The effect of biofeedback-based virtual reality game on pain, fear, and anxiety levels during port catheter needle insertion in pediatric oncology patients

This research was conducted to evaluate the effect of a biofeedback-based virtual reality game on pain, fear, and anxiety levels during port catheter needle insertion in pediatric oncology patients. The randomized controlled study was conducted with 62 (31 = intervention, 31 = control) pediatric oncology patients aged 6-12 years and their mothers in a city hospital between August and December 2023. In this study, BioVirtualPed, a biofeedback-based virtual reality game, was used to reduce children's pain, fear, and anxiety related to the port catheter needle insertion. Children in the intervention group were asked to wear virtual reality glasses and a respiratory sensor during the port catheter needle insertion process. Data were collected using ''Descriptive Information Form'', ''Wong-Baker Pain Assessment Scale'', ''Child Fear Scale'', '' Children's State Anxiety'', ''Satisfaction Scoring-Visual Analog Scale'' and ''ADXL354 Sensor''. Descriptive analyses, Mann-Whitney U test, Wilcoxon Signed-Rank Test, IntraClass Correlation Coefficient, and Chi-square Test were used for data analysis with the licensed SPSS (Statistical Package for the Social Science for Windows) IBM 29 program. The results were evaluated at a 95% confidence interval, and a p-value of <0.05 was considered statistically significant. The distribution of descriptive characteristics of pediatric oncology patients and their mothers in the intervention and control groups was similar (p>0.05). In the study, it was determined that the mean pain score of children in the intervention group was statistically significantly lower than that of children in the control group, and the effect size was large (U:5.506, p<0.001, d:1.841, 95% CI: (-2,432) – (-1,239)). While there was no statistically significant difference in pre-procedure fear and anxiety scores between the intervention and control groups (U:0.794, p>0.05 and U:0.730, p>0.05, respectively), it was found that the post-procedure fear and anxiety scores of children in the intervention group were statistically significantly lower than those of children in the control group, with a large effect size (U:5.962, p<0.001, d:2.202, 95% CI: (-2.831) – (-1,562) and U:5.458, p<0.001, d:1.879, 95% CI: (-2,474) – (-1,273), respectively). Additionally, the mean respiratory rates of children in the intervention group during the procedure were lower than those in the control group (U: 4.765, p<0.001, d:1.373, 95% CI: (-1,924) – (-0,814)), and the satisfaction scores of children in the intervention group were higher than those in the control group, with a large effect size (U:6.635, p<0.001, d: 2.848, 95% CI: (2,130) – (3,553)). The agreement between the pain, fear, and anxiety scores reported by children and mothers in the intervention and control groups was found to be good and excellent for all three variables (p:<0.001). As a result of the research, it was determined that BioVirtualPed reduced procedure-related pain, anxiety, and fear, increased care satisfaction, and had a positive effect by keeping the mean respiratory rate within normal limits. BioVirtualPed is recommended for use in pediatric oncology clinics in the management of pain, fear, and anxiety symptoms caused by port catheter needle insertion.