methods: Children aged 5 to 18 years old undergoing urodynamic testing were recruited through a quota sampling approach. VR software designed by KindVR (Alameda, California) allowed the patient to immerse in an underwater world with minimum simulator side effects. There are two phases of the research: baseline (VR education and implementation during the imaging portion of the urodynamic test) and follow-up (VR utilized and tested during the entire urodynamic procedure). Acceptability and feasibility were determined by two questionnaires. Pain, anxiety, and fear were measured pre and post-urodynamic procedures using the VAS Pain scale, Anxiety Thermometer Scale, and Children¿s Fear Scale. Satisfaction surveys were completed by the subject and clinical staff post-procedure.

Results: A total of twelve patients were eligible to be enrolled for phase 1. One patient of 5 years of age opted out of the VR due to high levels of anxiety. 80% of the participants ¿completely agree¿ that the implementation of VR made them feel better about their procedure and a majority reported that they will play VR again when in pain. There was no significant safety, technical, or equipment issues. There was minimal disruption to exam workflow and the implementation of VR was well received from the clinician survey (n=26). 80.7% of clinicians agree that VR helped the patient to cooperate during the medical procedure and 100% would use virtual reality again to distract children.

Conclusion: Preliminary data showing positive patient and clinical staff satisfaction suggests VR may be beneficial as a complimentary modality in pediatric urodynamic testing. Continued enrollment and data collection through Cycle #2 will further inform the usability of VR in a spine position and throughout the entire urodynamic procedure and exam.