Assessment 3 Critical Appraisal of Evidence HLSC122

Article 1: Effects of virtual reality on pain, fear and anxiety during blood draw in children aged 5–12 years old: A randomised controlled study
In this article, researchers were focussing on the problem of pain, fear and anxiety in children of 5-12 year of age during blood draw or other procedures like wound care, chemotherapy, port access, dental procedures etc. Their research question was to assess the effects of virtual reality on pain, fear and anxiety scores of children during these procedures. They hypothesise that if children use Virtual reality unit during these procedures, they’ll get distracted and therefore they ‘ll feel less pain and anxiety as well as their fear also subsides. To check their hypothesis, they selected 136 children as per their inclusion criteria and randomly allocated them to two groups: One group that uses VR during blood draw and other group as control i.e., no use of VR during blood draw. The pain score and fear and anxiety score of both groups were recorded by Child Fear Scale and Children's Anxiety Meter and statistically analyzed.
The randomized controlled trial was well designed as clearly addresses the problem and research question. It addresses the use of distraction methods with the highest level of evidence in reducing children's procedure-related pain. This was the first study about the use of different virtual reality methods on pain, fear and anxiety during blood draw. It was performed under complete ethical approval which was received from the Non-Invasive Clinical Studies Ethics Committee of the University. The study is appropriately designed with clearly defined study protocol and low risk of bias. The data was collected homogenously and proper statistical tests were performed for the data analysis. Children were allocated by blocked randomisation (gender and age) and the allocation concealment was definite as cross-checked by a computer-generated number table. The allocation sequence was concealed from the investigators and the participants. This was a cost-effective analysis since Virtual reality (VR) is selected here because it can easily be adapted to clinical procedures due to its low cost. Included children and their parents were well aware about the intervention. But the preference of children was also taken into consideration regarding which distraction method he/she wants to use. Children were assigned to three groups: the VR-Rollercoaster group (moving, exciting environment), the VR-Ocean Rift group (relaxing music environment) and the No VR group (control). Each group has received the same level of care and follow up intervals were same for each study group. The pain, fear and anxiety score of children of both control and VR using group was recorded during blood draw by parents or researchers and was statistically analyzed by one-way analysis of variance and linear regression analysis. The results were reported in terms of Mean ± Standard Deviation (minimum–maximum) along with respective p-value for showing their statistical significance. The p value of less than 0.05 was considered as statistically significant. As per their hypothesis that use of virtual reality can distract the children mind and therefore reduces the anxiety, pain and fear related to blood draw, the study also found the reduction in pain score, fear and anxiety score in both the...