Authors' objectives: HTW undertook an evidence review to address the following question: What is the clinical and cost effectiveness of virtual reality as a distraction therapy for the management of procedural pain? This is an updated version of an appraisal published by HTW in May 2020. This appraisal uses both the original findings and evidence published subsequently.

Authors' results and conclusions: HTW identified three recent systematic reviews with meta-analyses, all of which studied children. We identified a further 17 randomised control trials (RCTs) across a wide range of different medical procedures. Two meta-analyses were carried out using standardised mean differences in pain intensity in adults undergoing a variety of medical procedures. One meta-analysis focused on average pain scores while the other focused on worst pain scores. In both analyses, pain scores were found to be lower when using virtual reality (VR). For studies involving children, we identified three systematic reviews and meta-analyses. The findings were consistent with the evidence in adults with most studies reporting that VR reduced pain in comparison to standard care. For both adults and children, VR systems also appear to be effective at reducing anxiety levels. No economic evidence was identified on the use of VR distraction therapy in people at risk of pain during medical procedures. There is the potential for the cost of using VR systems to be offset by savings in healthcare resource use, such as a reduction in the use of analgesics, anaesthesia, and associated recovery time. Two illustrative analyses were undertaken to demonstrate potential cost savings and it was found that the VR system could result in net cost savings if the VR device is used with sufficient frequency. The appropriate mechanism for patient engagement was determined and the patient perspective was considered where possible. A literature search was also undertaken to report the experiences, views and opinions of patients and families who have used VR headsets across multiple healthcare settings to manage procedural pain.

Authors' recommendations: The evidence partially supports the adoption of VR interventions for the management of pain and anxiety in adults and children undergoing medical procedures, but the evidence is insufficient to support routine adoption. The use of VR reduces pain and anxiety associated with a range of medical procedures as compared with standard care and is well tolerated. While there is the potential for cost savings through a reduction in the use of analgesics, sedation or anaesthesia, the evidence to support this is currently limited. HTW would encourage the gathering of further evidence to define the economic and clinical impact of virtual reality in more detail.

Authors' methods: This is an updated version of the original Evidence Appraisal Report published by Health Technology Wales in May 2020. The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this. Where the data allowed, we conducted two separate meta-analyses of the worst and average pain scores across the adult population studying a variety of medical procedures.

Authors' identified further research: HTW would encourage the gathering of further evidence to define the economic and clinical impact of virtual reality in more detail.

Project Status: Completed

Year Published: 2022

URL for published report: https://www.healthtechnology.wales/reports-guidance/virtual-reality-distraction-therapy/

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales