Interactive video games to reduce paediatric procedural pain and anxiety: a systematic review and meta-analysis.


This article is based on 34 studies suitable for meta-analysis out of 36 eligible studies suitable for systematic reviews, which were in turn selected out from 2185 abstracts found through a literature search using Medline, Embase & PsyINFO, and 5 articles from Google Scholar manual search.   The combined selected studies have 3406 patients between ages of 1 and 18 years old presenting for a variety of procedures with the commonest being venous access (33%) and day surgery (31%).  “Video games” definition is based on the Oxford English dictionary, and this encompass a variety of devices that have an audio-visual component that responded to user input including (virtual reality (VR) games, conventional video games and non-VR customised games.

The selected studies were analysed using the ‘Preferred Reporting Items for Systematic Reviews and Meta-Analyses’ guidelines.  Primary outcomes were paediatric anxiety and paediatric pain, which found children that played video games reported less anxiety and pain.  Interestingly, in the subgroup analysis, there were no significant differences between types of video games used.  Secondary outcomes looking at caregivers’ anxiety and need for patient physical restraint were also favourable in the video games groups.  Secondary outcomes which were either equivocal or showed no difference include improvement in burns wound healing, perioperative procedural compliance and emergence delirium.  Adverse events from the studies were found to be either small or no difference found, with commonest adverse events being nausea, vomiting, and motion sickness; and less common ones being dizziness, headaches, seizures and claustrophobia.

Take Home Message/Commentary

There is increasing evidence that peri-procedural anxiety in the paediatric population is a common occurrence and has an impact on patient morbidity.  This meta-analysis suggests the use of video games appears to have a small to modest effect in improving procedural anxiety and pain, with very little unwanted side effects, and a high level of patient acceptability.

Encouragingly, the type of video games used did not appear to have a difference to generate this effect, which may make this option economically more viable, although the authors stated more research is needed to confirm this conclusion, as well as to look at optimal timing of this intervention and staff involvement in its implementation.

Personally, given most parents/carers have access to video games on their smartphones or tablet device, I would be happy for their child to continue to play on it during anaesthetic intervention as one method of reducing periprocedural anxiety.

Reviewed by  K.C. Law