Key result
Biofeedback-based virtual reality maintains target heart rate variability in ~89% of pediatric surgical sessions.
Why the study?
Biofeedback-based virtual reality has not been integrated into perioperative care, and no defined treatment protocols for preoperative training and postoperative application exist, particularly in children.
Does biofeedback-based virtual reality (VR-BF) achieve target heart rate variability parameters in children and adolescents undergoing surgery?
Cohort (n=23)
No
Does biofeedback-based virtual reality (VR-BF) achieve target heart rate variability parameters in children and adolescents undergoing surgery?
A biofeedback-based virtual reality intervention is feasible and capable of achieving target physiological relaxation parameters in pediatric surgical patients.
Supports feasibility of VR-BF for HRV targets in pediatric surgery; hypothesis-generating and should not yet change practice.
There is a great need for nonpharmacologic pain management strategies, given the catastrophic effects of the opioid epidemic and the role of opioid prescription in precipitating addiction [1], particularly in children and adolescents at risk of chronic pain and opioid use after surgery [2], [3], [4]. Biofeedback-based virtual reality (VR-BF) is an innovative approach to managing pain that compliments and may even increase accessibility [5] and acceptability [6] of existing mind-body therapies for pain management, like biofeedback (BF). BF teaches patients behavioral modification techniques that impact involuntary processes [7,8]. For example, slow breathing increases heart rate variability (HRV) [9] to reduce pain through the downregulation of the sympathetic nervous system [10,11]. However, barriers to widespread use, such as the need for trained personnel and high costs of direct intervention, have hindered its widespread clinical use and access to this therapy [5,12]. VR-BF has not yet been integrated into perioperative care, and as such, no defined treatment protocols for preoperative training and postoperative application of VR-BF exist, particularly in children. The dataset presented in this article may help fill the unmet, critical need for accessible, effective, alternative therapeutic options for reducing postoperative pain and opioid exposure in children. This investigation aimed to establish measurable outcomes impacting a perioperative treatment protocol of VR-BF, a novel VR-based therapy that teaches patients relaxation techniques and monitors the sensitivity of heart rate variability (HRV) to different frequencies and durations of VR-BF sessions. Achievement of target physiological parameters, including HRV, was measured in children and adolescents undergoing surgery anticipated to cause moderate to severe pain (e.g., orthopedic, chest) requiring postoperative pain management by the Acute Pain Services at Nationwide Children's Hospital (NCH). This dataset included 23 surgical patients evaluated quantitatively and qualitatively to refine a treatment protocol for the feasibility and acceptability of (a) preoperative education and training in relaxation, and (b) postoperative application of a VR-BF intervention for pain management [13]. Qualitative data was collected using an investigator-derived questionnaire to obtain feedback and understand the patient and family experience using VR-BF. Descriptive statistics (mean±SD or median with interquartile range [IQR] for continuous variables; frequencies and percentages for categorical variables) and exploratory spline regression analyses were generated to define measurable outcomes for a future pilot, randomized clinical trial protocol.
No takes yet. Share an insight, caveat, or question.
Orgil et al. (2023) conducted a cohort in Postoperative pain and anxiety in pediatric surgical patients (n=23). Biofeedback-based virtual reality (VR-BF) was evaluated on Percentage of sessions maintaining target heart rate variability (HRV) parameters for >=50% of session time. In a cohort of 23 pediatric surgical patients, 89% of overall biofeedback-based virtual reality sessions successfully maintained target heart rate variability parameters for at least 50% of the session time.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: