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Wang Y, Wang L, Liang N, Wang K. Effect of video-based interventions on emergence delirium in pediatric patients: a systematic review and meta-analysis of randomized controlled trials. J Pediatr (Rio J) 2024:S0021-7557(24)00107-4. [PMID: 39245239 DOI: 10.1016/j.jped.2024.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2024] [Revised: 06/24/2024] [Accepted: 06/26/2024] [Indexed: 09/10/2024] Open
Abstract
OBJECTIVE Emergence delirium is frequently observed in pediatric patients. With advancements in video-based interventions, such as cartoons, video games, and virtual reality, these modalities may contribute to a reduced incidence of emergency delirium among children. However, robust evidence supporting their efficacy remains necessary. METHODS The authors conducted a systematic search across multiple databases, including Embase, MEDLINE, and Cochrane Library, to identify all randomized controlled trials comparing video-based interventions with control treatments in pediatric emergence delirium. Data were aggregated and analyzed using Review Manager 5.4 to evaluate the effectiveness of video-based interventions. RESULTS The analysis included eight randomized controlled trials comprising 872 children. The intervention group showed a trend toward lower Pediatric Anesthesia Emergence Delirium scores (p = 0.10) and fewer emergence delirium events (p = 0.52). Seven studies demonstrated that video-based interventions significantly reduced preoperative anxiety, as indicated by decreased scores on the modified Yale Pre-operative Anxiety Scale (p < 0.00001). Anesthesia duration did not significantly differ between the intervention and control groups (p = 0.16). Notably, subgroup analyses revealed a significant reduction in Pediatric Anesthesia Emergence Delirium scores among children under seven years of age (p = 0.001). CONCLUSIONS Video-based interventions were linked to lower Pediatric Anesthesia Emergence Delirium scores and a decreased incidence of emergence delirium events. However, these results did not reach statistical significance across the broader sample. Notably, in children under seven, these interventions significantly reduced the scores. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Yue Wang
- China-Japan Friendship Hospital, Department of Anesthesiology, Beijing, China
| | - Lifang Wang
- China-Japan Friendship Hospital, Department of Anesthesiology, Beijing, China
| | - Nan Liang
- China-Japan Friendship Hospital, Department of Anesthesiology, Beijing, China
| | - Kan Wang
- China-Japan Friendship Hospital, Department of Anesthesiology, Beijing, China.
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Carbó A, Tresandí D, Tril C, Fernández-Rodríguez D, Carrero E. Usefulness of a virtual reality educational program for reducing preoperative anxiety in children: A randomised, single-centre clinical trial. Eur J Anaesthesiol 2024; 41:657-667. [PMID: 38916221 DOI: 10.1097/eja.0000000000002032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/26/2024]
Abstract
BACKGROUND Preoperative anxiety (PA) is common in children and has detrimental effects on surgical outcome. Strategies based on virtual reality (VR) have recently been introduced to address this problem. OBJECTIVE This study evaluated the usefulness of a virtual reality educational program (VREP) for reducing preoperative anxiety in elective low-complexity paediatric surgery. DESIGN Randomised clinical trial. SETTING Single tertiary centre in Barcelona, Spain. Between January 2019 and June 2022. PATIENTS Children aged 3-13 years of age, American Society of Anesthesiologists (ASA) I-II, scheduled for elective low-complexity surgery were enrolled in the study. INTERVENTION Children were randomised into a control group (received oral/written information about the anaesthetic-surgical process, and patients and their parents remained in a playroom waiting for the surgery) or VREP (viewed a VR-based educational video on the surgical process, 7-10 days prior to surgery) using the MATLAB application. MAIN OUTCOME MEASURE PA using the modified Yale Preoperative Anxiety Scale (mYPAS) during separation from parents. RESULTS In total, 241 children aged 3-12 years of age were studied (120 patients with VREP and 121 controls). Randomisation eliminated the differences between the groups, except for a greater male presence in the VREP group (83.3% vs. 71.1%; P = 0.023). The mYPAS yielded was lower in the VREP group (29.2% vs. 83.5%; P < 0.001). Sex did not influence VREP-mediated decrease in PA ( P < 0.001). In turn, VREP patients were more cooperative (Induction Compliance Checklist [ICC] score 0 points vs. 2 points; P < 0.001) during anaesthesia induction, presented less delirium (Pediatric Anesthesia Emergence Delirium [PAED] score 1 point vs. 3 points; P = 0.001) on leaving the recovery room, and experienced less pain upon arrival in the hospital ward (Wong-Baker Faces Pain Rating Scale: 0-points vs. 1 point; P < 0.001). CONCLUSIONS The VREP-based prevention strategy reduced preoperative anxiety in children undergoing elective low-complexity surgery. TRIAL REGISTRATION NCT03578393.
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Affiliation(s)
- Adriana Carbó
- From the Department of Anesthesia, Centro Médico Teknon, Barcelona, Spain (AC, DT, CT), Department of Cardiology, Hospital Universitari Arnau de Vilanova de Lleida, Institut de Recerca Biomèdica de Lleida (IRBLleida), Lleida, Spain (DF-R), Department of Anesthesia, Hospital Clínic de Barcelona, Universitat de Barcelona, Barcelona, Spain (EC)
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Hu Z, Yao J, He L, Li X, Guo Y. The impact of virtual reality exposure on anxiety and pain levels in pediatric patients: A systematic review and meta-analysis. J Pediatr Nurs 2024; 78:e364-e374. [PMID: 39085008 DOI: 10.1016/j.pedn.2024.07.027] [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: 03/22/2024] [Revised: 07/22/2024] [Accepted: 07/24/2024] [Indexed: 08/02/2024]
Abstract
PROBLEM Virtual reality (VR) is used as a novel intervention technique to alleviate uncomfortable experiences such as anxiety and pain in children. Recently, VR distraction has gained prominence in pediatric medical procedures. However, no studies have yet conducted a further quantitative analysis of the intervention effects of virtual reality exposure (VRE). This systematic review aims to analyse the effect of VRE on anxiety and pain levels in paediatric patients undergoing medical procedures. ELIGIBILITY CRITERIA Relevant studies were searched from four databases, including PubMed, Cochrane Library, Embase, and Web of Science. This systematic review has been registered in the International Prospective Register of Systematic Reviews (PROSPERO). RESULTS The meta-analysis incorporated a total of 11 articles, encompassing 1,099 pediatric patients. The results showed that VRE relieved children's anxiety [SMD = -0.61, 95% CI (-0.93, -0.28), p < 0.001], but there was no significant difference in alleviating pain in children [SMD = -1.48, 95% CI (-3.40, 0.44), p = 0.131]. CONCLUSIONS The results suggest that VRE is effective in reducing children's anxiety during medical procedures. However, 7 of the 11 original studies included in this review were from the same research project, which may increase the risk of reporting bias. Also, more high-quality studies are needed in the future to verify its effectiveness for pain levels. IMPLICATIONS VRE can help children become familiar with the medical environment, overcome anxiety and fear, and learn about medical procedures in advance. This can enhance their cooperation during medical process, leading to a more positive medical experience.
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Affiliation(s)
- Zhixuan Hu
- Shaanxi University of Chinese Medicine School of Nursing, Xianyang 712000, China
| | - Jie Yao
- Shaanxi University of Chinese Medicine School of Nursing, Xianyang 712000, China.
| | - Liu He
- Shaanxi University of Chinese Medicine School of Nursing, Xianyang 712000, China
| | - Xiaowei Li
- Shaanxi University of Chinese Medicine School of Nursing, Xianyang 712000, China
| | - Yan Guo
- Shaanxi University of Chinese Medicine School of Nursing, Xianyang 712000, China
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Chen H, Chen L, Zhu C, Li S, Zhou J, Liu C. Immersive Virtual Reality Versus Video Distraction for the Management of Emergence Delirium in Children: A Randomized Controlled Study. J Perianesth Nurs 2024:S1089-9472(24)00190-4. [PMID: 39140922 DOI: 10.1016/j.jopan.2024.05.006] [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: 12/04/2023] [Revised: 04/15/2024] [Accepted: 05/17/2024] [Indexed: 08/15/2024]
Abstract
PURPOSE Emergence delirium (ED) presents challenges for both parents and health care providers in pediatric surgical settings. This study aims to evaluate the effectiveness of immersive virtual reality (VR) distraction and video distraction combined with parental presence in reducing ED in preschool-aged children undergoing elective surgery. DESIGN A prospective, randomized, controlled clinical trial was conducted with 90 children ages 4 to 7. Participants were randomly assigned to three groups: VR distraction (group V), tablet video distraction with parental presence (group T), and standard care (group C). The primary endpoints were the incidence of ED and Pediatric Anesthesia Emergence Delirium Scale scores, with secondary measures encompassing scores from the Parental Separation Anxiety Scale and the Faces, Legs, Activity, Cry, Consolability (FLACC) scale. METHODS Participants were assigned to one of the three intervention groups, and relevant scales were used to assess ED, parental separation anxiety, and postoperative pain. The immersive VR distraction and video distraction with parental presence interventions were compared against standard care. FINDINGS Immersive VR distraction significantly reduced the incidence of ED (6.67% in group V vs 40% in group T and 60% in group C), and the incidence of ED in group V was notably lower than in the other groups (P = .023 vs group T and P = .004 vs group C). Children in group V displayed significantly lower FLACC compared with the other groups as well (P < .05). However, no significant differences between the 3 groups were observed in perioperative anxiety as assessed by the Parental Separation Anxiety Scale scores (P = .27). CONCLUSIONS This study underscores the potential of immersive VR distraction as an effective intervention for mitigating ED in pediatric surgical patients. The findings suggest that incorporating VR technology during the perioperative period can positively impact postoperative outcomes. Further research in diverse surgical contexts is recommended to validate these findings and explore the broader applicability of VR distraction in pediatric health care settings.
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Affiliation(s)
- Hong Chen
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Le Chen
- Department of Pediatric Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Chen Zhu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Sainan Li
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Juan Zhou
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China
| | - Chengxiang Liu
- Department of Anesthesiology and Perioperative Medicine, The Second Affiliated Hospital of Anhui Medical University, Hefei City, Anhui Province, China.
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Shi X, Su L, Sun Y, Ma C, Wang Z. Non-pharmacological interventions for preventing emergence delirium in children under general anesthesia: A scoping review. J Pediatr Nurs 2024; 77:e38-e53. [PMID: 38523049 DOI: 10.1016/j.pedn.2024.03.014] [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: 06/14/2023] [Revised: 03/06/2024] [Accepted: 03/06/2024] [Indexed: 03/26/2024]
Abstract
PROBLEM The phenomenon of emergence delirium in pediatric patients undergoing general anesthesia has garnered increasing attention in the academic community. While formal non-pharmaceutical interventions have demonstrated efficacy in mitigating this phenomenon, the diversity of intervention types and their varying degrees of effectiveness necessitate further discussion. A scoping review was conducted to identify and explicate the categorization, content elements, and outcomes measures of non-pharmacological interventions utilized to forestall the onset of emergence delirium in children undergoing general anesthesia. ELIGIBILITY CRITERIA This review was conducted in accordance with the Arksey and O'Malley's methodology framework and PRISMA-ScR. It encompassed experimental and quasi-experimental studies that involved any non-pharmacological interventions during the perioperative period to prevent emergence delirium in children aged 0 to 18 years undergoing general anesthesia for elective surgery. SAMPLE Thirty-two articles met the inclusion criteria, of which 29 were randomized controlled trials. The total sample size of the population was 4633. RESULTS The scoping review revealed 10 non-pharmacological interventions, that included distraction intervention, visual preconditioning, virtual reality, parental participation, maternal voice, light drinking, acupuncture, auditory stimulation, monochromic light and breathing training. Emergence delirium, preoperative anxiety, and postoperative pain were the primary outcomes, and four assessment instruments were employed to measure the extent and incidence of emergence delirium. CONCLUSION Numerous non-pharmacological interventions have been employed to prevent emergence delirium. Nevertheless, the effectiveness of some interventions is not yet evident. IMPLICATIONS The utilization of visual preconditioning and distraction interventions appears to be an emerging area of interest.
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Affiliation(s)
- Xiaoxia Shi
- Pediatric Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Lili Su
- Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China; International Medical Centre, Henan Provincial People's Hospital, Zhengzhou, China
| | - Yue Sun
- School of Nursing, Peking University, Beijing, China; Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China
| | - Caixia Ma
- Pediatric Intensive Care Unit, Henan Provincial People's Hospital, Zhengzhou, China; Henan Provincial Key Medicine Laboratory of Nursing, Henan Evidence-based Nursing Centre: A JBI Affiliated Group, The University of Adelaide, Zhengzhou, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China; Peking University Health Science Centre for Evidence-Based Nursing, Beijing, China.
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Bexson C, Oldham G, Wray J. Safety of virtual reality use in children: a systematic review. Eur J Pediatr 2024; 183:2071-2090. [PMID: 38466416 DOI: 10.1007/s00431-024-05488-5] [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: 11/28/2023] [Revised: 01/25/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
The study aimed to systematically review available literature regarding the safety of virtual reality (VR) use via head-mounted display in children under 14 years of age. The study was a systematic review including all study designs. A search was conducted in January 2023 in PubMed and EMBASE using key terms referring to 'virtual reality', 'paediatrics' and 'safety'. Following title and abstract and full-text screening, data were extracted and a narrative synthesis undertaken. Twenty-six studies met criteria for inclusion in the final review. Limited data suggest that VR may cause mild cybersickness symptoms (not severe enough to cause participants to discontinue use of VR) and that for children with existing amblyopia using VR may result in double vision, which resolves on cessation of VR exposure. Two randomised control trials did not report differences in adverse events between the intervention (VR use) and control groups. Reporting of safety data was poor; only two studies used a validated measure, and in the remaining studies, it was often unclear how adverse events were defined (if at all), how they were categorised in terms of severity and how they were recorded. Conclusion: There is limited evidence regarding any potential harms from short exposure to VR in children under 14 years under supervision. Additional research is required to understand increases in cybersickness during and after VR exposure, and the impact of repeated exposure. Adverse events need to be accurately and routinely recorded to determine any hitherto unknown safety concerns for children < 14 years using VR. What is Known: • Virtual reality (VR) is increasingly being applied in paediatrics, with benefits in terms of anxiety reduction, improved pain management associated with procedures, as an adjunct to physiotherapy and supporting treatments in autistic spectrum disorder.. • Safety guidance in relation to VR use, particularly in younger children, is limited. What is New: • A systematic review of available literature regarding the safety of VR use via head-mounted display in children under 14 years of age demonstrated limited evidence regarding any potential harms from short exposure to VR.. • Studies rarely report safety data and adverse side effects are poorly defined, measured and/or reported. • The lack of a validated measure for evaluating VR-associated symptoms in children compounds the challenging ethical issues of undertaking research into the effects of VR on younger children.
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Affiliation(s)
- Charlotte Bexson
- Data Research, Innovation and Virtual Environments, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Geralyn Oldham
- Data Research, Innovation and Virtual Environments, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - Jo Wray
- Centre for Outcomes and Experience Research in Children's Health, Illness and Disability, Great Ormond Street Hospital for Children NHS Foundation Trust, London, WC1N 3JH, UK.
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Kilic U, Büyük Tural E, Oruc MA, Aydın Avci I. The effect of VR headsets used during burn dressing in children on satisfaction and anxiety level of their parents. J Pediatr Nurs 2024; 75:e152-e158. [PMID: 38233321 DOI: 10.1016/j.pedn.2024.01.006] [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: 09/14/2023] [Revised: 01/03/2024] [Accepted: 01/04/2024] [Indexed: 01/19/2024]
Abstract
PURPOSE The aim of this study was to determine the effect of virtual reality used during burn dressing in children on the satisfaction and anxiety levels of their parents. METHODS The study, which was designed as a prospective randomized controlled trial, was carried out with the parents of children aged 5-10 years who visited the only burns unit of a hospital in the northern region of Turkiye between 5 July 2021 and 1 April 2022 for dressing. There were a total of 52 participants in the study, 26 in the control and 26 in the intervention group. RESULTS The mean age of the children was 7.31 ± 1.81 years in the intervention group and 7.08 ± 1.72 in the control group. After the dressing was applied to the children, the mean anxiety score of the parents of the children was found to be 0.09 ± 0.28 in the intervention group and 0.64 ± 0.53 in the control group. The mean nursing care satisfaction score of the parents in the intervention group was found to be 4.70 ± 0.50 while it was 2.80 ± 0.26 in the control group. CONCLUSIONS In the study, while the anxiety levels of the ones in the intervention group decreased after the dressing, their satisfaction levels with nursing care were found higher than the control group. PRACTICE IMPLICATIONS Nursing interventions that would reduce the pain and anxiety experienced by children during medical procedures are also effective in reducing the anxiety of parents, and therefore, they should be included in distraction efforts with their children.
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Affiliation(s)
- Ummuhan Kilic
- R&D and Projects Specialist, Samsun Provincial Health Directorate, Adalet Mah, 100. Yıl Blv, No:232, 55060 Ilkadim, Samsun, Turkey
| | - Esra Büyük Tural
- Department of Child Health Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Samsun, Turkey.
| | - Muhammet Ali Oruc
- Department of Family Medicine, Samsun University, Provincial Health Director, Samsun Provincial Health Directorate, Adalet Mah, 100. Yıl Blv, No:232, 55060 Ilkadim, Samsun, Turkey
| | - Ilknur Aydın Avci
- Department of Public Health and Diseases Nursing, Faculty of Health Sciences, Ondokuz Mayıs University, Kurupelit Campus, 55200 Atakum, Samsun, Turkey.
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Mustafa MS, Shafique MA, Zaidi SDEZ, Qamber A, Rangwala BS, Ahmed A, Zaidi SMF, Rangwala HS, Uddin MMN, Ali M, Siddiq MA, Haseeb A. Preoperative anxiety management in pediatric patients: a systemic review and meta-analysis of randomized controlled trials on the efficacy of distraction techniques. Front Pediatr 2024; 12:1353508. [PMID: 38440185 PMCID: PMC10909818 DOI: 10.3389/fped.2024.1353508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Accepted: 02/09/2024] [Indexed: 03/06/2024] Open
Abstract
Background This study addresses the pervasive issue of heightened preoperative anxiety in healthcare, particularly among pediatric patients. Recognizing the various sources of anxiety, we explored both pharmacological and nonpharmacological interventions. Focusing on distraction techniques, including active and passive forms, our meta-analysis aimed to provide comprehensive insights into their impact on preoperative anxiety in pediatric patients. Methods Following the PRISMA and Cochrane guidelines, this meta-analysis and systematic review assessed the efficacy of pharmaceutical and distraction interventions in reducing pain and anxiety in pediatric surgery. This study was registered on PROSPERO (CRD42023449979). Results This meta-analysis, comprising 45 studies, investigated pharmaceutical interventions and distraction tactics in pediatric surgery. Risk of bias assessment revealed undisclosed risks in performance and detection bias. Distraction interventions significantly reduced preoperative anxiety compared to control groups, with notable heterogeneity. Comparison with Midazolam favored distraction techniques. Subgroup analysis highlighted varied efficacies among distraction methods, with a notable reduction in anxiety levels. Sensitivity analysis indicated stable results. However, publication bias was observed, suggesting a potential reporting bias. Conclusion Our study confirms distraction techniques as safe and effective for reducing pediatric preoperative anxiety, offering a valuable alternative to pharmacological interventions. Systematic Review Registration https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=449979, PROSPERO [CRD42023449979].
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Affiliation(s)
| | | | | | - Amna Qamber
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Aftab Ahmed
- Department of Paediatrics, National Institute of Child Health, Karachi, Pakistan
| | | | | | | | - Mirha Ali
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
| | | | - Abdul Haseeb
- Department of Medicine, Jinnah Sindh Medical University, Karachi, Pakistan
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Sommer JL, Reynolds K, Hebbard P, Smith MSD, Mota N, Mutch WAC, Maples-Keller J, Roos L, El-Gabalawy R. Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study. JMIR Form Res 2024; 8:e46367. [PMID: 38231570 PMCID: PMC10831694 DOI: 10.2196/46367] [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: 02/08/2023] [Revised: 11/16/2023] [Accepted: 12/04/2023] [Indexed: 01/18/2024] Open
Abstract
BACKGROUND Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation. OBJECTIVE This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction. METHODS Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study. RESULTS Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery"). CONCLUSIONS This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention. TRIAL REGISTRATION ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.
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Affiliation(s)
- Jordana L Sommer
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Kristin Reynolds
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
| | - Pamela Hebbard
- Department of Surgery, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
| | | | - Natalie Mota
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - W Alan C Mutch
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Jessica Maples-Keller
- Department of Psychiatry and Behavioral Sciences, Emory University, Atlanta, GA, United States
| | - Leslie Roos
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
| | - Renée El-Gabalawy
- Department of Anesthesiology, Perioperative and Pain Medicine, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychology, University of Manitoba, Winnipeg, MB, Canada
- Department of Psychiatry, University of Manitoba, Winnipeg, MB, Canada
- CancerCare Manitoba, Winnipeg, MB, Canada
- Department of Clinical Health Psychology, University of Manitoba, Winnipeg, MB, Canada
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