What we do
About our project
Objectives
The objectives of this study are two-fold:
1. To test the efficacy of smartphone-based virtual reality exposure (sVRE) versus care as usual (CAU) in 180 children undergoing surgery, focusing on the child’s postoperative pain (primary outcome) and secondary outcomes including:
a. postoperative analgesic use
b. anxiety levels during induction of anaesthesia
c. compliance during induction of anaesthesia
d. postoperative sleep disturbances
e. length of hospital stay
2. To examine predictors of sVRE efficacy, including:
a. socioeconomic status (SES)
b. age and sex
c. number of prior surgeries
d. preoperative child and parental anxiety
e. preoperative sleep disturbances
These analyses will be conducted separately for children undergoing scoliosis surgery and (adeno)tonsillectomy (A)TE.
Study Design
This multicentre randomized controlled trial (RCT) includes 180 children scheduled for (A)TE or scoliosis surgery. Participants are randomly assigned to either the sVRE or CAU group. Data will be collected at six time points before and after surgery. The two surgical groups will be analyzed separately to evaluate the intervention's impact on both primary and secondary outcomes.
Impact on Patient Care
If demonstrated effective, sVRE may serve as a widely accessible, non-invasive tool to improve pediatric perioperative care. By alleviating preoperative anxiety and reducing postoperative pain, its use could enhance recovery, shorten hospital stays, and minimize reliance on pharmacological pain management. These outcomes may significantly improve overall patient care and reduce healthcare system burden.
Our research focus
Study Population
The study will include pediatric patients aged 6–18 years undergoing scoliosis surgery at Erasmus MC–Sophia Children’s Hospital, or (adeno)tonsillectomy ((A)TE) at Maasstad Hospital and IJsselland Hospital, between January 2024 and December 2025.
Intervention
Participants in the sVRE group will use a smartphone VR app with plastic VR glasses to explore a 3D virtual environment simulating the hospital setting. This includes the waiting room, operating room, and recovery room. The VR app is designed to be used at home prior to surgery.
Main Study Parameters
The primary endpoint is postoperative pain measured upon awakening from anesthesia (T3), using the Face, Legs, Activity, Cry, Consolability (FLACC) scale and the Faces Pain Scale (FPS; 0 - 10).
Risks and Burden
The intervention involves minimal risk, as children use sVRE at home under adult supervision. The burden for both children and parents is low and consists of brief assessments, including pain and anxiety ratings, as well as user experience questionnaires.
Funds & Grants
This project is funded by Vrienden van Sophia.
Collaborations
Collaboration within of Erasmus MC
- The project collaborates with the departments of Child and Adolescent Psychiatry/Psychology (KJPP) and Anesthesiology within Erasmus MC.
Collaboration outside of Erasmus MC
- The project collaborates with the Maasstad Hospital and IJsselland Hospital.
Publications
Virtual reality exposure before elective day care surgery to reduce anxiety and pain in children: A randomised controlled trial.
Eijlers R, Dierckx B, Staals LM, Berghmans JM, van der Schroeff MP, Strabbing EM, Wijnen RMH, Hillegers MHJ, Legerstee JS, Utens EMWJ. 2019. Eur J Anaesthesiol. Oct;36(10):728-737. doi: 10.1097/EJA.0000000000001059. PMID: 31356373; PMCID: PMC6738544.
Our team
- Dr. Bram Dierckx, MD
b.dierckx@erasmusmc.nl
Child and adolescent psychiatrist
Clinical pharmacologist
- Dr. Lonneke Staals, MD
l.staals@erasmusmc.nl
Pediatric Anesthesiologist
Head of the Pediatric and Obstetric Anesthesiology Department
- Dr. Prof. Jeroen Legerstee
j.legerstee@levvel.nl
Full Professor of Innovative Treatment for Children with Compulsions, Anxiety, and Tics
GZ Psychologist
- Louise Meulenkamp-Yilmaz, MSc
Clinical Epidemiologist
PhD-student Preview-2 study
