The Ross Tilley Burn Centre (RTBC) is the largest burn care centre in Canada, admitting
~300 patients/year. Most of these severely injured patients require numerous dressing
changes and skin grafting procedures which cause extensive pain and anxiety in patients
already facing potential losses in terms of function and independence. Poorly managed
pain can reduce patient engagement and participation in effective rehabilitation, result
in chronic opioid dependence, and worsen post-traumatic stress disorder.
While burn health practitioners specialize in the use of multi-modal pharmacological
approach in an attempt to reduce patients' reliance on opioid, there is an increasing
recognition of the importance of non-pharmacological strategies to reduce painful
procedures in hospital. A number of studies have demonstrated reductions in pain, anxiety
and analgesic medications with the use of Virtual Reality (VR) during procedures in
hospital. VR can be applied in a variety of ways, with considerable variations in terms
of cost, efficacy, and applicability. The burn injury VR literature includes
predominantly small cases/series and is lacking on using VR-360 videos as a distraction
technique in burn patients. Thus, VR remains under-utilized in most burn centres locally
and internationally. To address this lack of knowledge, this study proposes to use VR-360
video as a distraction tool in patients during dressing changes after skin graft surgery.
This study aims to improve burn pain management by reducing opioid requirements, pain and
anxiety during painful dressing changes, while also improving patient safety and
satisfaction.
The study hypothesis is that immersive virtual reality use in the burn centre will reduce
the cumulative dosage of analgesia used during the first two dressing changes after skin
graft surgery when compared with patients not utilizing the technology.
The primary objective of this study is to evaluate the effect of VR-360 distraction video
on opioid analgesic consumption during burn dressing changes.
The secondary objectives are to investigate the effect of VR-360 on pain, requirement for
conscious sedation, additive effect of multiple VR exposures, anxiety, dressing change
efficiency, patient reported outcome and satisfaction. Finally, patient and staff surveys
will be undertaken which will allow iterative adaptation of 3600 immersive videos to the
patients' preferences optimal distraction from the painful stimuli during dressing
change.
The majority of patients suffering from burn injuries are committed to undergoing long,
complex treatment plans that have significant physical and emotional impact. Pain is a
challenge within this population and many patients require high doses of opioids. Indeed,
a sizable proportion of burn patients may still require opioids as long as three months
after discharge, delaying their reintegration into society and increasing the chance of
opioid dependence. VR is a strategy that helps patients alter pain behavior. This study
will be the first randomized trial to apply practitioner-designed VR-videos with patient
input for greatest impact. It will compare opioid use, pain scores and patient
satisfaction scores between this new, state of the art intervention, and current standard
practice. By demonstrating VR's 'non-pharmacologic' effectiveness to alter pain
perception the study team will develop a cost-effective, accessible tool that can align
with practice at Sunnybrook. Furthermore, this team-based quality improvement initiative
involving nurses, social workers, physio/occupational therapy and physicians aims to
introduce VR as an evidence-based innovative non-pharmacological strategy to reduce
opioid requirements and optimize the use of resources, workflow, and improve staff
experience in burn centres across Canada and internationally
