By Carolyn Crist

(Reuters Health) – A virtual reality program with cartoon characters may reduce children’s fear before imaging procedures, a South Korean study suggests.

Compared to verbal instructions, a virtual reality experience that explained the process of chest X-rays in detail reduced kids’ anxiety and stress, researchers reported in JAMA Pediatrics.

“Getting an X-ray can be scary for children but showing that VR education works helps pave the way for using it during more challenging medical procedures in the future,” Hunter Hoffman, director of the University of Washington’s Virtual Reality Research Center in Seattle, who was not involved in the new study, told Reuters Health by email.

Dr. Sung-Hee Han and colleagues from Seoul National University’s Medical Virtual Reality Research Group, who were unavailable for comment, conducted the trial at Bundang Hospital in Seongnam in the summer of 2018. They randomly assigned 100 children, ages 4 to 8, either to a control group that heard simple verbal instructions or a group that experienced a three-minute virtual reality program.

The research team measured the children’s stress and anxiety during the X-ray process with the Observational Scale of Behavioral Distress, which was originally developed for children requiring bone marrow procedures but has been expanded to other pediatric procedures that may be painful or distressing. It includes 11 behaviors that indicate distress, including crying, clinging, fear, restraint and screaming.

The VR experience was provided through a head-mounted VR display, which creates a 360-degree, three-dimensional virtual environment. Chatan and Ace, famous animation characters from the Korean series “Hello Carbot,” explained the process of chest radiography in detail, encouraging the children to cooperate during the procedure. The VR process took them into a radiography room, explained how to pose in front of a chest radiography machine, and reassured them to take a deep breath and not have anxiety.

The research team found that 78% of children in the VR group had a “low distress” score of less than five, as compared with 52% in the control group. Eight kids in the VR group requested parental presence, compared with 18 in the control group. Parental satisfaction scores were also slightly higher, with a 9.4 on a 10-point scale in the VR group and an 8.6 in the control group. The procedure time was slightly shorter in the VR group and required fewer repeats for children who moved around during the procedure.

“Pre-experiencing the procedure in virtual reality can be very helpful for reducing the patients’ anticipatory fears about the unknown,” Hoffman said. “Also, getting to try VR helps medical procedures become more cool. I’ll bet that what the kids take away from the experience (and what they tell their friends afterwards) is the memory of the VR instead of a memory of a scary hospital experience.”

In future studies, augmented reality using “see-through glasses” could allow children to see the cartoon characters while they go through the procedure, Hoffman said. Other studies have used virtual reality during dental procedures, blood draws, and burn wound cleaning to help children’s pain and anxiety.

“Now researchers need to know what in particular is helping our patients, whether the distraction component or isolation from visually-stressful stimuli, as well as what type of content is most helpful such as a calming scene or an exciting game,” said Dr. Samuel Rodriguez, director of Stanford University’s Chariot Program, which uses virtual reality, augmented reality and smart projectors to capture patients’ imaginations to decrease pain and anxiety.

“My hunch is that it’s not one-size-fits-all, and we need to have a variety of solutions based on the type of procedure or developmental level of the patient,” he told Reuters Health by phone. “We’re learning how to pair the best piece of content with each child based on experience.”

SOURCE: JAMA Pediatrics, online September 9, 2019.