Interactive video games to improve pediatric procedural pain and anxiety: a systematic review and meta-analysis

Background: procedural pain and anxiety in children can be poorly controlled, leading to significant short and long-term sequelae such as longer procedure times or future healthcare avoidance. Caregiver anxiety can exacerbate these effects. We aimed to evaluate the effect of interactive video game interventions on children’s procedural pain and anxiety, including the effect of different types of video games on those outcomes. Methods: we conducted a systematic review and meta-analysis of the effectiveness of interactive video games compared to standard care in children (0-18 years) undergoing painful procedures. We searched the databases MEDLINE, Embase and PsycInfo. We conducted random-effects meta-analysis using ‘R’ of children’s procedural pain and anxiety, and caregivers’ anxiety. Results: of 2,185 studies screened, 36 were eligible (n=3,406 patients). Studies commonly involved venous access (33%) or day surgery (31%). Thirty-four studies were eligible for meta-analyses. Interactive video games appear to reduce children’s procedural pain (standardised mean difference = -0.43, 95% CI -0.67, -0.20) and anxiety (SMD = 0.61, 95% CI -0.88, -0.34), and caregivers’ procedural anxiety (SMD = -0.31, 95% CI -0.58, -0.04). We observed no difference between preparatory and distracting games, or between virtual reality and non-virtual reality games. We also observed no difference between interactive video games compared to standard care for most medical outcomes (e.g. procedure length), except a reduced need for restraint. Studies reported minimal adverse effects and typically had high intervention acceptability and satisfaction. Conclusions: our findings support introducing easily available video games such as distraction-based conventional video games into routine practice, to minimise paediatric procedural pain and child/caregiver anxiety