Designing effective virtual reality environments for pain management in burn-injured patients.

Burn patients engage in repetitive painful therapeutic treatments, such as wound debridement, dressing changes, and other medical processes high in procedural pain. Pharmacological analgesics have been used for managing pain, but with ineffective results and negative side effects. Studies on pain management for burn patients suggested that Virtual Reality can treat procedural pain. This paper describes the process of designing, testing, and deploying a Virtual Reality system into a hospital setting. Firstly, a workshop was conducted to identify the most suitable types of Virtual Reality contents for the needs of burn-injured patients. Then, an experimental study, with 15 healthy adults, explored the analgesic impact of the Virtual Reality contents. The pain was induced through a cold pressor. Finally, we deployed the Virtual Reality system into the hospital to examine its efficiency on burn-injured inpatients. This study presents factors for the effective design and deployment of Virtual Reality for burn-injured patients residing in a hospital. Those factors refer to the use of cartoonish features and a choice of content based on each patient's interests to increase the positive emotions and the use of interactive features, portable equipment to reduce pain and increase the feasibility of the technology in clinical settings. Finally, our results indicated that the extension of the VR use after the therapeutic session could support more effective pain treatment. Trial registration number Protocol ID: AA8434.

Home-based immersive virtual reality physical rehabilitation in paediatric patients for upper limb motor impairment: a feasibility study.

Upper limb motor impairment (ULMI) rehabilitation is a long-term, demanding and challenging process to recover motor functionality. Children and adolescents may be limited in daily life activities due to reduced functions such as decreased joint movement or muscle weakness. Home-based therapy with Immersive Virtual Reality can offer greater accessibility, delivery and early rehabilitation to significantly optimise functional outcomes and quality of life. This feasibility study aimed to explore the perceptions and impacts of an immersive and interactive VR scenario suitable for ULMI rehabilitation for children at home. It was analysed using mixed methods (quantitative and qualitative) and from a multidirectional perspective (patients, clinicians and family members). Amongst the main results, it was found that IVR for ULMI home rehabilitation (1) is easy to learn and acceptable; (2) improves motor function; (3) reduces the difficulty in the reproduction of therapeutic movements; (4) is motivating and enjoyable and (5) improves quality of life. This study is the first study on the use of IVR applied to home rehabilitation of ULMI in children. These results suggested that similar outcomes may be possible with self-directed IVR home rehabilitation compared to face to face conventional rehabilitation, which can be costly to both the patient and the healthcare system, decreasing the length of stay at the hospital and treatment duration. It has also presented an innovative solution to the Covid-19 emergency where children could not receive their clinic therapy. Further research is recommended to understand better the mechanisms involved in physiotherapeutic recovery and how IVR rehabilitation helps to improve conventional treatments. Trial Registration Protocol ID NCT05272436. Release Date: 9th March 2022.

Immersive virtual reality in children with upper limb injuries: Findings from a feasibility study.

PURPOSE: Children who sustain Upper Limb Injuries (ULIs), including fractures and burns, may undergo intensive rehabilitation. The discomfort of therapy can reduce their compliance, limit their range of motion (ROM) and lead to chronic pain. Virtual Reality (VR) interventions have been found to reduce anticipated and procedural pain.This feasibility study aimed to explore perceptions and impacts of a custom-made, fully immersive Head-Mounted Display VR (HMD-VR) experience within a United Kingdom (UK) National Health Service (NHS) outpatient rehabilitation service for children with ULIs. METHODS: Ten children aged 9-16 in one UK Children's hospital trialled HMD-VR during one rehabilitation session. They, their parents (n = 10), and hospital physiotherapy staff (n = 2) were interviewed about their perceptions of pain, difficulty, enjoyability, therapeutic impacts, benefits, and limitations. Children rated the sessions on enjoyability, difficulty, and pain compared to usual rehabilitation exercises. Physiotherapists were asked to provide range of motion readings. RESULTS: Inductive thematic analysis of interview data generated three themes, 'Escape through Engagement'; 'Enhanced Movement'; and 'Adaptability and Practicality'. Children rated the session as more enjoyable, less difficult and painful than their usual rehabilitation exercises. Findings suggested that HMD-VR was an engaging, enjoyable experience that distracted children from the pain and boredom of therapy. Also, it seemed to enhance the movement they achieved. Participants perceived it was useful for rehabilitation and adaptable to individual needs and other patient groups. Suggestions were made to increase adaptability and build in practical safeguards. CONCLUSION: Findings from this small-scale feasibility study suggested HMD-VR was perceived as usable, acceptable, and effective with potential for further development. Future work could include larger scale trials.

Reducing Pain During Wound Dressings in Burn Care Using Virtual Reality: A Study of Perceived Impact and Usability With Patients and Nurses.

Burns patients often suffer severe pain during interventions such as dressing changes, even with analgesia. Virtual Reality (VR) can be used to distract patients and reduce pain. However, more evidence is needed from the patients and staff using the technology about its use in clinical practice and the impact of different VR strategies. This small-scale qualitative study explored patient and staff perceptions of the impact and usability of active and passive VR during painful dressing changes. Five patients took part in three observed dressing changes-one with an active VR scenario developed for the study, one with passive VR, and one with no VR-following which they were interviewed about their experiences. Three nurses who performed the dressing changes participated in a focus group. Thematic analysis of the resulting data generated four themes: "Caution replaced by contentment," "Distraction and implications for pain and wound care," "Anxiety, control and enjoyment," and "Preparation and communication concerns." Results suggested that user-informed active VR was acceptable to burn patients, helped manage their perceived pain, and was both usable and desirable within the clinical environment. Further testing with larger samples is now required.

Patients' perspective of the effectiveness and acceptability of pharmacological and non-pharmacological treatments of fibromyalgia.

Background and aims Fibromyalgia is a complex condition characterised by widespread pain, sleep disturbance, fatigue and cognitive impairment, with a global mean prevalence estimated at 2.7%. There are inconsistencies in guidelines on the treatment of fibromyalgia leading to dissatisfaction from patients and healthcare professionals. This study investigated patient-reported outcomes of pharmacological and non-pharmacological treatment usage and effectiveness with an assessment of acceptability. Methods Nine hundred and forty-one participants completed a self-administered anonymous questionnaire giving quantitative data of demographics, treatment usage and treatment outcomes. Participant-reported effectiveness and side effects were compared in the following treatment classes: analgesics, antidepressants, gabapentinoids, gastrointestinal treatments, activity interventions, dietary-based treatments, and psychological, physical and alternative therapies. Participants also reported whether they knew about or had tried different treatments. Results The results from the online survey indicated that the range of mean effectiveness ratings were similar for pharmacological and non-pharmacological treatments, whereas non-pharmacological treatments had lower side effects ratings and higher acceptability relative to pharmacological treatments. Participants were not aware of some treatment options. Conclusions The results show lower side effects ratings and higher acceptability for non-pharmacological treatments compared to pharmacological treatments despite similar effectiveness ratings. Implications This article presents results from a large online survey on fibromyalgia patient perspectives of pharmacological and non-pharmacological treatments. Results will inform healthcare professionals and patients about optimal treatments based on ratings of effectiveness, side effects and acceptability that are tailored to patient symptom profiles. Some participants were unaware of treatment options highlighting the importance of patient education allowing collaboration between patients and healthcare professionals to find optimal treatments.

A Mixed-Methods Investigation Into the Acceptability, Usability, and Perceived Effectiveness of Active and Passive Virtual Reality Scenarios in Managing Pain Under Experimental Conditions.

Burn patients often suffer excruciating pain during clinical procedures, even with analgesia. Virtual Reality (VR) as an adjunct to pharmacological therapy has proved promising in the management of burn pain. More evidence is needed regarding specific forms of VR. This mixed-method study examined the impact of active and passive VR scenarios in experimental conditions, gathering data relating to user experience, acceptability, and effectiveness in managing pain. Four scenarios were developed or selected following a consultative workshop with burn survivors and clinicians. Each was trialed using a cold pressor test with 15 University students. Data were gathered regarding pain threshold and tolerance at baseline and during each exposure. Short interviews were conducted afterwards. The two active scenarios were ranked highest and significantly extended participants' pain threshold and tolerance times compared to passive and baseline conditions. Passive scenarios offered little distraction and relief from pain. Active scenarios were perceived to be engaging, challenging, distracting, and immersive. They reduced subjective awareness of pain, though suggestions were made for further improvements. Results suggested that active VR was acceptable and enjoyable as a means of helping to control experimental pain. Following suggested improvements, scenarios should now be tested in the clinical environment.

What causes fibromyalgia? An online survey of patient perspectives.

Fibromyalgia is a severe chronic pain condition that affects every aspect of life. Causes of the condition remain unclear, and quantitative research cannot account for patients' personal illness narratives and perceptions. This online survey gathered qualitative accounts of the perceived causes of their condition from 596 people with fibromyalgia, which were analyzed thematically. Themes were "Bodily assault, ill-health, and change"; "Emotional trauma and distress"; "Stress and vulnerability"; and "Explaining and authenticating fibromyalgia." Discussion focuses on the complexity of causation, the importance of understanding and having symptoms validated, and the potential for benefiting from patient expertise in building better practitioner-client relationships.

A qualitative exploration of the experiences of living with and being treated for fibromyalgia.

This study explores the life and treatment experience of people in the United Kingdom with fibromyalgia in order to inform the development of treatments which are both effective and acceptable to users. Qualitative interviews were conducted with 14 participants with interpretative phenomenological analysis used as the theoretical framework and analytical method. The themes identified were as follows: Inauthenticity of fibromyalgia, An Unconventional healthcare experience, Re-creating support networks, Challenging the working identity, Threatening the family dynamic and Fighting, accepting or accommodating? The biopsychosocial impacts of fibromyalgia disrupted the identity, lifestyle, roles and relationships of our participants with such challenges further exacerbated by the contested nature of the illness.

Living Well With a Long-Term Condition: Service Users' Perspectives of a Self-Management Intervention.

The outcomes of self-management interventions are commonly assessed using quantitative measurement tools, and few studies ask people with long-term conditions to explain, in their own words, what aspects of the intervention they valued. In this Grounded Theory study, a Health Trainers service in the north of England was evaluated based on interviews with eight service-users. Open, focused, and theoretical coding led to the development of a preliminary model explaining participants' experiences and perceived impact of the service. The model reflects the findings that living well with a long-term condition encompassed social connectedness, changed identities, acceptance, and self-care. Health trainers performed four related roles that were perceived to contribute to these outcomes: conceptualizer, connector, coach, and champion. The evaluation contributes a grounded theoretical understanding of a personalized self-management intervention that emphasizes the benefits of a holistic approach to enable cognitive, behavioral, emotional, and social adjustments.

Maternal Obesity Management Using Mobile Technology: A Feasibility Study to Evaluate a Text Messaging Based Complex Intervention during Pregnancy.

BACKGROUND: Maternal obesity and excessive gestational weight gain (GWG) are on the rise with negative impact on pregnancy and birth outcomes. Research into managing GWG using accessible technology is limited. The maternal obesity management using mobile technology (MOMTech) study aimed at evaluating the feasibility of text messaging based complex intervention designed to support obese women (BMI ≥ 30) with healthier lifestyles and limit GWG. METHODS: Participants received two daily text messages, supported by four appointments with healthy lifestyle midwife, diet and activity goal setting, and self-monitoring diaries. The comparison group were obese mothers who declined to participate but consented for their routinely collected data to be used for comparison. Postnatal interviews and focus groups with participants and the comparison group explored the intervention's acceptability and suggested improvements. RESULTS: Fourteen women completed the study which did not allow statistical analyses. However, participants had lower mean GWG than the comparison group (6.65 kg versus 9.74 kg) and few (28% versus 50%) exceeded the Institute of Medicine's upper limit of 9 kg GWG for obese women. CONCLUSIONS: MOMTech was feasible within clinical setting and acceptable intervention to support women to limit GWG. Before further trials, slight modifications are planned to recruitment, text messages, and the logistics of consultation visits.

Maternal obesity support services: a qualitative study of the perspectives of women and midwives.

BACKGROUND: Twenty percent of pregnant women in the UK are obese (BMI ≥ 30 kg/m2), reflecting the growing public health challenge of obesity in the 21st century. Obesity increases the risk of adverse outcomes during pregnancy and birth and has significant cost implications for maternity services. Gestational weight management strategies are a high priority; however the evidence for effective, feasible and acceptable weight control interventions is limited and inconclusive. This qualitative study explored the experiences and perceptions of pregnant women and midwives regarding existing support for weight management in pregnancy and their ideas for service development. METHODS: A purposive sample of 6 women and 7 midwives from Doncaster, UK, participated in two separate focus groups. Transcripts were analysed thematically. RESULTS: Two overarching themes were identified, 'Explanations for obesity and weight management' and 'Best care for pregnant women'. 'Explanations' included a lack of knowledge about weight, diet and exercise during pregnancy; self-talk messages which excused overeating; difficulties maintaining motivation for a healthy lifestyle; the importance of social support; stigmatisation; and sensitivity surrounding communication about obesity between midwives and their clients. 'Best care' suggested that weight management required care which was consistent and continuous, supportive and non-judgemental, and which created opportunities for interaction and mutual support between obese pregnant women. CONCLUSIONS: Women need unambiguous advice regarding healthy lifestyles, diet and exercise in pregnancy to address a lack of knowledge and a tendency towards unhelpful self-talk messages. Midwives expressed difficulties in communicating with their clients about their weight, given awareness that obesity is a sensitive and potentially stigmatising issue. This indicates more could be done to educate and support them in their work with obese pregnant women. Motivation and social support were strong explanatory themes for obesity and weight management, suggesting that interventions should focus on motivational strategies and social support facilitation.

An evaluation of practice-based interprofessional education initiatives involving service users.

There is little published evidence regarding the impact of service-user focused interprofessional education in the practice setting. This article reports evaluative case studies of two practice-based interprofessional initiatives, in which service users played a central role. These initiatives formed part of the Trent Universities Interprofessional Learning in Practice (TUILIP) project ( http://tuilip.hwb.shu.ac.uk ), a collaboration between Sheffield Hallam University and the University of Nottingham. Practice settings were an acute mental health service and a community organisation offering care and services to adults with learning disabilities. Interprofessional initiatives were developed by facilitators, and empirically studied at each site. Facilitators, managers, practitioners, students and service users took part in interviews and focus groups to discuss their perceptions of the initiative in their practice setting. The study revealed participants' perceptions of the projects' aims, process and outcomes, factors which facilitated success or proved challenging, and their impact upon individuals, clinical practice and the organisations involved.

Adaptation after facial surgery: using the diary as a research tool.

We conducted a small-scale qualitative diary study to gather accounts from five facial cancer surgery patients. Participants were asked to record their experiences, thoughts, and feelings for up to 1 year, as they underwent and recovered from their surgery and adapted to living with alterations in their appearance. In this article, we consider evidence relating to the diary as a research tool and discuss our experiences of issues arising with the qualitative diary method employed in this study.These include comparability with interview data, factors affecting the quantity and quality of data (novelty, personal significance, and individual writing styles), chronological storytelling, and barriers to writing (visual difficulties and depression).

Exploring supportive care needs and experiences of facial surgery patients.

Research suggests that an important determinant of psychosocial outcomes following disfiguring surgery is social support. Healthcare professionals are in a position to offer emotional support to patients undergoing surgery, but evidence regarding the experience of supportive care among facial surgery patients is sparse. This study explored the experiences of facial surgery patients and their friends or family with regard to support from healthcare professionals. Twenty-nine facial surgery patients and nine significant others (eight marital partners and one close family member) participated in indepth interviews and focus groups, and the data were analysed using a grounded theory form of coding. Analysis identified three main categories of support: informational, practical and emotional. Findings also showed discrepancies between patients' need for emotional support and provision by healthcare staff.