Acceptability and Usability of Smileyscope Virtual Reality for Paediatric Pain Management During Burn Procedures: Perspectives of Patients, Carers and Clinicians.

There was no control group or standard-care comparison, so the study cannot show that Smileyscope reduced pain or anxiety more than usual care. The headset was used alongside usual analgesia, including paracetamol, ibuprofen, oxycodone or intranasal fentanyl when needed, so the effect of VR alone cannot be separated. Only 15 children completed the survey items because children under 8 were not asked to complete surveys, and fewer than half of all children could provide self-report. Survey answers had missing data, so the number answering each question varied. It was a busy, unfunded clinician-driven project, so many patients were missed and some feedback was not obtained. Children with facial burns and non-English-speaking children were excluded. The unit's usual burn cohort includes many children under 4, but this study only included children aged 4 or older and self-report surveys only from age 8 or older. Clinician pain ratings were lower than patient and parent ratings, so clinician scores alone may not capture the child's experience. No demographic information was collected from parents or clinicians.

The authors declared no conflicts of interest. The project was unfunded and clinician-driven.

Do not conclude that Smileyscope reduces pain better than standard care. There was no comparison group, and the headset was used alongside usual analgesia, so the contribution of VR alone cannot be separated. Some children still found the dressing bothersome, and 4 of 30 clinicians did not think pain or anxiety improved.