title: The effect of virtual reality on pain and range of motion in adults with burn injuries.
abstract: Few studies have empirically investigated the effects of immersive virtual reality (VR) on postburn physical therapy pain control and range of motion (ROM). We performed a prospective, randomized controlled study of the effects of adding VR to standard therapy in adults receiving active-assisted ROM physical therapy, by assessing pain scores and maximal joint ROM immediately before and after therapy on two consecutive days. Thirty-nine inpatients, aged 21 to 57 years (mean 35 years), with a mean TBSA burn of 18% (range, 3-60%) were studied using a within-subject, crossover design. All patients received their regular pretherapy pharmacologic analgesia regimen. During physical therapy sessions on two consecutive days (VR one day and no VR the other day; order randomized), each patient participated in active-assisted ROM exercises with an occupational or physical therapist. At the conclusion of each session, patients provided 0 to 100 Graphic Rating Scale measurements of pain after each 10-minute treatment condition. On the day with VR, patients wore a head-position-tracked, medical care environment-excluding VR helmet with stereophonic sound and interacted in a virtual environment conducive to burn care. ROM measurements for each joint exercised were recorded before and after each therapy session. Because of nonsignificant carryover and order effects, the data were analyzed using simple paired t-tests. VR reduced all Graphic Rating Scale pain scores (worst pain, time spent thinking about the pain, and pain unpleasantness by 27, 37, and 31% respectively), relative to the no VR condition. Average ROM improvement was slightly greater with the VR condition; however, this difference failed to reach clinical or statistical significance (P = .243). Ninety-seven percent of patients reported zero to mild nausea after the VR session. Immersive VR effectively reduced pain and did not impair ROM during postburn physical therapy. VR is easily used in the hospital setting and offers a safe, nonpharmacologic adjunctive analgesic treatment.
authors.affiliation: Department of Surgery, University of Washington, Seattle, Washington, USA.
authors.forename: Gretchen J
authors.initials: GJ
authors.lastname: Carrougher
authors.forename: Hunter G
authors.initials: HG
authors.lastname: Hoffman
authors.forename: Dana
authors.initials: D
authors.lastname: Nakamura
authors.forename: Dennis
authors.initials: D
authors.lastname: Lezotte
authors.forename: Maryam
authors.initials: M
authors.lastname: Soltani
authors.forename: Laura
authors.initials: L
authors.lastname: Leahy
authors.forename: Loren H
authors.initials: LH
authors.lastname: Engrav
authors.forename: David R
authors.initials: DR
authors.lastname: Patterson
mesh_terms: D000328:Adult; D000700:Analgesics / Q000627:therapeutic use; D002056:Burns / Q000503:physiopathology* / Q000534:rehabilitation*; D005260:Female; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology* / Q000534:rehabilitation*; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D016896:Treatment Outcome; D014584:User-Computer Interface; D014861:Washington
chemical_list: D000700:Analgesics
references.citation: Am J Clin Hypn. 2004 Jul;47(1):43-54
references.pmid: 15376608
references.citation: J Neurosci. 2001 Dec 15;21(24):9896-903
references.pmid: 11739597
references.citation: Pain. 2004 Sep;111(1-2):162-8
references.pmid: 15327820
references.citation: Anesth Analg. 2007 Dec;105(6):1776-83, table of contents
references.pmid: 18042882
references.citation: Clin J Pain. 2000 Sep;16(3):244-50
references.pmid: 11014398
references.citation: J Burn Care Rehabil. 1995 May-Jun;16(3 Pt 2):372-6
references.pmid: 7543901
references.citation: Clin J Pain. 2001 Sep;17(3):229-35
references.pmid: 11587113
references.citation: J Burn Care Rehabil. 1998 Sep-Oct;19(5):436-40
references.pmid: 9789180
references.citation: J Pain. 2006 Nov;7(11):843-50
references.pmid: 17074626
references.citation: J Exp Psychol Learn Mem Cogn. 1988 Jul;14(3):562-9
references.pmid: 2969947
references.citation: Pain. 2000 Mar;85(1-2):305-9
references.pmid: 10692634
references.citation: Neuroreport. 2004 Jun 7;15(8):1245-8
references.pmid: 15167542
references.citation: J Burn Care Rehabil. 1992 Sep-Oct;13(5):576-80
references.pmid: 1452593
references.citation: Brain. 1999 Sep;122 ( Pt 9):1765-80
references.pmid: 10468515