The effectiveness of virtual reality on reducing pain and anxiety in burn injury patients: a systematic review Morris LD, Louw QA, Grimmer-Somers K CRD summary The authors' concluded that virtual reality may be an effective non-pharmacologic non-invasive adjunct analgesic technique to pain management for burn injury patients receiving wound dressing changes or physiotherapy treatment. The conclusions reflected the results presented. However, as the limited available evidence came from small studies, the conclusions should be interpreted cautiously. Authors' objectives To evaluate the effectiveness of virtual reality combined with pharmacologic analgesia in reducing pain and anxiety in burn injury patients undergoing wound dressing changes and physiotherapy. Searching PubMed, CINAHL, The Cochrane Library, BIOMED, PEDro, Science Direct, PsycINFO, ProQuest Medical Library, IngentaConnect and SPORTDiscus were searched from inception to January 2009 for published English-language articles. Search terms were reported. Reference lists of retrieved articles were scanned for further studies. ClinicalTrials.gov was searched for ongoing trials. Study selection Randomised controlled trials (RCTs), controlled trials, case series and case studies of all types of burn injury patients who received virtual reality and pharmacologic analgesics in the process of wound dressing changes and physiotherapy management were eligible for inclusion in the review. Eligible comparators were pharmacologic analgesics alone (such as opioids, anaesthetics and non-steroidal anti-inflammatory drugs) or other distractors (such as standard video games and television). Participants were eligible regardless of receipt of pharmacologic analgesics prior or during the virtual reality intervention. Primary outcomes of interest were pain (measured by visual analogue scale, numeric rating pain scale, graphic rating scale, FACES pain scale or any similar measurement tool) and anxiety (measured by burn specific pain anxiety scale, Spielberger State-Trait Anxiety Inventory scale or any similar measurement tool). Most studies were conducted in USA in a hospital setting. Participant ages ranged (where reported) between five and 65 years. Virtual reality was most commonly offered during wound dressing changes or wound care. Virtual reality interventions included three different video games (reported in the paper). A range of included pharmacological analgesia was reported. Two reviewers independently selected studies for inclusion. Assessment of study quality Study quality was assessed using an adapted version of the PEDro scale with a maximum achievable score of 7. Two reviewers independently carried out the quality assessment. Any disagreements were resolved by reference to a third reviewer. Data extraction Data were extracted on the amount of reduction in pain and anxiety. This was reported in millimetres (on a scale from 0mm to 100mm). Where possible, data were collected to enable calculation of effect sizes and 95% confidence intervals (CI). Authors were contacted for missing information, where necessary. Two independent reviewers carried out data extraction. Database of Abstracts of Reviews of Effects (DARE) Produced by the Centre for Reviews and Dissemination Copyright © 2019 University of York Page: 1 / 3