Chronic kidney disease (CKD) is characterized by irreversible damage to renal function. For patients undergoing replacement therapies like hemodialysis (HD), the pain caused by arteriovenous fistula (AVF) cannulation becomes a significant aspect of their daily lives. This study aimed to examine the impact of virtual reality (VR) distraction techniques on the pain experienced during AVF needle insertion in patients undergoing HD.
Materials and methods:
This randomized clinical trial (RCT) recruited a total of 60 patients undergoing HD from the 9 Dey Hospital in Torbat Heydariyeh, Iran, between March and August 2022. These patients were then divided into two groups: the intervention group and the control group. The intervention group received distraction techniques using the Shinecon 4th Gen Virtual Reality Headset, while the control group received routine care services. To assess the level of pain experienced during AVF cannulation, the Visual Analog Scale (VAS) was utilized. The collected data were analyzed using SPSS20. Various statistical tests, including the Chi-square test, Mann-Whitney U test, Multiple linear regression, and independent-samples t-test, were employed for data analysis. Additionally, Cohen’s d was used to determine the effect size of the intervention.
Results:
The analysis of the data revealed a statistically significant difference in the mean (SD) pain scores between the control group (7.6 ± 0.8) and the intervention group (5.1 ± 0.9) (p < 0.002 after Bonferroni correction). Furthermore, it was observed that a majority of patients in the intervention group reported experiencing moderate pain, whereas the control group experienced more severe pain.
Conclusions:
The study findings demonstrated that the use of virtual reality (VR) was effective in reducing the intensity of pain experienced during AVF needle insertion in patients undergoing HD. Based on these results, it is recommended to incorporate VR as a routine practice in the HD department of the hospital.
Trial registration:
This study, with the code no. IRCT20180429039463N3, was registered on the Iranian Registry of Clinical Trials on 28/03/2022.
ArabVBagheri-NesamiMMousavinasabSN, et al. Comparison of the effects of hegu point ice massage and 2% lidocaine gel on arteriovenous fistula puncture-related pain in hemodialysis patients: a randomized controlled trial. J Caring Sci2017; 6: 141–151.
2.
KovesdyCP.Epidemiology of chronic kidney disease: an update 2022. Kidney Int Suppl2022; 12: 7–11.
3.
GhodsAAAbforoshNHGhorbaniR, et al. The effect of topical application of lavender essential oil on the intensity of pain caused by the insertion of dialysis needles in hemodialysis patients: a randomized clinical trial. Complement Ther Med2015; 23: 325–330.
4.
NygårdhAMalmDWikbyK, et al. The complexity in the implementation process of empowerment-based chronic kidney care: a case study. BMC Nurs2014; 13: 22–10.
5.
BadveSVPalmerSCHawleyCM, et al. Glomerular filtration rate decline as a surrogate end point in kidney disease progression trials. Nephrol Dial Transplant2016; 31: 1425–1436.
6.
RosenbergM.Overview of the management of chronic kidney disease in adults. UpToDate[Internet], 2018.
7.
ÇelikGÖzbekOYılmazM, et al. Vapocoolant spray vs lidocaine/prilocaine cream for reducing the pain of venipuncture in hemodialysis patients: a randomized, placebo-controlled, crossover study. Int J Med Sci2011; 8: 623–627.
8.
Alizadeh-TaghiabadBMazloumSRMiriK, et al. Determining the frequency of burn wound dressing for clinically competent nursing students: establishing standards based on learning curves. BMC Medical Education2023; 23: 678.
9.
Al AmerHSDatorWLAbunabHY, et al. Cryotherapy intervention in relieving arteriovenous fistula cannulation-related pain among hemodialysis patients at the King Khalid Hospital, Tabuk, Kingdom of Saudi Arabia. Saudi J Kidney Dis Transpl2017; 28: 1050.
10.
NoroziHGolmohammadi KavakiMHajiabadiF, et al. The effect of motivational abdominal breathing device on breathing patterns and shortness of breath in patients with chronic obstructive pulmonary disease. Évid Based Care2017; 6: 36–46.
11.
ArtaSMazlomSAminiS, et al. Comparing the effect of continuous versus intermittent flushing on maintaining patency of arterial line after coronary artery bypass graft surgery. J Mazandaran Univ Med Sci2017; 27: 45–55.
12.
Kakhki JagharghHBagheriMAghebatiN, et al. Effect of increased blood flow velocity on fatigue in hemodialysis patients. Evidence Based Care2020; 10: 48–57.
13.
NojabaeeASalehmoghaddamAMazlomS, et al. Effect of flourishing promotion program on social health in the elderly. Évid Based Care2018; 8: 39–48.
14.
IbrahimMBAbdelaal BadawiSEAlameriRA.Assessment of pain and anxiety during arteriovenous fistula cannulation among hemodialysis patients: a cross-sectional study in Saudi Arabia. J Multidiscip Healthc2022; 15: 705–718.
15.
Shabandokht-ZarmiHBagheri-NesamiMShorofiSA, et al. The effect of self-selected soothing music on fistula puncture-related pain in hemodialysis patients. Complement Ther Clin Pract2017; 29: 53–57.
16.
KoushkiBEbrahimiHTalebiS, et al. Effect of topical ginger on the pain of venipuncture in hemodialysis patients: a randomized controlled trial. Hayat2022; 27: 387–400.
17.
MazloumSRRajabzadehMMohajerS, et al. Comparing the effects of warm footbath and foot reflexology on the fatigue of patients undergoing radiotherapy: A randomized clinical trial. Integrative Cancer Therapies2023; 22: 15347354231172940.
18.
Rajabzadeh MalayjerdyZMazlomSMalekzadehJ. Effect of mirror therapy on arteriovenous fistula cannulation-related pain severity in hemodialysis patients. Évid Based Care2019; 9: 31–37.
19.
GunarathneTGNSAbdullahKLYoongTL, et al. Factors Influencing Stress Perception among Hemodialysis Patients: a Systematic Review. Iranian Red Crescent Medical Journal2022; 24.
20.
MillettCRGoodingLF.Comparing active and passive distraction-based music therapy interventions on preoperative anxiety in pediatric patients and their caregivers. J Music Ther2018; 54: 460–478.
21.
ÖzkanTKPolatF.The effect of virtual reality and kaleidoscope on pain and anxiety levels during venipuncture in children. J Perianesth Nurs2020; 35: 206–211.
22.
MohajerSMazlumSRajabzadehM, et al. The effect of laughter yoga on depression in cancer patients undergoing chemotherapy: a randomized clinical trial. Hayat2022; 28: 284–295.
ChaurasiaBJainDMehtaS, et al. Incentive-based game for allaying preoperative anxiety in children: a prospective, randomized trial. Anesth Analg2019; 129: 1629–1634.
25.
VafaeiSMManzariZSHeydariA, et al. Improving nursing care documentation in emergency department: a participatory action research study in Iran. Open Access Maced J Med Sci2018; 6: 1527–1532.
26.
FordCGManegoldEMRandallCL, et al. Assessing the feasibility of implementing low-cost virtual reality therapy during routine burn care. Burns2018; 44: 886–895.
27.
HardiePDarleyACarrollL, et al. Nursing & Midwifery students’ experience of immersive virtual reality storytelling: an evaluative study. BMC Nurs2020; 19: 78–12.
28.
OnyesoluMEzeF.Understanding virtual reality technology: advances and applications. In: SchmidtM (ed.) Advances in computer science and engineering. Rijeka: IntechOpen, 2011, pp.53–70.
29.
IndovinaPBaroneDGalloL, et al. Virtual reality as a distraction intervention to relieve pain and distress during medical procedures: a comprehensive literature review. Clin J Pain2018; 34: 858–877.
30.
RyuJ-HParkJ-WNahmFS, et al. The effect of gamification through a virtual reality on preoperative anxiety in pediatric patients undergoing general anesthesia: a prospective, randomized, and controlled trial. J Clin Med2018; 7: 284.
31.
DehghanFJalaliRBashiriH.The effect of virtual reality technology on preoperative anxiety in children: a Solomon four-group randomized clinical trial. Perioper Med2019; 8(1): 5.
32.
Zuazua-RicoDMosteiro-DiazMPMaestro-GonzalezA, et al. Nursing workload, knowledge about pain, and their relation to pain records. Pain Manag Nurs2020; 21: 510–515.
33.
HajialibeiglooRMazlumSRMohajerS, et al. Effect of self-administration of medication programme on cardiovascular inpatients’ medication adherence and nurses’ satisfaction: a randomized clinical trial. Nurs Open2021; 8: 1947–1957.
34.
Haji Ali BeiglooRMohajerSEshraghiA, et al. Self-administered medications in cardiovascular ward: a study on patients’ self-efficacy, knowledge and satisfaction. Évid Based Care2019; 9: 16–25.
35.
Sarboozi-HoseinabadiTAskariMMiriK, et al. Depression, anxiety, and stress of nurses’ family members in covid–19 pandemic; a case study of Torbat-e Heydariyeh Hospitals. Iran J War Public Health2020; 12: 241–248.
36.
PiskorzJCzubM.Effectiveness of a virtual reality intervention to minimize pediatric stress and pain intensity during venipuncture. J Spec Pediatr Nurs2018; 23: e12201.
37.
DawoodBGadoEAhmedS, et al. Effect of virtual reality compared to guided visualization on arteriovenous fistula cannulation pain and pain anxiety among hemodialysis children. Assiut Sci Nurs J2021; 9: 115–126.
38.
NasirzadehAMircheraghiSGhodratiM, et al. Comparing the effect of guided visualization and virtual reality techniques on cannulation pain in hemodialysis patients. J Res Med Dent Sci2019; 7: 55–62.
39.
KothgassnerODGoreisAKafkaJX, et al. Virtual reality exposure therapy for posttraumatic stress disorder (PTSD): a meta-analysis. Eur J Psychotraumatol2019; 10: 1654782.
40.
GallagherEJBijurPELatimerC, et al. Reliability and validity of a visual analog scale for acute abdominal pain in the ED. Am J Emerg Med2002; 20: 287–290.
41.
CohenJ.Statistical power analysis for the behavioral sciences. Burlington: Academic Press, 2013.
42.
HuaYQiuRYaoWY, et al. The effect of virtual reality distraction on pain relief during dressing changes in children with chronic wounds on lower limbs. Pain Manag Nurs2015; 16: 685–691.
43.
BrownNJKimbleRMRodgerS, et al. Play and heal: randomized controlled trial of Ditto™ intervention efficacy on improving re-epithelialization in pediatric burns. Burns2014; 40: 204–213.
44.
GerçekerGÖBinayŞBilsinE, et al. Effects of virtual reality and external cold and vibration on pain in 7- to 12-year-old children during phlebotomy: a randomized controlled trial. J Perianesth Nurs2018; 33: 981–989.
45.
GuoCDengHYangJ.Effect of virtual reality distraction on pain among patients with hand injury undergoing dressing change. J Clin Nurs2015; 24: 115–120.
46.
PandaA.Effect of virtual reality distraction on pain perception during dental treatment in children. Int J Oral Care Res2017; 5: 278–281.
47.
MalloyKMMillingLS.The effectiveness of virtual reality distraction for pain reduction: a systematic review. Clin Psychol Rev2010; 30: 1011–1018.
48.
SemerciRAkgün KostakMErenT, et al. Effects of virtual reality on pain during venous port access in pediatric oncology patients: a randomized controlled study. J Pediatr Oncol Nurs2021; 38: 142–151.
49.
WongCLLuiMMWChoiKC.Effects of immersive virtual reality intervention on pain and anxiety among pediatric patients undergoing venipuncture: a study protocol for a randomized controlled trial. Trials2019; 20(1): 369.
50.
Walther-LarsenSPetersenTFriisSM, et al. Immersive virtual reality for pediatric procedural pain: a randomized clinical trial. Hosp Pediatrics2019; 9: 501–507.
51.
DumoulinSBouchardSEllisJ, et al. A randomized controlled trial on the use of virtual reality for needle-related procedures in children and adolescents in the emergency department. Games Health J2019; 8: 285–293.
52.
WongMSSpiegelBMRGregoryKD.Virtual reality reduces pain in laboring women: a randomized controlled trial. Am J Perinatol2021; 38: e167–e172.
53.
BermoMSPattersonDShararSR, et al. Virtual reality to relieve pain in burn patients undergoing imaging and treatment. Top Magn Reson Imaging2020; 29: 203–208.
54.
MaaniCVHoffmanHGMorrowM, et al. Virtual reality pain control during burn wound debridement of combat-related burn injuries using robot-like arm mounted VR goggles. J Trauma2011; 71: S125–S130.
55.
AtzoriBLauro GrottoRGiugniA, et al. Virtual reality analgesia for pediatric dental patients. Front Psychol2018; 9: 2265.
56.
AtzoriBHoffmanHVagnoliL, et al. Virtual reality as distraction technique for pain management in children and adolescents. In Mehdi Khosrow-PourDBA (ed.) Encyclopedia of information science and technology, fourth edition. Hershey, PA: IGI Global, 2018, pp.5955–5965.
57.
FurmanEJasineviciusTRBissadaNF, et al. Virtual reality distraction for pain control during periodontal scaling and root planing procedures. J Am Dent Assoc2009; 140: 1508–1516.
58.
JeffsDDormanDBrownS, et al. Effect of virtual reality on adolescent pain during burn wound care. J Burn Care Res2014; 35: 395–408.
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