The influence of different immersive virtual reality devices on children's pain during needle-based procedures: A network meta-analysis and systematic review

BACKGROUND: To evaluate the effectiveness of virtual reality (VR) devices with different immersion levels on procedure-related pain in children through network meta-analysis. METHODS: We systematically searched multiple databases for randomized controlled trials comparing VR interventions versus standard care for managing needle-based procedural pain in children. Traditional pairwise and network meta-analyses were performed. RESULTS: Nineteen studies (2042 participants) were included. VR devices effectively reduced procedural pain. Network meta-analysis (11 studies, 1362 participants) revealed: non-immersive VR performed best for Wong-Baker FACES scores, fully immersive VR for Face, Legs, Activity, Cry, Consolability (FLACC) scores, and semi-immersive VR ranked second for Children's Face Scale outcomes. Overall, semi-immersive VR demonstrated superior effectiveness across all pain measures. CONCLUSIONS: Semi-immersive VR showed the best overall therapeutic effect. We recommend semi-immersive VR as the preferred intervention for managing procedure-related pain in pediatric clinical practice. PRACTICE IMPLICATIONS: These findings provide evidence-based guidance for clinical technology selection. Semi-immersive VR offers a practical, cost-effective, non-pharmacological intervention for outpatient and inpatient settings. Implementation should incorporate standardized operator training, 5-7 min immersion duration, and scenario activation 30 s pre-procedure.