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Levit T, Grzela P, Lavoie DCT, Wang L, Agarwal A, Couban RJ, Shanthanna H. The Effectiveness of Virtual and Augmented Reality in Surgical Pain Management: A Systematic Review of Randomized Controlled Trials. Anesth Analg 2024:00000539-990000000-00888. [PMID: 39088374 DOI: 10.1213/ane.0000000000007051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/03/2024]
Abstract
BACKGROUND Satisfactory management of postoperative pain remains challenging. Nonpharmacological modalities such as virtual and augmented reality (VR/AR) offer potential benefits and are becoming increasingly popular. This systematic review evaluates the effectiveness and safety of VR/AR interventions on postoperative pain and recovery. METHODS MEDLINE, Embase, CINAHL, Web of Science, and CENTRAL databases were searched from inception to July 27, 2023, for randomized controlled trials (RCTs), published in English, evaluating the use of VR/AR interventions for surgical pain relief. Study selection and data extraction were performed by pairs of reviewers independently and in duplicate, and potential risk of bias was determined using the Risk of Bias-version 2 (RoB 2) tool. Our outcomes included pain relief, reduction of anxiety, satisfaction, and adverse effects. Due to substantial heterogeneity, a narrative synthesis without meta-analysis was performed. RESULTS We included 35 trials among 2257 citations, categorized as surgery (n = 12), minor procedures (n = 15), and postoperative physiotherapy (n = 8). Surgical group included various surgeries, with 11 using immersive VR predominantly in the postoperative period, and most reporting no differences in pain, but potential for reduced anxiety and sedation requirements. In the minor procedures group, most studies reported decreased pain and anxiety during the procedural performance. Two studies reported increased heart rate, while 2 others reported better hemodynamic stability. Home-based AR physiotherapy achieved (n = 6) similar pain and functional outcomes after knee replacement, with 1 large study (n = 306) reporting reduction of mean costs by $2745 for provision of 12 weeks physiotherapy. There were some concerns around potential bias for most studies, as the nature of interventions make it challenging to blind assessors and participants. No important adverse effects were noted using VR/AR technology. CONCLUSIONS Evidence from RCTs indicates that the use of immersive VR during minor procedures may reduce procedural pain, decrease anxiety, and improve satisfaction. However, small studies, inconsistent effect, and variation in the application of interventions are important limitations. Evidence to support the application of AR/VR for major surgeries is limited and needs to be further investigated. Use of home-based physiotherapy with AR likely has economic advantages, and facilitates virtual care for appropriate patients who can access and use the technology safely.
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Affiliation(s)
- Tal Levit
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Patrick Grzela
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Declan C T Lavoie
- From the Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Li Wang
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Aashna Agarwal
- Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Rachel J Couban
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
| | - Harsha Shanthanna
- Department of Anesthesia, McMaster University, Hamilton, Ontario, Canada
- Michael G. DeGroote Institute for Pain Research and Care, McMaster University, Hamilton, Ontario, Canada
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Baradwan S, Hafedh B, Alyafi M, Algreisi F, Baradwan A, Alghamdi DS, Atalla EMI, El-Mazzally YM, Ismail HS, Shrief KE, Abdelhakim AM, Khodry MM. The Effect of Virtual Reality Application on Pain and Anxiety During Episiotomy Repair: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Int Urogynecol J 2024:10.1007/s00192-024-05867-4. [PMID: 39042152 DOI: 10.1007/s00192-024-05867-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 06/20/2024] [Indexed: 07/24/2024]
Abstract
INTRODUCTION AND HYPOTHESIS There is a rising trend among women towards nonpharmacological approaches owing to their minimally invasive nature and limited adverse effects. Virtual reality (VR) has recently gained popularity as a new technology for reducing pain and anxiety in medical settings. Our research sought to investigate the impact of VR on pain and anxiety levels while undergoing episiotomy repair. METHODS A comprehensive search was carried out across PubMed, Scopus, Cochrane Library, and ISI Web of Science to find relevant randomized clinical trials (RCTs) up to January 2024. These trials investigated the use of VR as a treatment during episiotomy repair compared with a control group that did not receive VR intervention. Meta-analysis was performed using Review Manager software to analyze the data collected. Our primary outcomes were pain scores reported during and after episiotomy repair measured by a visual analog scale. Secondary outcomes analyzed included anxiety scores during and after the procedure, as well as the duration of episiotomy repair. RESULTS Seven RCTs, involving 578 patients, met the inclusion criteria. VR resulted in a significant reduction in pain scores both during and after episiotomy repair (p < 0.001). Additionally, anxiety levels during and after the procedure were significantly reduced in the VR group compared with the control group. Moreover, the duration of episiotomy repair was significantly shorter in the VR group. CONCLUSION Using VR has proven to be an effective technique in reducing pain and anxiety during and after episiotomy repair, as well as potentially speeding up the procedure.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Bandr Hafedh
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mohammad Alyafi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Fahad Algreisi
- Department of Obstetrics and Gynecology, Jeddah University, Jeddah, Saudi Arabia
| | - Afnan Baradwan
- Department of Obstetrics and Gynecology, Al Salama Hospital, Jeddah, Saudi Arabia
| | - Deama Saeed Alghamdi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Khalid University, Abha, Saudi Arabia
| | | | - Yousef Mohamed El-Mazzally
- Department of Community Medicine and Industrial Medicine, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Hany Said Ismail
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Khaled Elsheshtawy Shrief
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Mohamed Abdelhakim
- Kasr Al-Ainy, Faculty of Medicine, Cairo University, 395 Portsaid Street, Bab El-Kalq, Cairo, 11638, Egypt.
| | - Mostafa Mohamed Khodry
- Department of Obstetrics and Gynecology, Faculty of Medicine, South Valley University, Qena, Egypt
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Fang Y. Comment On: Patients' Use of Virtual Reality Technology for Pain Reduction During Outpatient Hysteroscopy: A Meta-Analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2024; 31:626. [PMID: 38641050 DOI: 10.1016/j.jmig.2024.02.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 02/27/2024] [Indexed: 04/21/2024]
Affiliation(s)
- Yuan Fang
- Department of Obstetrics and Gynecology, The Central Hospital of Enshi Tujia and Miao Autonomous Prefecture, Enshi, Hubei, China.
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Gaina MA, Sbarcea SV, Popa BS, Stefanescu BV, Gaina AM, Szalontay AS, Bolos A, Stefanescu C. SAFEvR MentalVeRse.app: Development of a Free Immersive Virtual Reality Exposure Therapy for Acrophobia and Claustrophobia. Brain Sci 2024; 14:651. [PMID: 39061393 PMCID: PMC11274658 DOI: 10.3390/brainsci14070651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2024] [Revised: 06/13/2024] [Accepted: 06/24/2024] [Indexed: 07/28/2024] Open
Abstract
Background: Specific phobias impact over 400 million people worldwide. Digitalizing mental health could alleviate the burden. Still, although the corporate-driven Metaverse is expanding rapidly, there needs to be more momentum in harnessing virtual reality exposure therapy uptake. Objective: This study aims to conceptualize, develop, and deploy a free Virtual Reality Exposure Therapy (VRET) application specifically designed for treating acrophobia and claustrophobia. This pilot study, which holds the promise of a future where mental health is more accessible and effective, explores the feasibility of leveraging transdisciplinary collaboration among specialists to create a safe, accessible, and effective VRET solution. Methods: We conducted a Delphi heuristic approach involving bioethicists, neuroscientists, and tech developers. Second, we reviewed the existing psychological theories and therapeutic strategies for addressing phobias in VR. Third, we conceptualized a thematic analysis-derived framework for a safe, adaptive-gamified free exposure to virtual reality acrophobia and claustrophobia (SAFEvR ACT). Finally, we provide an overview of the iterative improvements made during 12 workshops and 76 weekly briefings on developmental implementations. Results: We developed the SAFEvR ACT into a proof-of-concept application freely deployed on the MentalVerse app platform. Our safety-focused approach can benefit from prevalidation perspectives within future randomized control trials. Conclusions: The resulting application derived from the SAFEvR ACT framework represents a blueprint to counter the current lack of iVR mental health uptake by offering a free VRET alternative. Future research should aim towards developing similar free platforms to lessen mental health burdens and gather quantitative data. We conclude with a call to action to researchers to fine-tune our current approach and take a stand for free digital mental health within MentalVeRse.app.
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Affiliation(s)
- Marcel-Alexandru Gaina
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
- The Association of Integrative Psychotherapy and Clinical Psychology, 700469 Iasi, Romania
| | - Stefan-Vladimir Sbarcea
- Faculty of Computer Science, “Alexandru Ioan Cuza” University, 700483 Iasi, Romania; (S.-V.S.); (B.-S.P.)
| | - Bianca-Stefana Popa
- Faculty of Computer Science, “Alexandru Ioan Cuza” University, 700483 Iasi, Romania; (S.-V.S.); (B.-S.P.)
| | - Bogdan-Victor Stefanescu
- Faculty of Medicine, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania
| | - Alexandra-Maria Gaina
- PhD Department, University of Medicine and Pharmacy “Grigore T. Popa” Iași, 700115 Iasi, Romania;
| | - Andreea-Silvana Szalontay
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Alexandra Bolos
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
| | - Cristinel Stefanescu
- Psychiatry, Department of Medicine III, Faculty of Medicine, Grigore T. Popa University of Medicine and Pharmacy of Iasi, 16 Universitatii Street, 700115 Iasi, Romania; (A.-S.S.); (A.B.); (C.S.)
- Institute of Psychiatry “Socola”, 36 Bucium Street, 700282 Iasi, Romania
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Rosielle K, van Haaps AP, Kuijper EAM, Tonch N, Karim DENB, Oskam MA, van den IJssel R, Mol BWJ, Lambalk CB, Dreyer K, Mijatovic V. No pain relief by virtual reality during hysterosalpingography (HSG): results from a randomized controlled trial. Hum Reprod 2024:deae133. [PMID: 38863305 DOI: 10.1093/humrep/deae133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
STUDY QUESTION Is virtual reality (VR) an effective non-pharmacological tool to reduce procedural pain during hysterosalpingography (HSG)? SUMMARY ANSWER An HSG with VR does not reduce procedural pain scores compared to an HSG without VR. WHAT IS KNOWN ALREADY An HSG is often experienced as painful and uncomfortable. VR has been proven successful to reduce acute procedural pain during a variety of medical procedures and interventions. STUDY DESIGN, SIZE, DURATION We performed a two-centre open-label randomized controlled trial between January 2021 and October 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Women scheduled for HSG as part of their infertility work-up were screened for participation. After informed consent, women were randomized between HSG with or without VR. Due to the nature of the intervention, the study was not blinded. VR was administered by a head-mounted device displaying nature movies and/or relaxation exercises. The primary endpoint was procedural pain measured using VAS (scale 0.0-10.0 cm). Procedural pain was divided into overall pain score and peak pain score during the procedure. It was measured immediately after HSG. Secondary endpoints included patient satisfaction, VR preferences, and adverse effects of VR. MAIN RESULTS AND THE ROLE OF CHANCE We included a total of 134 women, 69 to the intervention group (HSG with VR) and 65 to the control group (HSG without VR). The mean VAS for peak pain was 6.80 cm (SD 2.25) in the intervention group versus 6.60 cm (SD 2.40) in the control group (mean difference 0.28 (95% CI -0.57, 1.12), P = 0.52). The mean VAS for overall pain was 5.00 cm (SD 2.10) in the intervention group versus 4.90 cm (SD 2.13) in the control group (mean difference 0.06 (95% CI -0.71, 0.84), P = 0.88). The expectation that VR would be a good distraction from pain during HSG was correlated with both overall and peak pain scores. When correcting for this expectation, we found that women in the intervention group reported significantly higher scores, both in peak (adjusted MD 0.58 (95% CI -0.81, 1.97), P = 0.021) and overall (adjusted MD 0.43 (95% CI -0.84, 1.71), P = 0.013) pain, compared to the control group. There were no differences in the prevalence of symptoms that were considered as adverse effects of VR. LIMITATIONS, REASONS FOR CAUTION The study was not blinded. Reasons for declining participation in the study were anxiety or wanting full control during HSG, which might have created selection bias. The distraction score possibly indicates that the level of VR immersiveness was not optimal due to the lack of sound and/or the type of VR applications. Future studies should investigate whether more immersive or interactive VR applications could decrease procedural pain scores during HSG. WIDER IMPLICATIONS OF THE FINDINGS Since VR does not reduce procedural pain, this additional tool should not be used during HSG. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. KR and AvH report receiving a travel grant from Merck outside the scope of this study. BM is supported by a National Health and Medical Research Council (NHMRC) investigator grant (GNT1176437) and BM reports consultancy for Merck, Organon, and Norgine and travel and research funding from Merck. BM holds stock for ObsEva. CL reports receiving research grants from Merck, and Ferring. KD and VM report receiving travel and speaker's fees from Guerbet and research grants from Guerbet. VM also reports research grants from Merck and Ferring. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER The trial is registered prospectively in the Netherlands Trial Register (trialregister.nl registration number NL9203, currently accessible on trialsearch.who.int). TRIAL REGISTRATION DATE 16-01-2021. DATE OF FIRST PATIENT’S ENROLMENT The first participant was enrolled on 19 January 2021.
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Affiliation(s)
- K Rosielle
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - A P van Haaps
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - E A M Kuijper
- Department of Gynaecology and Obstetrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - N Tonch
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Reproductive Medicine, Amsterdam UMC Location Academic Medical Center, Amsterdam, The Netherlands
| | - D E N B Karim
- VUMC School of Medical Sciences, Amsterdam, The Netherlands
| | - M A Oskam
- VUMC School of Medical Sciences, Amsterdam, The Netherlands
| | | | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Department of Gynaecology and Obstetrics, Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Girishan Prabhu V, Stanley L, Morgan R, Shirley B. Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients. Aging Ment Health 2024; 28:738-753. [PMID: 37850735 DOI: 10.1080/13607863.2023.2270442] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023]
Abstract
OBJECTIVES Total knee arthroplasty (TKA) is one of the most common joint surgeries, with over a million procedures performed annually in the US. Over 70% of patients report moderate to high pain and anxiety surrounding TKA surgery, and 96% are discharged with an opioid prescription. This population requires special attention as approximately 90% of TKA patients are older adults and one of the riskiest groups prone to misusing opioids. This study aimed to develop and compare the efficacy of nature-based virtual reality (VR) with heart rate variability biofeedback (HRVBF) to mitigate surgical pain and anxiety. METHODS This randomized control trial recruited 30 patients (mean age = 66.3 ± 8.2 years, 23 F, 7 M) undergoing TKA surgery and randomly assigned to a control, 2D video with HRVBF, or VR with HRVBF group. A visual analog scale (VAS) was used to measure pain levels before and after the intervention. In addition, a second VAS and the State-Trait Anxiety Inventory (STAI) were used to measure anxiety before and after the intervention. Electrocardiogram (ECG) was used to continuously measure HRV and respiration rate in preoperative and postoperative settings. RESULTS VR and 2D-video with HRVBF decreased pain and anxiety post-intervention compared with the control group, p's <.01. On analyzing physiological signals, both treatment groups showed greater parasympathetic activity levels, and VR with HRVBF reduced pain more than the 2D video, p < .01. CONCLUSIONS Nature-based VR and 2D video with HRVBF can mitigate surgical pain and anxiety. However, VR may be more efficacious than 2D video in reducing pain.
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Affiliation(s)
| | - Laura Stanley
- Gianforte School of Computing, Montana State University, Bozeman, MT, USA
| | - Robert Morgan
- Department of Anesthesiology, Prisma Health, Greenville, SC, USA
| | - Brayton Shirley
- Department of Orthopaedics, Prisma Health, Greenville, SC, USA
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Cohen N, Nasra LA, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Pain and anxiety management with virtual reality for office hysteroscopy: systemic review and meta-analysis. Arch Gynecol Obstet 2024; 309:1127-1134. [PMID: 37917158 DOI: 10.1007/s00404-023-07261-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 10/06/2023] [Indexed: 11/03/2023]
Abstract
PURPOSE Office hysteroscopy (OH) is a commonly performed procedure, although it might be associated with some degree of pain and anxiety. Our aim was to determine the effects of virtual reality on pain and anxiety levels felt by patients undergoing OH. METHODS MEDLINE, Embase, Google Scholar, Cochrane Library, clinicaltrials.gov, ProQuest, Grey literature, and manual searching of references within studies found in the initial search were systematically searched using the terms 'Virtual Reality' and 'Hysteroscopy' without time or language limitations. The review considered all studies assessing the impact of virtual reality (VR) over OH outcomes, and prospective randomized trials were included in the meta-analysis. Retrospective and case - control studies were excluded from the meta-analysis. RESULTS We identified 17 studies, of which four randomized controlled studies were included in the meta-analysis (327 participants, 168 in the VR group and 159 in the control group). On a 0-10 scale, pain sensation and maximal pain sensation during the operation were not statistically different between study and control groups (relative risk (RR) = -0.64, 95% C.I (-1.57)0.29) and (RR = -0.93, 95% C.I (-3.33) - 1.47), respectively. Anxiety measurement was statistically lower in the study group (RR = -1.73, 95% C.I (-2.79) - ( -0.67)). CONCLUSIONS The available data suggest that VR techniques do not decrease the pain sensation during OH however, they do contribute to a reduction in the anxiety levels experienced by patients. PROSPERO registration number CRD42023432819.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel.
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel.
| | - Lelia Abu Nasra
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, Haifa, Israel
- Rappaport Faculty of Medicine, Technion University, Haifa, Israel
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Baradwan S, Alshahrani MS, AlSghan R, Alyafi M, Elsayed RE, Abdel-Hakam FA, Moustafa AA, Hussien AE, Yahia OS, Shama AA, Magdy AA, Abdelhakim AM, Badran H. The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2024; 309:1267-1280. [PMID: 38165441 DOI: 10.1007/s00404-023-07319-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy. METHODS Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety. RESULTS Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001). CONCLUSIONS Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia
| | - Mohammad Alyafi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rasha Ezzat Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Faiza Ahmed Abdel-Hakam
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ayman Esmail Hussien
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Othman Saadeldien Yahia
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Abdelaziz Shama
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Ahmed Magdy
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Haitham Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Teh JJ, Pascoe DJ, Hafeji S, Parchure R, Koczoski A, Rimmer MP, Khan KS, Al Wattar BH. Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. BMC Med 2024; 22:64. [PMID: 38355563 PMCID: PMC10865524 DOI: 10.1186/s12916-024-03266-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses. RESULTS In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018. CONCLUSIONS Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.
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Affiliation(s)
- Jhia J Teh
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Safiya Hafeji
- Kings College Hospital, Denmark Hill, Brixton, London, UK
| | | | - Adam Koczoski
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Michael P Rimmer
- MRC Centre for Reproductive Health, Institute of Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK.
- . Johns Hospital, Livingston, West Lothian, Scotland, UK.
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Bassel H Al Wattar
- University College London, London, UK
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
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Cohen N, Kedem HI, Abu-Foul L, Paz M, Kaufman Y, Lavie O, Zilberlicht A. Does vaginal cleansing with iodine decreases infection rate in office hysteroscopy? Arch Gynecol Obstet 2023; 308:1791-1796. [PMID: 37653251 DOI: 10.1007/s00404-023-07199-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2023] [Accepted: 08/19/2023] [Indexed: 09/02/2023]
Abstract
PURPOSE To determine whether preoperative vaginal cleansing with iodine-based solution prior to hysteroscopy, reduces postoperative infection rate compared to no vaginal cleansing. METHODS A retrospective study at a single tertiary, university affiliated hospital of all individuals who have had an office hysteroscopy. Study group consisted of patients who have had preoperative vaginal cleansing with iodine-based solution and were compared to those who have not. Any procedural related complaints at the 30 days following the hysteroscopy were recorded. RESULTS A total of 505 were available for analysis, 183 in the study group and 322 in the control group. The most common indications for operation were infertility evaluation (33.9% vs. 28.6%) and retained products of conception (33.3% vs. 29.2%), and most common procedures were diagnostic only (49.7% vs. 42.5%) followed by adhesiolysis (12% vs. 14.3%). No statistical differences were noted with regards to postoperative infections, as only one case of pelvic inflammatory disease was noted, in the iodine cleansing group (0.19% for postoperative infection). CONCLUSION Our comparative study may suggest that the use of preoperative iodine solution prior to office hysteroscopy does not decrease the postoperative infection rate up to 30 days, thus can be avoided.
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Affiliation(s)
- Nadav Cohen
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel.
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel.
| | - Hagit Itzhak Kedem
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Luna Abu-Foul
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Moran Paz
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Yuval Kaufman
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ofer Lavie
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
| | - Ariel Zilberlicht
- Department of Obstetrics and Gynecology, Lady Davis Carmel Medical Center, 7 Michal Street, Haifa, Israel
- Ruth and Bruch Rappaport Faculty of Medicine, Technion - Israel Institute of Technology, Haifa, Israel
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Sewell T, Fung Y, Al-Kufaishi A, Clifford K, Quinn S. Does virtual reality technology reduce pain and anxiety during outpatient hysteroscopy? A randomised controlled trial. BJOG 2023; 130:1466-1472. [PMID: 37218438 DOI: 10.1111/1471-0528.17550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of virtual reality technology in reducing pain and anxiety during outpatient hysteroscopy. DESIGN A prospective randomised controlled trial. SETTING A London University Teaching Hospital. POPULATION Women aged 18-70 years undergoing outpatient hysteroscopy procedures. METHODS An unblinded randomised controlled trial was performed between March and October 2022 comparing standard outpatient hysteroscopy care with standard care with the addition of a virtual reality headset playing a virtual reality immersive scenario as a distraction technique. MAIN OUTCOME MEASURES Pain and anxiety numeric rating scores (NRS) from 0 to 11. RESULTS Eighty-three participants were randomly allocated to the control (n = 42) and virtual reality groups (n = 41). The virtual reality group experienced significantly less anxiety during the procedure than the control group (mean NRS 3.29 versus 4.73, mean difference 1.50; 95% confidence interval [CI] 0.12-2.88; P = 0.03). There was no difference in reported average pain (mean NRS 3.73. versus 4.24, mean difference 0.51; 95% CI -1.76 to 0.64; p = 0.41) or maximum pain scores (mean NRS 5.32 versus 5.07, mean difference 0.25; 95% CI -1.05 to 1.55; P = 0.71). CONCLUSIONS The use of virtual reality technology as an adjunct to standard care can reduce patient-reported anxiety but not pain during outpatient hysteroscopy procedures. Continued improvements in the technology and the development of increasingly immersive environments may continue to increase the potential to improve the patient experience in this setting.
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Affiliation(s)
- Thomas Sewell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Yinka Fung
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Asmaa Al-Kufaishi
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Katy Clifford
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Stephen Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
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Vitagliano A, Dellino M, Favilli A, D' Amato A, Nicolì P, Laganà AS, Noventa M, Bochicchio MA, Cicinelli E, Damiani GR. Patients' Use of Virtual Reality Technology for Pain Reduction during Outpatient Hysteroscopy: A Meta-analysis of Randomized Controlled Trials. J Minim Invasive Gynecol 2023; 30:866-876. [PMID: 37648150 DOI: 10.1016/j.jmig.2023.08.427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 09/01/2023]
Abstract
OBJECTIVE To summarize evidence from randomized controlled trials (RCTs) on the effectiveness of virtual reality technology (VRT), as used by patients, for reducing pain during outpatient hysteroscopy. DATA SOURCES Electronic databases and clinical registers were searched until June 21, 2023. The review protocol was registered in PROSPERO before the data extraction (CRD42023434340). METHODS OF STUDY SELECTION We included RCTs of patients receiving VRT compared with controls receiving routine care during outpatient hysteroscopy. TABULATION, INTEGRATION, AND RESULTS The primary outcome was average pain during hysteroscopy. Pooled results were expressed as mean differences (MDs) with 95% confidence interval (CI). Sources of heterogeneity were investigated through sensitivity and subgroups analysis. Five RCTs were included (435 participants). The comparison between the intervention and control groups showed a borderline difference in perceived pain during hysteroscopy (MD -0.88, 95% CI -1.77 to 0.01). Subgroup analysis based on the type of VRT (active or passive) indicated that active VRT potentially reduced the perception of pain (MD -1.42, 95% CI -2.21 to -0.62), whereas passive VRT had no effect (MD -0.06, 95% CI -1.15 to 1.03). CONCLUSION Patients' use of active VRT may be associated with a reduction in pain during outpatient hysteroscopy (evidence Grading of Recommendations Assessment, Development, and Evaluation 2/4). Future research should focus on conducting methodologically robust studies with larger sample sizes and more homogeneous populations.
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Affiliation(s)
- Amerigo Vitagliano
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy.
| | - Miriam Dellino
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Alessandro Favilli
- Section of Obstetrics and Gynecology, Department of Medicine and Surgery (Drs. Favilli), University of Perugia, Perugia, Italy
| | - Antonio D' Amato
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Pierpaolo Nicolì
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Antonio Simone Laganà
- Department of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties (PROMISE) (Dr. Laganà), University of Palermo, Palermo, Italy
| | - Marco Noventa
- Gynaecologic and Obstetrics Clinic, Department of Women's and Children's Health (Dr. Noventa), University of Padua, Padua, Italy
| | | | - Ettore Cicinelli
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
| | - Gianluca Raffaello Damiani
- 1st Unit of Obstetrics and Gynecology, Department of Interdisciplinary Medicine (Drs. Vitagliano, Dellino, D' Amato, Nicolì, Cicinelli, and Damiani), University of Bari, Bari, Italy
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Çallıoğlu N, Kanza Gül D, Özer Aslan İ, Fendal Tunca A, Başlı Kasım K, Akay B, Uysal E, Ekin M. The effect of informing the patient about the procedure with video imaging before office hysteroscopy on pain. J Obstet Gynaecol Res 2023; 49:2387-2392. [PMID: 37462062 DOI: 10.1111/jog.15738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 06/27/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To evaluate the effect of informing patients undergoing diagnostic office hysteroscopy via a video 24 h before the procedure and determine the changes in pain scores, channel transit time, the degree of difficulty of the procedure, and physiological parameters. DESIGN Single-blind randomized controlled trial. SETTING The study was conducted between September 1, 2021 and April 1, 2022 at the University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital. PARTICIPANTS A total of 134 patients aged 18-65 years who needed diagnostic office hysteroscopy. INTERVENTIONS Participants were randomized into two groups, the standard information group (Group 1: controls), and the video information + standard information group (Group 2). After office hysteroscopy, a visual analog scale (VAS) and Likert scale were used to assess pain and the degree of difficulty of the procedure, respectively. Physiological parameters were evaluated before and after the procedure. MAIN OUTCOME MEASURE To determine the effect of video-based multimedia information administered 24 h before office hysteroscopy on post-procedure pain. RESULTS The mean VAS score of the group that watched the training video (3.02 ± 1.88) was significantly lower than the control group (4.72 ± 2.54) who did not watch the training video (p < 0.001). The mean cervical channel transit time in seconds (sec) during the procedure was found to be significantly higher in the control group (21.57 ± 15.10 s) than in the video-watching group (p = 0.011). There was no significant difference between the groups in terms of physiological parameters and the degree of ease of the procedure. CONCLUSION Our study has shown that informing patients in a pre-procedure video is an effective approach that shortens the duration of the channel transit time and reduces pain.
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Affiliation(s)
- Nihal Çallıoğlu
- Department of Obstetrics and Gynecology, University of Health Sciences, Basaksehir Cam and Sakura City Hospital, Istanbul, Turkey
| | - Derya Kanza Gül
- Medipol University School of Medicine Health, Istanbul, Turkey
| | - İlke Özer Aslan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Tekirdağ Namık Kemal University, Tekirdağ, Turkey
| | - Aysun Fendal Tunca
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Kardelen Başlı Kasım
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Burcu Akay
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Elif Uysal
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Murat Ekin
- Department of Obstetrics and Gynecology, University of Health Sciences Istanbul, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
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Pelazas-Hernández JA, Varillas-Delgado D, González-Casado T, Cristóbal-Quevedo I, Alonso-Bermejo A, Ronchas-Martínez M, Cristóbal-García I. The Effect of Virtual Reality on the Reduction of Pain in Women with an Indication for Outpatient Diagnostic Hysteroscopy: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12113645. [PMID: 37297840 DOI: 10.3390/jcm12113645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Background: The cognitive distraction caused by Virtual Reality (VR) seems to cause a decrease both in pain and its perception as in the time spent thinking about possible pain, among anxiety about hysteroscopy procedure. The main objective of this investigation was to evaluate the efficacy of virtual reality for pain relief during outpatient hysteroscopy. Method: A total of 83 patients underwent outpatient diagnostic hysteroscopy in a single-centre, open-label, randomized control trial. Overall, 180 women with medical indication for an outpatient diagnostic hysteroscopy were randomized. Ten were excluded due to the impossibility of entering the endometrial cavity caused by a cervical canal that was not permeable, and 15 did not tolerate the pain at the beginning and during the procedure, excluding themselves from the final model. Finally, 154 were analysed per protocol to use VR (n = 82, study group) or standard treatment (n = 72, control group) assessing the differences between both groups by reduction in pain using Visual Analogue Scale score (VAS: 0-10 cm) and clinical data (arterial pressure, heart rate, and oxygen saturation) at the end of hysteroscopy, at 15 and 30 min after hysteroscopy. Results: Women with VR outpatient diagnostic hysteroscopy experienced less pain at final (VAS score 2.451 vs. 3.972, standard mean difference (SMD) -1.521, 95% CI -2.601 to -0.440; p = 0.006), at 15 min (VAS 1.769 vs. 3.300, SMD -1.531, 95% CI -2.557 to -0.504; p = 0.004), and at 30 min (VAS 1.621 vs. 2.719, SMD -1.099, 95% CI -2.166 to -0.031; p = 0.044) after the ending of the hysteroscopy, compared with no VR. Conclusions: The use of VR during outpatient diagnostic hysteroscopy proved effective in the reduction of pain in this randomized control trial. It shows wide potential role in ambulatory gynaecologic procedures to avoid repeating tests, perform surgeries without anaesthesia, and the use of medication and its side effects.
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Affiliation(s)
- Jesus A Pelazas-Hernández
- Department of Obstetrics and Gynaecology, El Escorial University Hospital, 28200 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | | | - Teresa González-Casado
- Department of Obstetrics and Gynaecology, Sierra de Guadarrama Health Centre, 28440 Madrid, Spain
| | | | - Agustina Alonso-Bermejo
- Department of Obstetrics and Gynaecology, El Escorial University Hospital, 28200 Madrid, Spain
| | - Marina Ronchas-Martínez
- Department of Obstetrics and Gynaecology, El Escorial University Hospital, 28200 Madrid, Spain
| | - Ignacio Cristóbal-García
- Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Obstetrics and Gynaecology, San Carlos Clinic Hospital, 28040 Madrid, Spain
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Yılmaz Sezer N, Aker MN, Gönenç İM, Topuz Ş, Şükür YE. The effect of virtual reality on women's perceived pain, fear, anxiety, and views about the procedure during hysterosalpingography: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol 2023; 286:5-9. [PMID: 37156133 DOI: 10.1016/j.ejogrb.2023.04.028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 04/24/2023] [Accepted: 04/27/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Hysterosalpingography is a stressful procedure that causes pain and anxiety. Therefore, measures must be taken to reduce or eliminate the pain and anxiety associated with it. OBJECTIVES This paper investigated the effect of virtual reality (VR) during hysterosalpingography on pain, anxiety, fear, physiological parameters, and satisfaction. METHODS A randomized controlled trial design was used. Patients were randomized into two groups (VR group = 31, control group = 31). The study was conducted between April 26 and June 30, 2022. Anxiety was evaluated using the State Anxiety Inventory. Pain, fear, and satisfaction were evaluated using the Visual Analogue Scale (VAS). Temperature, pulse, blood pressure, and oxygen saturation were followed up. RESULTS There was a significant difference in the mean VAS scores during and 15 min after hysterosalpingography between the VR and control groups. There was no significant difference in the mean SAI scores between the groups. The VR group participants were significantly more satisfied with hysterosalpingography than the control group. There was no significant difference in physiological parameters just before, immediately after, and 15 min after hysterosalpingography between the groups. CONCLUSION Virtual reality helps patients experience less pain and fear and makes them more satisfied with hysterosalpingography. However, it does not affect their anxiety and vital signs. Patients are highly satisfied with VR technology.
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Affiliation(s)
| | | | | | - Şenay Topuz
- Ankara University Faculty of Medicine, Ankara, Turkey
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Cooke CM, Flaxman TE, La Russa DJ, Duigenan S, Singh SS. Endometriosis Imaging: Enter the Metaverse of Possibilities. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2023; 45:309-313. [PMID: 36868352 DOI: 10.1016/j.jogc.2023.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 02/07/2023] [Accepted: 02/09/2023] [Indexed: 03/05/2023]
Abstract
While laparoscopy has classically been defined as the gold standard for diagnosis of endometriosis, there is now a strong recommendation for the use of advanced imaging in diagnosing the disease. In addition to playing a crucial role in the diagnosis of endometriosis, advanced imaging is also essential for assisting gynaecologic surgeons in planning the surgical management of complex cases of deep endometriosis. This case demonstrates a metaverse of high-level imaging modalities, including advanced ultrasound and magnetic resonance (MRI), which were further enhanced with medical virtual reality, and used for assessment of a patient seen in an outpatient tertiary care gynaecology clinic.
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Affiliation(s)
- Carly M Cooke
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON
| | - Teresa E Flaxman
- Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON; Department of Radiology, University of Ottawa, Ottawa, ON
| | | | | | - Sukhbir S Singh
- Department of Obstetrics and Gynecology, University of Ottawa, Ottawa, ON; Department of Clinical Epidemiology, The Ottawa Hospital Research Institute, Ottawa, ON.
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Dualé C, Mourgues C. The price of pain relief, or should non-invasive medical devices be treated differently in analgesic clinical trials? Eur J Pain 2021; 26:553-554. [PMID: 34845803 DOI: 10.1002/ejp.1896] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 11/27/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Christian Dualé
- CHU Clermont-Ferrand, Plateforme d'Investigation Clinique (INSERM CIC1405), Clermont-Ferrand, France.,INSERM, UMR1107 Neuro-Dol, Clermont-Ferrand, France
| | - Charline Mourgues
- CHU Clermont-Ferrand, Direction de la Recherche Clinique et des Innovations, Unité de Biostatistiques, Clermont-Ferrand, France
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