Emerging Utility of Virtual Reality as a Multidisciplinary Tool in Clinical Medicine.

OBJECTIVE Among the more recent products borne of the evolution of digital technology, virtual reality (VR) is gaining a foothold in clinical medicine as an adjunct to traditional therapies. Early studies suggest a growing role for VR applications in pain management, clinical skills training, cognitive assessment and cognitive therapy, and physical rehabilitation. MATERIALS AND METHODS To complete a review of the literature, we searched PubMed and MEDLINE databases with the following search terms: "virtual reality," "procedural medicine," "oncology," "physical therapy," and "burn." We further limited our search to publications in the English language. Boolean operators were used to combine search terms. RESULTS The included search terms yielded 97 potential articles, of which 45 were identified as meeting study criteria, and are included in this review. These articles provide data, which strongly support the hypothesis that VR simulations can enhance pain management (by reducing patient perception of pain and anxiety), can augment clinical training curricula and physical rehabilitation protocols (through immersive audiovisual environments), and can improve clinical assessment of cognitive function (through improved ecological validity). CONCLUSION Through computer-generated, life-like digital landscapes, VR stands to change the current approach to pain management, medical training, neurocognitive diagnosis, and physical rehabilitation. Additional studies are needed to help define best practices in VR utilization, and to explore new therapeutic uses for VR in clinical practice.

[1]  J. Dale,et al.  Effects of Distraction on Pain, Fear, and Distress During Venous Port Access and Venipuncture in Children and Adolescents With Cancer , 2007, Journal of pediatric oncology nursing : official journal of the Association of Pediatric Oncology Nurses.

[2]  E. Tunik,et al.  Sensorimotor training in virtual reality: a review. , 2009, NeuroRehabilitation.

[3]  Jaebum Son,et al.  Unsupervised virtual reality-based exercise program improves hip muscle strength and balance control in older adults: a pilot study. , 2013, Archives of physical medicine and rehabilitation.

[4]  D. McLinden,et al.  A Virtual Reality Curriculum for Pediatric Residents Decreases Rates of Influenza Vaccine Refusal. , 2017, Academic pediatrics.

[5]  S. Droit-Volet,et al.  The time–emotion paradox , 2009, Philosophical Transactions of the Royal Society B: Biological Sciences.

[6]  B. Thomas,et al.  The efficacy of playing a virtual reality game in modulating pain for children with acute burn injuries: A randomized controlled trial [ISRCTN87413556] , 2005, BMC pediatrics.

[7]  Sylvia Rodger,et al.  Virtual reality for acute pain reduction in adolescents undergoing burn wound care: a prospective randomized controlled trial. , 2012, Burns : journal of the International Society for Burn Injuries.

[8]  David R. Patterson,et al.  Repeated Use of Immersive Virtual Reality Therapy to Control Pain During Wound Dressing Changes in Pediatric and Adult Burn Patients , 2013, Journal of burn care & research : official publication of the American Burn Association.

[9]  B. Rothbaum,et al.  A pilot and feasibility study of virtual reality as a distraction for children with cancer. , 2004, Journal of the American Academy of Child and Adolescent Psychiatry.

[10]  A Saratzis,et al.  Role of Simulation in Endovascular Aneurysm Repair (EVAR) Training: A Preliminary Study. , 2017, European Journal of Vascular and Endovascular Surgery.

[11]  K. Weiss,et al.  Effects of videogame distraction using a virtual reality type head-mounted display helmet on cold pressor pain in children. , 2009, Journal of pediatric psychology.

[12]  H. Hoffman,et al.  Virtual Reality Pain Control During Burn Wound Debridement in the Hydrotank , 2008, The Clinical journal of pain.

[13]  Robert M Sweet,et al.  Virtual reality as an adjunctive pain control during transurethral microwave thermotherapy. , 2005, Urology.

[14]  Susan M. Schneider,et al.  Effect of virtual reality on time perception in patients receiving chemotherapy , 2011, Supportive Care in Cancer.

[15]  Eric J. Seibel,et al.  Feasibility of Articulated Arm Mounted Oculus Rift Virtual Reality Goggles for Adjunctive Pain Control During Occupational Therapy in Pediatric Burn Patients , 2014, Cyberpsychology Behav. Soc. Netw..

[16]  T Roma Jasinevicius,et al.  Virtual reality distraction for pain control during periodontal scaling and root planing procedures. , 2009, Journal of the American Dental Association.

[17]  Brenda K. Wiederhold,et al.  Virtual Reality for Pain Management in Cardiac Surgery , 2014, Cyberpsychology Behav. Soc. Netw..

[18]  K. Mahan The Opioid Crisis. , 2017, The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons.

[19]  P. Dijkstra,et al.  Immersive virtual reality improves movement patterns in patients after ACL reconstruction: implications for enhanced criteria-based return-to-sport rehabilitation , 2016, Knee Surgery, Sports Traumatology, Arthroscopy.

[20]  J. Wearden,et al.  The Perception of Time: Basic Research and Some Potential Links to the Study of Language. , 2008 .

[21]  Suzanne Sander Wint,et al.  Effects of distraction using virtual reality glasses during lumbar punctures in adolescents with cancer. , 2002, Oncology nursing forum.

[22]  M. Jensen,et al.  Virtual Reality Hypnosis Pain Control in the Treatment of Multiple Fractures: A Case Series 1 , 2012, The American journal of clinical hypnosis.

[23]  K. Mccaul,et al.  Distraction and coping with pain. , 1984, Psychological bulletin.

[24]  Brenda K. Wiederhold,et al.  Clinical Use of Virtual Reality Distraction System to Reduce Anxiety and Pain in Dental Procedures , 2014, Cyberpsychology Behav. Soc. Netw..

[25]  M. Schurr,et al.  Virtual reality: feasibility of implementation in a regional burn center. , 2009, Burns : journal of the International Society for Burn Injuries.

[26]  Björn van Twillert,et al.  Computer-Generated Virtual Reality to Control Pain and Anxiety in Pediatric and Adult Burn Patients During Wound Dressing Changes , 2007, Journal of burn care & research : official publication of the American Burn Association.

[27]  Dimitrios Tzovaras,et al.  A Preliminary Study on the Feasibility of Using a Virtual Reality Cognitive Training Application for Remote Detection of Mild Cognitive Impairment. , 2017, Journal of Alzheimer's disease : JAD.

[28]  H. Hoffman,et al.  Use of virtual reality for adjunctive treatment of adult burn pain during physical therapy: a controlled study. , 2000, The Clinical journal of pain.

[29]  Hunter G Hoffman,et al.  Water-friendly virtual reality pain control during wound care. , 2004, Journal of clinical psychology.

[30]  Susan M Schneider,et al.  Virtual reality as a distraction intervention for women receiving chemotherapy. , 2004, Oncology nursing forum.

[31]  Larry F. Hodges,et al.  Use of Virtual Reality as a Distractor for Painful Procedures in a Patient with Pediatric Cancer: A Case Study , 2003, Cyberpsychology Behav. Soc. Netw..

[32]  Werner X. Schneider,et al.  Using the virtual reality device Oculus Rift for neuropsychological assessment of visual processing capabilities , 2016, Scientific Reports.

[33]  Hunter G Hoffman,et al.  A randomized, controlled trial of immersive virtual reality analgesia, during physical therapy for pediatric burns. , 2011, Burns : journal of the International Society for Burn Injuries.

[34]  Cristina Botella,et al.  A positive psychological intervention using virtual reality for patients with advanced cancer in a hospital setting: a pilot study to assess feasibility , 2012, Supportive Care in Cancer.

[35]  Patrick Bordnick,et al.  A pilot feasibility study of virtual patient simulation to enhance social work students’ brief mental health assessment skills , 2016, Social work in health care.

[36]  Alan Kingstone,et al.  Time estimation: The effect of cortically mediated attention , 2004, Brain and Cognition.

[37]  Albert Rizzo,et al.  Virtual Reality Exposure Therapy for Post-Traumatic Stress Disorder and Other Anxiety Disorders , 2010, Current psychiatry reports.

[38]  Sam R. Sharar,et al.  Virtual Reality Hypnosis for Pain Associated With Recovery From Physical Trauma , 2010, The International journal of clinical and experimental hypnosis.

[39]  Hunter G Hoffman,et al.  The Effect of Virtual Reality on Pain and Range of Motion in Adults With Burn Injuries , 2009, Journal of burn care & research : official publication of the American Burn Association.

[40]  Hunter G Hoffman,et al.  Factors influencing the efficacy of virtual reality distraction analgesia during postburn physical therapy: preliminary results from 3 ongoing studies. , 2007, Archives of physical medicine and rehabilitation.

[41]  C. Swearingen,et al.  Effect of Virtual Reality on Adolescent Pain During Burn Wound Care , 2014, Journal of burn care & research : official publication of the American Burn Association.