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Orgil Z, Karthic A, Bell NF, Heisterberg LM, Williams SE, Ding L, Kashikar-Zuck S, King CD, Olbrecht VA. Use of Biofeedback-Based Virtual Reality in Pediatric Perioperative and Postoperative Settings: Observational Study. JMIR Perioper Med 2024; 7:e48959. [PMID: 38742940 DOI: 10.2196/48959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 02/08/2024] [Accepted: 04/01/2024] [Indexed: 05/16/2024] Open
Abstract
BACKGROUND Biofeedback-based virtual reality (VR-BF) is a novel, nonpharmacologic method for teaching patients how to control their breathing, which in turn increases heart rate variability (HRV) and may reduce pain. Unlike traditional forms of biofeedback, VR-BF is delivered through a gamified virtual reality environment, increasing the accessibility of biofeedback. This is the first study to systematically integrate VR-BF use in the pediatric perioperative setting, with the ultimate goal of evaluating the efficacy of VR-BF to reduce pain, anxiety, and opioid consumption once feasibility and acceptability have been established. OBJECTIVES The primary objective was to develop a clinical trial protocol for VR-BF use in the pediatric perioperative setting, including preoperative education and training, and postoperative application of VR-BF in children undergoing surgery. A secondary objective was to evaluate the patient and parent experience with VR-BF. METHODS A total of 23 patients (12-18 years of age) scheduled for surgery at Nationwide Children's Hospital were recruited using purposive sampling. Following training, participants independently completed a daily, 10-minute VR-BF session for 7 days before surgery and during their inpatient stay. Participants could use VR-BF up to 2 weeks after hospital discharge. Patient- and session-level data of VR-BF usage and achievement of target HRV parameters were measured to identify the optimal frequency and duration of sessions before and after surgery for this population. Standardized questionnaires and semistructured interviews were conducted to obtain qualitative information about patients' experiences with VR-BF. RESULTS Patient-level data indicated that the highest odds of achieving 1 session under target HRV parameters was after 4 sessions (odds ratio [OR] 5.1 for 4 vs 3 sessions, 95% CI 1.3-20.6; OR 16.6 for 3 vs 2 sessions, 95% CI 1.2-217.0). Session-level data showed that a session duration of 9 to 10 minutes provided the greatest odds of achieving 1 session under target HRV parameters (OR 1.3 for 9 vs 8 min, 95% CI 1.1-1.7; OR 1.4 for 8 vs 7 min, 95% CI 1.1-1.8; OR 1 for 10 vs 9 min, 95% CI 0.9-1.2). Qualitative data revealed patient satisfaction with the VR-BF technology, particularly in managing perioperative stress (17/20, 85%). Few patients reported VR-BF as beneficial for pain (8/20, 40%). CONCLUSIONS Children and adolescents undergoing surgery successfully learned behavioral strategies with VR-BF with 10-minute sessions once daily for 5 days. To integrate VR-BF as a therapeutic intervention in a subsequent clinical trial, patients will be instructed to complete three 10-minute sessions a day for 7 days after surgery. TRIAL REGISTRATION ClinicalTrials NCT04943874; https://clinicaltrials.gov/ct2/show/NCT04943874.
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Affiliation(s)
- Zandantsetseg Orgil
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, OH, United States
| | - Anitra Karthic
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, United States
- Department of Anesthesiology & Pain Medicine, Nationwide Children's Hospital, Columbus, OH, United States
| | - Nora F Bell
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
| | - Lisa M Heisterberg
- Department of Anesthesiology, The Ohio State University College of Medicine, Columbus, OH, United States
| | - Sara E Williams
- Department of Anesthesiology, Perioperative and Pain Medicine, Stanford University School of Medicine, Palo Alto, CA, United States
| | - Lili Ding
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Susmita Kashikar-Zuck
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christopher D King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, United States
- Pediatric Pain Research Center, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Vanessa A Olbrecht
- Department of Anesthesiology and Perioperative Medicine, Nemours Children's Health, Delaware Valley, Wilmington, DE, United States
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2
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Smith A, Wyles KJ, Hernandez SM, Clarke S, Schofield P, Hughes SW. Harnessing the therapeutic effects of nature for chronic Pain: A role for immersive virtual reality? A narrative review. Eur J Pain 2024. [PMID: 39254114 DOI: 10.1002/ejp.4727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2024] [Revised: 07/16/2024] [Accepted: 08/24/2024] [Indexed: 09/11/2024]
Abstract
BACKGROUND AND OBJECTIVE There is a growing interest in the relationship between nature and pain relief. Evidence from environmental psychology, neuroscience and physiology-based studies point towards analgesic effects of nature being mediated through various cognitive, affective and/or autonomic factors. Being able to harness these therapeutic effects using immersive virtual reality (VR) could help to optimize and improve accessibility of nature-based environments as part of chronic pain management plans. In this narrative review, we present evidence supporting a new theoretical framework for nature-based analgesia and suggest ways for applying this through immersive VR. DATABASES AND DATA TREATMENT We provide an overview of the evidence on (1) the therapeutic effects of nature on pain, (2) environmental psychology theory that underpins the health benefits of nature, (3) key mechanistic evidence from nature neuroimaging and physiology-based studies, (4) previous studies that have used VR-based nature in pain research and (5) how to design effective VR interventions that can be used to integrate nature into immersive 360 environments. RESULTS We have demonstrated how environmental psychology, neuroscience and physiology-based research can be used to form a novel theoretical framework for nature-based analgesia. Using this framework, we identify how key aspects of nature can act as analgesic and how this can be harnessed using immersive VR. CONCLUSIONS Through developing this theoretical framework, we have provided a foundation on which to guide future experimental and clinical studies as well as helping to improve the accessibility of nature for chronic pain patients through immersive VR technologies. SIGNIFICANCE This review article summarizes key multidisciplinary evidence to help understand how nature exerts beneficial effects on pain processing. The use of this theoretical framework alongside advances in immersive VR technologies provides a springboard for future research and can be used to help develop new nature-based therapeutics using VR.
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Affiliation(s)
- Alexander Smith
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, Barrack Road, University of Exeter, Exeter, Devon, UK
| | - Kayleigh J Wyles
- School of Psychology, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sonia Medina Hernandez
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, Barrack Road, University of Exeter, Exeter, Devon, UK
| | - Sophie Clarke
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, Barrack Road, University of Exeter, Exeter, Devon, UK
| | - Patricia Schofield
- School of Nursing and Midwifery, Faculty of Health, University of Plymouth, Plymouth, UK
| | - Sam W Hughes
- Department of Clinical and Biomedical Sciences, Faculty of Health and Life Sciences, Barrack Road, University of Exeter, Exeter, Devon, UK
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Moreau S, Thérond A, Cerda IH, Studer K, Pan A, Tharpe J, Crowther JE, Abd-Elsayed A, Gilligan C, Tolba R, Ashina S, Schatman ME, Kaye AD, Yong RJ, Robinson CL. Virtual Reality in Acute and Chronic Pain Medicine: An Updated Review. Curr Pain Headache Rep 2024; 28:893-928. [PMID: 38587725 DOI: 10.1007/s11916-024-01246-2] [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] [Accepted: 03/18/2024] [Indexed: 04/09/2024]
Abstract
PURPOSE OF REVIEW This review critically analyzes the recent literature on virtual reality's (VR) use in acute and chronic pain management, offering insights into its efficacy, applications, and limitations. RECENT FINDINGS Recent studies, including meta-analyses and randomized controlled trials, have demonstrated VR's effectiveness in reducing pain intensity in various acute pain scenarios, such as procedural/acute pain and in chronic pain conditions. The role of factors such as immersion and presence in enhancing VR's efficacy has been emphasized. Further benefits have been identified in the use of VR for assessment as well as symptom gathering through conversational avatars. However, studies are limited, and strong conclusions will require further investigation. VR is emerging as a promising non-pharmacological intervention in pain management for acute and chronic pain. However, its long-term efficacy, particularly in chronic pain management, remains an area requiring further research. Key findings highlight that VR programs vary in efficacy depending on the specificity of the origin of pain.
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Affiliation(s)
- Sacha Moreau
- Massachusetts Institute of Technology, Boston, MA, USA
| | - Alexandra Thérond
- Department of Psychology, Université du Québec a Montréal, 100 Sherbrooke St W, Montréal, QC, H2X 3P2, Canada.
| | - Ivo H Cerda
- Harvard Medical School, Boston, MA, USA
- Department of Anesthesiology, Perioperative, and Pain Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kachina Studer
- Department of Earth and Planetary Science, Harvard University, Cambridge, MA, USA
- Department Mechanical Engineering, Massachusetts Institute of Technology (MIT), Cambridge, MA, USA
| | - Alicia Pan
- Northeastern University, Boston, MA, USA
| | - Jacob Tharpe
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Jason E Crowther
- Department of Anesthesiology and Perioperative Medicine, University of Massachusetts, Worcester, MA, USA
| | - Alaa Abd-Elsayed
- Department of Anesthesiology, School of Medicine and Public Health, University of Wisconsin, Madison, WI, USA
| | | | - Reda Tolba
- Pain Management Department in the Anesthesiology Institute, Cleveland Clinic Abu Dhabi, Abu Dhabi, UAE
| | - Sait Ashina
- Department of Neurology, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Michael E Schatman
- Department of Anesthesiology, Perioperative Care, and Pain Medicine, NYU Grossman School of Medicine, New York, NY, USA
- Department of Population Health-Division of Medical Ethics, NYU Grossman School of Medicine, New York, NY, USA
| | - Alan D Kaye
- Department of Anesthesiology, Louisiana State University Health Sciences Center Shreveport, Shreveport, LA, USA
| | | | - Christopher L Robinson
- Department of Anesthesiology, Critical Care, and Pain Medicine, Harvard Medical School, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Rosa A, Ronsivalle V, Fiorillo L, Arcuri C. Different Uses of Conscious Sedation for Managing Dental Anxiety During Third-Molar Extraction: Clinical Evidence and State of the Art. J Craniofac Surg 2024:00001665-990000000-01859. [PMID: 39207162 DOI: 10.1097/scs.0000000000010513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2024] [Accepted: 06/27/2024] [Indexed: 09/04/2024] Open
Abstract
Dental anxiety, linked to avoiding dental treatment and heightened medical and surgical risks, prompted this systematic review. The objective is to synthesize existing evidence on conscious sedation techniques employed for managing dental anxiety in patients scheduled for third molar extraction surgery, aiming to identify optimal approaches and address knowledge gaps. This systematic review followed the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" checklist and the population, investigation, comparation, outcome framework. The protocol still needs to be registered. A thorough search was conducted, incorporating MEDLINE/PubMed, EMBASE, SCOPUS, clinicaltrials.gov, and the Cochrane Database of Systematic Reviews until February 2024. Only randomized controlled trials were considered, following "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The risk of bias was evaluated following the Cochrane Handbook for Systematic Reviews of Interventions. Eighteen randomized controlled trials involving 2081 patients were included. Certain factors limited the feasibility of a meaningful meta-analysis, leading to a narrative synthesis. Conscious sedation with virtual reality showed an association with improved dental anxiety in 4 studies. One study reported reduced cortisol levels with midazolam compared with a placebo, whereas another noted significant variations in perioperative renin levels with remifentanil versus placebo. This review reveals inconclusive and conflicting findings regarding the role of conscious sedation in managing dental anxiety during third molar extraction surgery. Persistent uncertainties arise due to a need for consistent, standardized outcome measures. Addressing these limitations in study design is crucial for future research.
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Affiliation(s)
- Alessio Rosa
- Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, Rome
| | - Vincenzo Ronsivalle
- Department of General Surgery and Surgical-Medical Specialties, School of Dentistry, University of Catania, Catania
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, G. Martino Polyclinic, University of Messina, Messina
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania "Luigi Vanvitelli," Naples, Italy
- Department of Dental Research Cell, Dr D. Y. Patil Dental College and Hospital, Dr D. Y. Patil Vidyapeeth, Pimpri, Pune, MH, India
| | - Claudio Arcuri
- Department of Clinical Sciences and Translational Medicine, University of Rome Tor Vergata, Rome, Italy
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Clark A. Hacking the Predictive Mind. ENTROPY (BASEL, SWITZERLAND) 2024; 26:677. [PMID: 39202147 PMCID: PMC11353553 DOI: 10.3390/e26080677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2024] [Revised: 08/06/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
According to active inference, constantly running prediction engines in our brain play a large role in delivering all human experience. These predictions help deliver everything we see, hear, touch, and feel. In this paper, I pursue one apparent consequence of this increasingly well-supported view. Given the constant influence of hidden predictions on human experience, can we leverage the power of prediction in the service of human flourishing? Can we learn to hack our own predictive regimes in ways that better serve our needs and purposes? Asking this question rapidly reveals a landscape that is at once familiar and new. It is also challenging, suggesting important questions about scope and dangers while casting further doubt (as if any was needed) on old assumptions about a firm mind/body divide. I review a range of possible hacks, starting with the careful use of placebos, moving on to look at chronic pain and functional disorders, and ending with some speculations concerning the complex role of genetic influences on the predictive brain.
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Affiliation(s)
- Andy Clark
- Department of Philosophy, University of Sussex, Brighton BN1 9RH, UK;
- Department of Informatics, University of Sussex, Brighton BN1 9RH, UK
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6
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Pretat T, Koller C, Hügle T. Virtual reality as a treatment for chronic musculoskeletal pain syndromes. Joint Bone Spine 2024; 92:105769. [PMID: 39117101 DOI: 10.1016/j.jbspin.2024.105769] [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: 02/03/2024] [Revised: 07/11/2024] [Accepted: 07/25/2024] [Indexed: 08/10/2024]
Abstract
Chronic musculoskeletal pain syndromes, including fibromyalgia, are often resistant to conventional medications and invasive therapies. Central hypersensitization, neurotransmitter dysregulation, and autonomic nervous system abnormalities are key pathomechanisms, frequently resulting in widespread pain and a variety of psychosomatic symptoms. Virtual Reality (VR) applications have demonstrated effectiveness in reducing pain, both during and after interventions, and in chronic conditions such as fibromyalgia and back pain. The proposed mechanisms behind VR's effectiveness include distraction and immersion, coupled with cognitive behavioral therapy, which promote neuroplasticity and alter pain perceptions. Functional MRI studies have shown the impact of VR interventions on specific brain regions. Advances in hardware and software, potentially combined with treatments like biofeedback, could enhance VR's role in managing chronic pain. Currently, VR for musculoskeletal pain syndromes is primarily used within multimodal programs, but it is also available for home use as a standalone health application. Future research should focus on the 'drug-like' effects of VR, requiring controlled trials with comparable study populations and appropriate sham interventions.
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Affiliation(s)
- Tiffany Pretat
- Department of Rheumatology, University Hospital Lausanne (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Cinja Koller
- Department of Rheumatology, University Hospital Lausanne (CHUV) and University of Lausanne, Lausanne, Switzerland
| | - Thomas Hügle
- Department of Rheumatology, University Hospital Lausanne (CHUV) and University of Lausanne, Lausanne, Switzerland.
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7
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Reitze A, Voigt M, Klawonn F, Dusch M, Grigull L, Mücke U. Impact of virtual reality on peri-interventional pain, anxiety and distress in a pediatric oncology outpatient clinic: a randomized controlled trial. BMC Pediatr 2024; 24:501. [PMID: 39097718 PMCID: PMC11297639 DOI: 10.1186/s12887-024-04952-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2024] [Accepted: 07/16/2024] [Indexed: 08/05/2024] Open
Abstract
PURPOSE Pain and anxiety-inducing interventions have a major impact on pediatric patients. Pain reduction by virtual reality (VR) during port and vein punctures is well studied. This study investigates peri-interventional reduction of pain, anxiety and distress using VR compared to the standard of care (SOC) in a pediatric oncology outpatient clinic. METHODS In a randomized, controlled cross-over design, patients aged 6-18 years experience potentially painful interventions accompanied by VR. Observational instruments include NRS, FPS-r, BAADS, mYPAS-SF, PedsQL and SSKJ3-8R. All patients undergo two observations: SOC (A) and VR (B) in a randomized order. In addition, parents and staff are interviewed. Specific conditions for VR in an outpatient clinic setting derived from interprofessional focus group discussion are being explored. RESULTS Between July 2021 and December 2022 57 eligible patients were included and randomized to the orders A/B (n = 28) and B/A (n = 29). Thirty-eight patients completed both observations. Characteristics in both groups did not differ significantly. More than half of the patients had no previous experience with VR, 5% decided to discontinue VR prematurely. Peri-interventional pain, anxiety and distress were significantly reduced by VR compared with SOC. 71% of patients and 76% of parents perceived punctures with VR to be more relaxed than previous ones. 95% of patients perceived fun with VR goggles. Detailed questionnaires on individual stress and anxiety were returned from 26 of 38 patients. Focus group discussion with staff yielded evidence for successful implementation of VR in an outpatient clinic. CONCLUSIONS The present study shows that VR can be used for peri-interventional reduction of pain, anxiety, and distress in the special environment of a pediatric outpatient clinic. Specific conditions must be met for successful implementation. Further studies are needed to identify particularly susceptible patients and to illuminate alternatives for distraction that are feasible to implement with limited resources. TRIAL REGISTRATION NUMBER (ClinicalTrials.gov ID): NCT06235723; 01/02/2024; retrospectively registered. This study adheres to the standard checklist of CONSORT guidelines.
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Affiliation(s)
- Alicia Reitze
- Hannover Medical School, Pediatric Oncology and Hematology, Hanover, Germany
| | - Marie Voigt
- Hannover Medical School, Pediatric Oncology and Hematology, Hanover, Germany
| | - Frank Klawonn
- Helmholtz Centre for Infection Research, Braunschweig, Germany
- Ostfalia University, Wolfenbüttel, Germany
| | - Martin Dusch
- Hannover Medical School, Anesthesiology and Intensive Care Medicine, Hanover, Germany
| | - Lorenz Grigull
- University Hospital Bonn, Center for Rare Diseases, Bonn, Germany
| | - Urs Mücke
- Hannover Medical School, Pediatric Oncology and Hematology, Hanover, Germany.
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8
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Skidmore N, Ryan C, Mankelow J, Bradford C, Graham A, Martin D. Exploring the potential of virtual reality for the self-management of chronic pain: A scoping review of its use to address health literacy. Musculoskelet Sci Pract 2024; 72:102962. [PMID: 38703701 DOI: 10.1016/j.msksp.2024.102962] [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: 09/19/2023] [Revised: 04/11/2024] [Accepted: 04/19/2024] [Indexed: 05/06/2024]
Abstract
BACKGROUND Individuals with low health literacy struggle to manage long-term conditions. Addressing pain-related health competencies is important in the management of chronic pain. Virtual reality may be a useful tool for empowering sustainable health-related stratgies due to its unique ability to engage users in artificial environments. OBJECTIVES The aim of this scoping review was to explore existing research on the use of virtual reality as a tool to promote health literacy in people with chronic pain. DESIGN Scoping Review guided by framework proposed by Arksey & O'Malley. METHOD Articles related to "pain", "virtual reality" and "health literacy" were searched in four electronic databases: CINAHL, PubMed, Embase and PsycINFO using a formal search strategy. Studies were categorised based on intervention content using the Health Literacy Pathway Model which encompasses health knowledge, self-management skills, health communication and information seeking. RESULTS Thirteen studies met the inclusion criteria. Several elements of pain related health literacy were not addressed in the research. Interventions addressed health knowledge, self-management skills, decision making and featured content aiming to address emotional barriers to pain-related health literacy. Other components including active information seeking and use, actively communicating with health professionals and seeking and negotiating treatment options, were not explicitly addressed. CONCLUSION There is heterogeneity in existing research exploring the use of VR to support people with chronic pain. Existing VR tools to address pain-related health literacy do not cover several key components of health literacy. More research is required before a robust assessment of efficacy can be undertaken.
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Affiliation(s)
- N Skidmore
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - C Ryan
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - J Mankelow
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - C Bradford
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - A Graham
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom.
| | - D Martin
- Centre for Rehabilitation, School of Health and Life Sciences, Teesside University, Middlesbrough, Tees Valley, TS1 3BX, United Kingdom; NIHR Applied Research Collaboration for the North East and Cumbria, United Kingdom.
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9
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Venkatakrishnan R, Venkatakrishnan R, Raveendranath B, Sarno DM, Robb AC, Lin WC, Babu SV. The Effects of Auditory, Visual, and Cognitive Distractions on Cybersickness in Virtual Reality. IEEE TRANSACTIONS ON VISUALIZATION AND COMPUTER GRAPHICS 2024; 30:5350-5369. [PMID: 37418399 DOI: 10.1109/tvcg.2023.3293405] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/09/2023]
Abstract
Cybersickness (CS) is one of the challenges that has hindered the widespread adoption of Virtual Reality (VR). Consequently, researchers continue to explore novel means to mitigate the undesirable effects associated with this affliction, one that may require a combination of remedies as opposed to a solitary stratagem. Inspired by research probing into the use of distractions as a means to control pain, we investigated the efficacy of this countermeasure against CS, studying how the introduction of temporally time-gated distractions affects this malady during a virtual experience featuring active exploration. Downstream of this, we studied how other aspects of the VR experience are affected by this intervention. We discuss the results of a between-subjects study manipulating the presence, sensory modality, and nature of periodic and short-lived (5-12 seconds) distractor stimuli across four experimental conditions: 1) no-distractors (ND); 2) auditory distractors (AD); 3) visual distractors (VD); 4) cognitive distractors (CD). Two of these conditions (VD and AD) formed a yoked control design wherein every matched pair of 'seers' and 'hearers' was periodically exposed to distractors that were identical in terms of content, temporality, duration, and sequence. In the CD condition, each participant had to periodically perform a 2-back working memory task, the duration and temporality of which was matched to distractors presented in each matched pair of the yoked conditions. These three conditions were compared to a baseline control group featuring no distractions. Results indicated that the reported sickness levels were lower in all three distraction groups in comparison to the control group. The intervention also increased the amount of time users were able to endure the VR simulation and avoided causing detriments to spatial memory and virtual travel efficiency. Overall, it appears that it may be possible to make users less consciously aware and bothered by the symptoms of CS, thereby reducing its perceived severity.
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10
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Van Leugenhaege L, Van de Craen N, Maes K, Vanden Bergh L, Timmerman K, Van Aken S, Mestdagh E, Kuipers YJ. Virtual Reality as a Method to Cope With Labor Pain: What Do Women Want? Comput Inform Nurs 2024; 42:574-582. [PMID: 38701038 DOI: 10.1097/cin.0000000000001120] [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: 05/05/2024]
Abstract
This study aimed to determine what childbearing women want when using virtual reality as an intrapartum pain management method. Researchers performed a qualitative exploratory study using content analysis. Two focus groups were organized including pregnant women anticipating a vaginal birth and women who recently had given birth, no longer than 6 months ago. The focus groups included a 30-minute virtual reality demo. In total, 10 women participated. Five themes emerged: (1) "try, test and explore": the need to receive information and to get acquainted with virtual reality during the antenatal period; (2) "variety and diversity in physical and digital options": the preference for a variety in virtual content and view virtual reality as a complementary method to methods for intrapartum pain management; (3) "distraction versus focus": virtual reality as a method to distract from pain, from the clinical context or to help them focus; (4) "comfort both physical and digital": measures to ensure a comfortable physical and virtual experience; and (5) "birthing partner": the potential need to include partners. This study is an essential step informing the development, implementation, and research of labor-specific virtual reality and informing antenatal healthcare providers when offering women virtual reality as intrapartum pain management.
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Affiliation(s)
- Luka Van Leugenhaege
- Author Affiliations: Department of Health and Life Science, AP University of Applied Sciences and Arts, Antwerp (Mss Van Leugenhaege, Van de Craen, Maes, and Vanden Bergh and Drs Mestdagh and Kuipers); Centre for Research and Innovation in Care, University of Antwerp, Universiteitsplein 1, 2610 Antwerp, Belgium MAXlab, Royal Academy of Fine Arts Antwerp, AP University of Applied Sciences and Arts (Mr Timmerman); and Immersive Lab, Department of Science and Technology, AP University of Applied Sciences and Arts (Dr Van Aken), Antwerp, Belgium; and School of Health and Social Care, Edinburgh Napier University, Scotland (Dr Kuipers)
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11
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van der Meulen M, Rischer KM, González Roldán AM, Terrasa JL, Montoya P, Anton F. Age-related differences in functional connectivity associated with pain modulation. Neurobiol Aging 2024; 140:1-11. [PMID: 38691941 DOI: 10.1016/j.neurobiolaging.2024.04.008] [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: 11/10/2023] [Revised: 04/17/2024] [Accepted: 04/18/2024] [Indexed: 05/03/2024]
Abstract
Growing evidence suggests that aging is associated with impaired endogenous pain modulation, and that this likely underlies the increased transition from acute to chronic pain in older individuals. Resting-state functional connectivity (rsFC) offers a valuable tool to examine the neural mechanisms behind these age-related changes in pain modulation. RsFC studies generally observe decreased within-network connectivity due to aging, but its relevance for pain modulation remains unknown. We compared rsFC within a set of brain regions involved in pain modulation between young and older adults and explored the relationship with the efficacy of distraction from pain. This revealed several age-related increases and decreases in connectivity strength. Importantly, we found a significant association between lower pain relief and decreased strength of three connections in older adults, namely between the periaqueductal gray and right insula, between the anterior cingulate cortex (ACC) and right insula, and between the ACC and left amygdala. These findings suggest that the functional integrity of the pain control system is critical for effective pain modulation, and that its function is compromised by aging.
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Affiliation(s)
- Marian van der Meulen
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg.
| | - Katharina M Rischer
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
| | - Ana María González Roldán
- Cognitive and Affective Neuroscience and Clinical Psychology, University of the Balearic Islands, Palma, Spain
| | - Juan Lorenzo Terrasa
- Cognitive and Affective Neuroscience and Clinical Psychology, University of the Balearic Islands, Palma, Spain
| | - Pedro Montoya
- Cognitive and Affective Neuroscience and Clinical Psychology, University of the Balearic Islands, Palma, Spain
| | - Fernand Anton
- Department of Behavioural and Cognitive Sciences, University of Luxembourg, Luxembourg
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12
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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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13
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Landmann G, Aerni M, Abächerli R, Ernst M, Ljutow A, Ottiger-Böttger K. Virtual walking therapy in neuropathic spinal cord injury pain: a feasibility study. Spinal Cord Ser Cases 2024; 10:53. [PMID: 39080247 PMCID: PMC11289286 DOI: 10.1038/s41394-024-00667-w] [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: 11/20/2023] [Revised: 07/01/2024] [Accepted: 07/23/2024] [Indexed: 08/02/2024] Open
Abstract
STUDY DESIGN A feasibility study. OBJECTIVES Chronic neuropathic pain is a prevalent comorbidity in patients with spinal cord injury (SCI), and current medical treatments remain unsatisfactory. New developments as virtual walking are emerging which has been established and further developed at our centre. This study aims to investigate the feasibility of our virtual walking setup in a small group of SCI patients. SETTING The study was conducted at the Swiss Paraplegic Centre in Nottwil, Switzerland. METHODS Four patients aged 22 to 60 years were observed during and after therapy. Three had complete paraplegia (levels Th4-Th8) with neuropathic at- and below-level pain, while one had incomplete paraplegia (Th10) with at-level pain. The primary outcome measured was satisfaction with acceptance of and adherence to virtual walking therapy, alongside suggestions for therapy improvements. Additionally, patients kept a pain diary and pain drawings to measure the extent of pain distribution and intensity before and after therapy. Therapy schedules included either two sessions per week for five weeks or five sessions per week for two weeks. RESULTS There was a sound satisfaction and good acceptance amongst participants. Support, duration, and number of sessions were perceived well and acceptable. Pain as a secondary outcome did not change during or after therapy in all but one patient which improved in pain intensity, pain quality as well as pain distribution. CONCLUSION Results suggest that our virtual walking setting is a feasible tool that should be further studied in patients with SCI-related chronic neuropathic pain.
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Affiliation(s)
- Gunther Landmann
- Neurology, Swiss Paraplegic Centre, Nottwil, Switzerland
- Swiss Paraplegic Research, Nottwil, Switzerland
| | - Marina Aerni
- Institute of Physiotherapy, School of Health Professions, Zurich University of Applied Sciences, Winterthur, Switzerland
| | - Roger Abächerli
- Lucerne University of Applied Sciences and Arts (HSLU), Horw, Switzerland
| | - Mario Ernst
- Swiss Paraplegic Research, Nottwil, Switzerland
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
| | - André Ljutow
- Centre for Pain Medicine, Swiss Paraplegic Centre, Nottwil, Switzerland
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Groninger H, Violanti D, Mete M. Virtual reality for pain management in hospitalized patients with cancer: A randomized controlled trial. Cancer 2024; 130:2552-2560. [PMID: 38943468 DOI: 10.1002/cncr.35282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 01/31/2024] [Accepted: 02/26/2024] [Indexed: 07/01/2024]
Abstract
BACKGROUND Hospitalized patients with cancer often experience acute and/or chronic pain. Although virtual reality (VR) has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management in this patient population. METHODS Prospective randomized controlled trial at an urban academic hospital comparing VR against an active control to mitigate moderate-severe cancer disease and treatment-related pain. RESULTS A total of 128 adult hospitalized patients with cancer (any tumor type) were randomized to 10 minutes of immersive VR distraction therapy or 10 minutes of two-dimensional guided imagery distraction therapy delivered by handheld tablet. Participants in the two arms were similar in age, sex, race, presence of metastatic disease, concurrent pain specialist consultation, and baseline opioid use. Although both groups experienced improved self-reported pain scores (primary outcome), those randomized to VR experienced significantly greater reduction in pain immediately after intervention compared with active control (p = .03). This difference was sustained for 24 hours as well (p = .004). Within-group analysis showed significant improvement in VR arm of pain bothersomeness (p = .05) and general distress (p = .03) as well. CONCLUSION Among hospitalized adult patients with moderate-severe pain related to cancer and cancer therapies, VR provided more nonpharmacologic pain relief than active control and this benefit sustained long after conclusion of the intervention. PLAIN LANGUAGE SUMMARY Virtual reality (VR), a developing technology that immerses the user in new environments, has been shown to improve pain in different patient populations. To test the role of VR in improving pain in hospitalized patients with cancer who report moderate-severe pain, we compared the impact of a 10-minute immersive VR intervention to that of a 10-minute two-dimensional guided imagery experience to improve self-reported pain scores. We found that, although both interventions improved pain, VR did so significantly more. Moreover, participants assigned to VR had sustained improvement in pain 24 hours later.
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Affiliation(s)
- Hunter Groninger
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
| | - Diana Violanti
- Roswell Park Comprehensive Cancer Center, Buffalo, New York, USA
| | - Mihriye Mete
- MedStar Health Research Institute, Hyattsville, Maryland, USA
- Georgetown University School of Medicine, Washington, District of Columbia, USA
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Giannelli A, Moscato S, Ostan R, Pannuti R, Chiari L, Biasco G, Varani S. Virtual Reality for advanced cancer patients assisted at home: A randomized controlled interventional study. Psychooncology 2024; 33:e6368. [PMID: 38937094 DOI: 10.1002/pon.6368] [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: 06/30/2023] [Revised: 05/27/2024] [Accepted: 06/13/2024] [Indexed: 06/29/2024]
Abstract
OBJECTIVE Virtual Reality (VR) has been demonstrated to be an effective option for integrating psychological interventions in different therapeutic settings. This randomized controlled interventional study aims to assess the effects of VR, compared to tablet controlled intervention, on anxiety, depression, pain, and short-term psychophysical symptoms in advanced cancer patients assisted at home. METHODS Participants were provided with a VR headset or a tablet (TAB) for 4 days. On the first and last day, anxiety and depression were measured by Hospital Anxiety and Depression Scale and pain by Brief Pain Inventory. Before and after each VR and tablet session, symptoms were collected by the Edmonton Symptom Assessment Scale (ESAS). RESULTS Fifty-three patients (27 VR vs. 26 TAB) completed the study. Anxiety significantly decreased in the VR group after the 4-day intervention. The analysis of ESAS showed a significant improvement in pain (p = 0.013), tiredness (p < 0.001), and anxiety (p = 0.013) for TAB group, and a significant reduction in tiredness (p < 0.001) in the VR group. CONCLUSIONS Technological and user-friendly tools, such as VR and tablets, might be integrated with traditional psychological interventions to improve anxiety and cancer-related short-term symptoms. Further studies are needed to better consolidate the possible beneficial effects of VR.
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Affiliation(s)
| | - Serena Moscato
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
| | - Rita Ostan
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
| | | | - Lorenzo Chiari
- Department of Electrical, Electronic, and Information Engineering "Guglielmo Marconi" (DEI), University of Bologna, Bologna, Italy
- Health Sciences and Technologies - Interdepartmental Center for Industrial Research (CIRI-SDV), University of Bologna, Bologna, Italy
| | - Guido Biasco
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
| | - Silvia Varani
- National Tumor Assistance (ANT) Foundation, Bologna, Italy
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Wei W, Tang H, Luo Y, Yan S, Ji Q, Liu Z, Li H, Wu F, Yang S, Yang X. Efficacy of virtual reality exercise in knee osteoarthritis rehabilitation: a systematic review and meta-analysis. Front Physiol 2024; 15:1424815. [PMID: 38962070 PMCID: PMC11220424 DOI: 10.3389/fphys.2024.1424815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2024] [Accepted: 06/03/2024] [Indexed: 07/05/2024] Open
Abstract
Background This systematic review and meta-analysis aims to investigate the effects of virtual reality (VR) exercise compared to traditional rehabilitation on pain, function, and muscle strength in patients with knee osteoarthritis (KOA). Additionally, the study explores the mechanisms by which VR exercise contributes to the rehabilitation of KOA patients. Methods We systematically searched PubMed, the Cochrane Library, Embase, Web of Science, Scopus, and PEDro according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Our search spanned from the library construction to 24 May 2024, focusing on randomized controlled trials Primary outcomes included pain, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and muscle strength. Meta-analysis was conducted using RevMan (version 5.4) and Stata (version 14.0). The bias risk of included studies was assessed using the Cochrane RoB 2.0 tool, while the quality of evidence was evaluated using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Results This meta-analysis and systematic review included nine studies involving 456 KOA patients. The results indicated that VR exercise significantly improved pain scores (SMD, -1.53; 95% CI: -2.50 to -0.55; p = 0.002), WOMAC total score (MD, -14.79; 95% CI: -28.26 to -1.33; p = 0.03), WOMAC pain score (MD, -0.93; 95% CI: -1.52 to -0.34; p = 0.002), knee extensor strength (SMD, 0.51; 95% CI: 0.14 to 0.87; p = 0.006), and knee flexor strength (SMD, 0.65; 95% CI: 0.28 to 1.01; p = 0.0005), but not significantly for WOMAC stiffness (MD, -0.01; 95% CI: -1.21 to 1.19; p = 0.99) and physical function (MD, -0.35; 95% CI: -0.79 to -0.09; p = 0.12). Conclusion VR exercise significantly alleviates pain, enhances muscle strength and WOMAC total score in KOA patients, but improvements in joint stiffness and physical function are not significant. However, the current number of studies is limited, necessitating further research to expand on the present findings. Systematic review registration https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42024540061, identifier CRD42024540061.
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Affiliation(s)
- Wei Wei
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Haiting Tang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Yu Luo
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shichang Yan
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Qipei Ji
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Zhixiang Liu
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Huaqiang Li
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Fei Wu
- School of Foreign Languages, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Shenqiao Yang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
| | - Xin Yang
- School of Health Preservation and Rehabilitation, Chengdu University of Traditional Chinese Medicine, Chengdu, China
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Caballero R, Pasten A, Giménez C, Rodríguez R, Carmona RM, Mora J, Valls-Esteve A, Lustig P, Lombardini F, Balsells S, Krauel L. Beyond Needles: Pioneering Pediatric Care with Virtual Reality (VR) for TIVAD Access in Oncology. Cancers (Basel) 2024; 16:2187. [PMID: 38927893 PMCID: PMC11201373 DOI: 10.3390/cancers16122187] [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: 04/29/2024] [Revised: 06/06/2024] [Accepted: 06/08/2024] [Indexed: 06/28/2024] Open
Abstract
INTRODUCTION Pediatric oncology patients use totally implantable venous access devices (TIVADs) to enable central venous access. Anxiety, pain and/or discomfort are common despite anesthesia. Virtual reality (VR) is a non-pharmacological approach that may reduce pain and anxiety in these patients. We aimed to assess the use of VR for reducing anxiety/pain in patients with TIVADs while facilitating the task of healthcare providers when accessing a TIVAD. METHODS patients 4-18 years old with a TIVAD were prospectively randomized to an intervention group (IG) or a control group (CG). In the IG, VR goggles (Oculus Quest 2, Meta Platforms®, Menlo Park, CA, USA) were used displaying a relaxing video in the Raja Ampat environment (Ecosphere app from Phoria®) while the TIVAD was accessed. The CG was managed as per standard of care. Satisfaction and pain were measured by FPS-R and STAIC scales, respectively. RESULTS this is the report of a prospective, randomized (60 per group)-unblinded-, single institution study of 120 pediatric oncology patients enrolled from January to April 2022. Median ages for IG and CG were 9.22 and 10.52 years, respectively. Satisfaction was higher in the IG (4.80) compared to the CG (3.92), p ≤ 0.0001. Regarding pain, mean FPS-R scores were 1.79 for the CG and 0.83 for the IG. Significantly different scores were found in the 12 to 18 years group, p ≤ 0.05. The healthcare professionals index of satisfaction was high (4.50 mean Likert score) for the IG compared to accessing the TIVAD without VR (3.73 mean Likert score). CONCLUSION The use of VR helped reduce pain and/or discomfort in pediatric oncology patients, mainly in the older age group as they can better interact with VR. Healthcare providers were satisfied with the help of VR for TIVAD management.
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Affiliation(s)
- Rubén Caballero
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (R.C.)
| | - Albert Pasten
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (R.C.)
| | - Carla Giménez
- Pediatric Oncology Nurse, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (C.G.); (R.R.); (R.M.C.)
| | - Raquel Rodríguez
- Pediatric Oncology Nurse, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (C.G.); (R.R.); (R.M.C.)
| | - Rosa María Carmona
- Pediatric Oncology Nurse, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (C.G.); (R.R.); (R.M.C.)
| | - Jaume Mora
- Pediatric Cancer Center Barcelona, SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain;
| | - Arnau Valls-Esteve
- Innovation Department, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain (P.L.)
| | - Pamela Lustig
- Innovation Department, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain (P.L.)
| | - Federica Lombardini
- Child and Adolescent Psychiatry and Psychology Department, Hospital Sant Joan de Déu, 08950 Barcelona, Spain
| | - Sol Balsells
- Statistical Advising Service, Fundació de Recerca Sant Joan de Déu, 08950 Barcelona, Spain;
| | - Lucas Krauel
- Pediatric Surgical Oncology Unit, Department of Pediatric Surgery, PCCB-SJD Barcelona Children’s Hospital, University of Barcelona, 08950 Barcelona, Spain; (R.C.)
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Grange L, Grange R, Bertholon S, Morisson S, Martin I, Boutet C, Grange S. Virtual reality for interventional radiology patients: a preliminary study. Support Care Cancer 2024; 32:416. [PMID: 38847962 DOI: 10.1007/s00520-024-08621-0] [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: 02/03/2024] [Accepted: 05/30/2024] [Indexed: 07/16/2024]
Abstract
PURPOSE The aim of this prospective study was to evaluate the tolerance and feasibility of using virtual reality headsets with patients during interventional radiology procedures. MATERIAL AND METHOD In this single-center prospective study, the use of a virtual reality headset in addition to the usual analgesic and anxiolytic treatment was proposed to all patients presenting in the interventional radiology department from December 2020 to June 2022. Exclusion criteria were as follows: (1) patients with whom it was not possible to communicate (2) epileptic patients, (3) non-verbal patients, and (4) pregnant women. The main objective was to evaluate the safety of the procedure by screening complications during and after the procedure. The second objective was to evaluate feasibility, as defined by the number of patients using the helmet until the end of the procedure. Effectiveness (patient's self-evaluation of pain and anxiety), comfort, satisfaction, emotions felt, sense of security, and feeling of immersion were also evaluated. Caregivers completed a feedback questionnaire. RESULTS Virtual reality headsets were offered to 100 patients, 9 of whom declined. Procedures were achieved in 93.5% of cases: 6/91 patients removed the headset before the end of the procedure. There were minor adverse events in 2/85 (2.3%) procedures (discomfort and nausea) and no major adverse events. 93.9% of patients found an overall benefit, and 90.2% would recommend virtual reality to another patient. 94.4% of caregivers were satisfied with the virtual reality equipment. The mean pain level was 2.5 ± 2.7 before the procedure, 3.3 ± 2.5 during the procedure, and 1.6 ± 2.7 after the procedure. Mean anxiety scores were 4.6 ± 2.9 before the procedure, 3.1 ± 2.7 during the procedure, and 1.1 ± 1.9 after the procedure. CONCLUSION The use of virtual reality technology as a complement to traditional therapy for procedures under local anesthesia is feasible and safe in interventional radiology and can be beneficial for pain and anxiety management.
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Affiliation(s)
- Loïc Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Rémi Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Sylvain Bertholon
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Stéphanie Morisson
- Department of Supportive Care in Oncology, University Hospital of Saint Etienne, Saint-Priest-En-Jarez, France
| | - Isabelle Martin
- Infection Control Unit, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Claire Boutet
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France
| | - Sylvain Grange
- Department of Radiology, University Hospital of Saint-Etienne, Saint-Priest-En-Jarez, France.
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Mittal A, Wakim J, Huq S, Wynn T. Effectiveness of Virtual Reality in Reducing Perceived Pain and Anxiety Among Patients Within a Hospital System: Protocol for a Mixed Methods Study. JMIR Res Protoc 2024; 13:e52649. [PMID: 38722681 PMCID: PMC11117134 DOI: 10.2196/52649] [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: 09/11/2023] [Revised: 12/04/2023] [Accepted: 03/06/2024] [Indexed: 05/15/2024] Open
Abstract
BACKGROUND Within hospital systems, diverse subsets of patients are subject to minimally invasive procedures that provide therapeutic relief and necessary health data that are often perceived as anxiogenic or painful. These feelings are particularly relevant to patients experiencing procedures where they are conscious and not sedated or placed under general anesthesia that renders them incapacitated. Pharmacologic pain management and topical anesthetic creams are used to manage these feelings; however, distraction-based methods can provide nonpharmacologic means to modify the painful experience and discomfort often associated with these procedures. Recent studies support distraction as a useful method for reducing anxiety and pain and as a result, improving patient experience. Virtual reality (VR) is an emerging technology that provides an immersive user experience and can operate through a distraction-based method to reduce the negative or painful experience often related to procedures where the patient is conscious. Given the possible short-term and long-term outcomes of poorly managed pain and enduring among patients, health care professionals are challenged to improve patient well-being during medically essential procedures. OBJECTIVE The purpose of this pilot project is to assess the efficacy of using VR as a distraction-based intervention for anxiety or pain management compared to other nonpharmacologic interventions in a variety of hospital settings, specifically in patients undergoing lumbar puncture procedures and bone marrow biopsies at the oncology ward, patients receiving nerve block for a broken bone at an anesthesia or surgical center, patients undergoing a cleaning at a dental clinic, patients conscious during an ablation procedure at a cardiology clinic, and patients awake during a kidney biopsy at a nephrology clinic. This will provide the framework for additional studies in other health care settings. METHODS In a single visit, patients eligible for the study will complete brief preprocedural and postprocedural questionnaires about their perceived fear, anxiety, and pain levels. During the procedure, research assistants will place a VR headset on the patient and the patient will undergo a VR experience to distract from any pain felt from the procedure. Participants' vitals, including blood pressure, heart rate, and rate of respiration, will also be recorded before, during, and after the procedure. RESULTS The study is already underway, and results support a decrease in perceived pain by 1.00 and a decrease in perceived anxiety by 0.3 compared to the control group (on a 10-point Likert scale). Among the VR intervention group, the average rating for comfort was 4.35 out of 5. CONCLUSIONS This study will provide greater insight into how patients' perception of anxiety and pain could potentially be altered. Furthermore, metrics related to the operational efficiency of providing a VR intervention compared to a control will provide insight into the feasibility and integration of such technologies in routine practice. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/52649.
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Affiliation(s)
- Ajay Mittal
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Jonathan Wakim
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States
| | - Suhaiba Huq
- College of Medicine, University of Florida, Gainesville, FL, United States
| | - Tung Wynn
- College of Medicine, University of Florida, Gainesville, FL, United States
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20
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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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Fabricant PD, Gross PW, Mackie AT, Heath MR, Pascual-Leone N, Denneen JP, Gelley PE, Scher DM, Ipp LS. Virtual Reality Distraction Is No Better Than Simple Distraction Techniques for Reducing Pain and Anxiety During Pediatric Orthopaedic Outpatient Procedures: A Randomized Controlled Trial. Clin Orthop Relat Res 2024; 482:854-863. [PMID: 37939199 PMCID: PMC11008647 DOI: 10.1097/corr.0000000000002889] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/19/2023] [Accepted: 09/14/2023] [Indexed: 11/10/2023]
Abstract
BACKGROUND In-office procedures can be painful and anxiety-provoking for pediatric patients. Minimizing such pain and anxiety in children improves the patient experience and promotes a rewarding and productive patient-caregiver-provider relationship, which may for some young patients be their first memorable encounter with the healthcare system. Although virtual reality (VR) techniques have proven to be helpful in minimizing pain and anxiety during procedures in pediatric intensive care settings, it remains unclear how VR affects objective and subjective measures of pain and anxiety in children undergoing in-office orthopaedic procedures such as cast removal or percutaneous pin removal after fracture healing. QUESTIONS/PURPOSES Is a VR gaming simulation more effective than either of two forms of noninteractive visual distraction (VR goggles or tablet computer displaying a noninteractive video) for reducing (1) objective measures of pain and anxiety and (2) subjective measures of pain and anxiety in children undergoing in-office cast removal or percutaneous pin removal? METHODS This study was a randomized controlled trial with two parallel, separately analyzed cohorts: children undergoing in-office cast removal or in-office percutaneous pin removal at a single urban tertiary institution. We approached eligible patients who were scheduled to undergo outpatient cast or percutaneous pin removal and who met prespecified inclusion criteria. We enrolled until 105 patients were available for analysis in each of the cast removal and pin removal cohorts. Of note, the study institution was in an urban epicenter of the coronavirus-19 pandemic, and clinical research was paused sporadically, which resulted in a longer-than-expected enrollment period. In the cast removal cohort, all patients were eligible for inclusion and were enrolled and randomized into one of three groups: VR gaming simulation (n = 37), VR goggles with a noninteractive video (n = 36), or a tablet computer with the same noninteractive video (n = 40). Eleven percent (4), 8% (3), and 3% (1) withdrew from each of the three intervention groups, respectively. In the pin removal cohort, all patients were eligible for inclusion and were enrolled and randomized into the same three groups (37, 44, and 41 patients, respectively). In the pin removal group, 14% (5), 18% (8), and 10% (4) withdrew from each of the three intervention groups, respectively. In all, 235 patients were enrolled in the study and 210 patients (mean ± SD age 9 ± 3 years; 48% [100] girls) were included in the final analyses. There were no clinically important differences in age, gender, preprocedure pain, or anxiety among the intervention groups. Primary outcomes included preprocedure-to-maximum heart rate increase (objective measure) and preprocedure and postprocedure pain and anxiety using a VAS (subjective measures). One-way ANOVA and Bonferroni-adjusted pairwise comparisons were used to calculate between-group differences for the primary outcomes. RESULTS There were no intervention-level groupwise differences between VR goggles with an interactive game, VR goggles with a noninteractive video, or the tablet computer with the same video in preprocedure-to-maximum heart rate increase in the cast removal cohort (18 ± 21 bpm versus 14 ± 11 bpm versus 20 ± 16 bpm, respectively; largest mean difference -6 bpm [95% CI -16 to 3]; p = 0.36) or pin removal cohort (27 ± 20 bpm versus 23 ± 12 bpm versus 24 ± 19 bpm, respectively; largest mean difference 4 bpm [95% CI -7 to 14]; p = 0.99). Similarly, there were no intervention-level groupwise differences in preprocedure to postprocedure VAS pain in the cast removal cohort (1 ± 1 versus 1 ± 2 versus 0 ± 2, respectively; largest mean difference 0 points [95% CI 0 to 1]; p = 0.89) or pin removal cohort (0 ± 3 versus 2 ± 3 versus 0 ± 3 points, respectively; largest mean difference 1 point [95% CI 0 to 3]; p = 0.13). Finally, there were no intervention-level groupwise differences between the same intervention groups in preprocedure to postprocedure VAS anxiety in the cast removal cohort (-2 ± 2 versus -1 ± 2 versus -1 ± 2 points, respectively; largest mean difference -1 point [95% CI -2 to 1]; p = 0.63) or pin removal cohort (-3 ± 3 versus -4 ± 4 versus -3 ± 3 points, respectively; largest mean difference -1 point [95% CI -2 to 1]; p = 0.99). CONCLUSION During in-office cast and pin removal in pediatric patients, simple distraction techniques such as tablet video viewing are as effective as higher-fidelity VR headset video and interactive games in minimizing objective measures of procedural pain and subjective measures of pain and anxiety. Because of these findings and because of the associated costs, implementation logistics, and variable tolerance by young patients, widespread use of VR distraction techniques in the pediatric orthopaedic outpatient setting is unnecessary. LEVEL OF EVIDENCE Level I, therapeutic study.
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Affiliation(s)
| | | | | | - Madison R. Heath
- Columbia University Vagelos College of Physicians and Surgeons, New York, NY, USA
| | | | | | | | | | - Lisa S. Ipp
- Hospital for Special Surgery, New York, NY, USA
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22
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Baydoun M, Gajtani Z, Patton M, McLennan A, Cartwright S, Carlson LE. Virtual reality-guided mindfulness for chronic pain in cancer survivors: protocol for the virtual mind study-a single-group feasibility trial. FRONTIERS IN PAIN RESEARCH 2024; 5:1291374. [PMID: 38638535 PMCID: PMC11024301 DOI: 10.3389/fpain.2024.1291374] [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: 09/09/2023] [Accepted: 03/19/2024] [Indexed: 04/20/2024] Open
Abstract
Background Chronic cancer-related pain (CRP) can have a significant negative impact on quality of life. Mindfulness is hypothesized to mitigate chronic CRP by regulating both physical and emotional resistance to pain. In recent years, there has been interest in the use of virtual reality (VR) to deliver mindfulness meditation. VR provides an immersive and engaging environment, which may enhance one's focused attention to present-moment experiences, potentially making mindfulness less effortful and more efficacious for individuals with chronic pain. There has been little research in this area for people with a history of cancer. Objective The aim of this mixed methods study is to evaluate the feasibility of a VR-guided mindfulness (VRGM) intervention offered to adult cancer survivors with chronic CRP. Methods This mixed methods feasibility study will employ a single-arm, pretest-posttest design with semistructured interviews. In total, 15 cancer survivors will be enrolled in a 6-week home-based intervention that consists of 10-15 min of daily VRGM practice. The primary outcome is feasibility as assessed by accrual rates, retention in the study, intervention adherence, questionnaire completion, and side effect rates. Participants will be assessed on psychosocial outcome measures (i.e., pain, sleep, depressive and anxiety symptoms, fatigue, quality of life, and mindfulness) before and after the intervention, and 6 weeks post intervention (follow-up). Changes in pain will be described in relation to levels of immersion and presence in the virtual environment, trait mindfulness, and amount of VRGM practice. Qualitative information will provide subjective detail on participants' experience with VRGM to complement quantitative data. This study has been approved by the Health Research Ethics Board of Alberta Cancer Committee (HREBA.CC-20-0411). Conclusions This novel intervention provides a potential alternative treatment to pharmacological pain management. Results from this study may inform future larger VGRM trials for chronic CRP to help reduce suffering in people with cancer. Study findings will be disseminated through open access publications, traditional conference presentations, professional cancer organizations, and social media platforms.
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Affiliation(s)
- Mohamad Baydoun
- Faculty of Nursing, University of Regina, Regina, SK, Canada
| | - Zen Gajtani
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
| | - Michaela Patton
- Department of Psychology, University of Calgary, Calgary, AB, Canada
| | - Andrew McLennan
- Department of Psychology, University of Regina, Regina, SK, Canada
| | - Stephen Cartwright
- Centre for Simulation and Visualization, University of Calgary, Calgary, AB, Canada
| | - Linda E. Carlson
- Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, AB, Canada
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23
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Araujo-Duran J, Kopac O, Montalvo Campana M, Bakal O, Sessler DI, Hofstra RL, Shah K, Turan A, Ayad S. Virtual Reality Distraction for Reducing Acute Postoperative Pain After Hip Arthroplasty: A Randomized Trial. Anesth Analg 2024; 138:751-759. [PMID: 37678233 PMCID: PMC10909914 DOI: 10.1213/ane.0000000000006642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
BACKGROUND Relaxation and distraction provided by virtual reality presentations might be analgesic and reduce the need for opioid analgesia. We tested the hypothesis that a virtual reality program (AppliedVR) decreases acute postoperative pain and opioid requirements in patients recovering from hip arthroplasty. We also evaluated whether virtual reality distraction improves patient mobility and reduces the need for antiemetics. METHODS We evaluated 106 adults who were recovering from elective primary total hip arthroplasty. Participating patients were randomized to 2- to 8-minute-long 3-dimensional immersive virtual reality relaxation and distraction video presentations (eg, guided breathing exercises, games, mindfulness) or to 2-dimensional presentations of nature short films (eg, forest wildlife) with neutral music that was chosen to be neither overly relaxing nor distracting, presented through identical headsets. Our primary outcome was pain after virtual reality or sham video presentations, adjusted for pretreatment scores. Secondary outcomes included total opioid consumption, pain scores obtained per routine by nurse staff, perception of video system usability, and pain 1 week after hospital discharge. RESULTS Fifty-two patients were randomized to virtual reality distraction and relaxation, and 54 were assigned to 2-dimensional sham presentations. Virtual reality presentations were not found to affect pain scores before and after presentations, with an estimated difference in means (virtual reality minus sham video) of -0.1 points (95% confidence interval [CI], -0.5 to 0.2; P = .391) on a 0 to 10 scale, with 10 being the worst. The mean (standard error [SE]) after-intervention pain score was estimated to be 3.4 (0.3) in the virtual reality group and 3.5 (0.2) in the reference group. Virtual reality treatment was not found to affect postoperative opioid consumption in morphine milligram equivalents, with an estimated ratio of geometric means (virtual reality/sham video) of 1.2 (95% CI, 0.6-2.1; P = .608). Virtual reality presentations were not found to reduce pain scores collected every 4 hours by nursing staff, with an estimated difference in means of 0.1 points (95% CI, -0.9 to 0.7; P = .768). CONCLUSIONS We did not observe statistically significant or clinically meaningful reductions in average pain scores or opioid consumption. As used in our trial, virtual reality did not reduce acute postoperative pain.
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Affiliation(s)
| | | | | | - Omer Bakal
- From the Department of Outcomes Research
| | | | | | - Karan Shah
- Department of Quantitative Health Sciences
| | - Alparslan Turan
- From the Department of Outcomes Research
- Department of General Anesthesiology, Cleveland Clinic, Cleveland, Ohio
| | - Sabry Ayad
- From the Department of Outcomes Research
- Department of Regional Practice, Anesthesiology Institute, Cleveland Clinic/Fairview Hospital, Cleveland, Ohio
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Napolitano G, Has C, Schwerk A, Yuan JH, Ullrich C. Potential of Artificial Intelligence to Accelerate Drug Development for Rare Diseases. Pharmaceut Med 2024; 38:79-86. [PMID: 38315404 DOI: 10.1007/s40290-023-00504-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/16/2023] [Indexed: 02/07/2024]
Abstract
The growth in breadth and depth of artificial intelligence (AI) applications has been fast, running hand in hand with the increasing amount of digital data available. Here, we comment on the application of AI in the field of drug development, with a strong focus on the specific achievements and challenges posed by rare diseases. Data paucity and high costs make drug development for rare diseases especially hard. AI can enable otherwise inaccessible approaches based on the large-scale integration of heterogeneous datasets and knowledge bases, guided by expert biological understanding. Obstacles still exist for the routine use of AI in the usually conservative pharmaceutical domain, which can easily become disillusioned. It is crucial to acknowledge that AI is a powerful, supportive tool that can assist but not replace human expertise in the various phases and aspects of drug discovery and development.
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Affiliation(s)
| | - Canan Has
- Centogene GmbH, Alboinstraße 36-42, 12103, Berlin, Germany
| | - Anne Schwerk
- Beriln Institute of Health Center for Regenerative Therapies (BCRT), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Jui-Hung Yuan
- Beriln Institute of Health Center for Regenerative Therapies (BCRT), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Carsten Ullrich
- Beriln Institute of Health Center for Regenerative Therapies (BCRT), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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25
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Javvaji CK, Reddy H, Vagha JD, Taksande A, Kommareddy A, Reddy NS. Immersive Innovations: Exploring the Diverse Applications of Virtual Reality (VR) in Healthcare. Cureus 2024; 16:e56137. [PMID: 38618363 PMCID: PMC11016331 DOI: 10.7759/cureus.56137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Accepted: 03/14/2024] [Indexed: 04/16/2024] Open
Abstract
Virtual reality (VR) has experienced a remarkable evolution over recent decades, evolving from its initial applications in specific military domains to becoming a ubiquitous and easily accessible technology. This thorough review delves into the intricate domain of VR within healthcare, seeking to offer a comprehensive understanding of its historical evolution, theoretical foundations, and current adoption status. The examination explores the advantages of VR in enhancing the educational experience for medical students, with a particular focus on skill acquisition and retention. Within this exploration, the review dissects the applications of VR across diverse medical disciplines, highlighting its role in surgical training and anatomy/physiology education. While navigating the expansive landscape of VR, the review addresses challenges related to technology and pedagogy, providing insights into overcoming technical hurdles and seamlessly integrating VR into healthcare practices. Additionally, the review looks ahead to future directions and emerging trends, examining the potential impact of technological advancements and innovative applications in healthcare. This review illuminates the transformative potential of VR as a tool poised to revolutionize healthcare practices.
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Affiliation(s)
- Chaitanya Kumar Javvaji
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Harshitha Reddy
- Internal Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Jayant D Vagha
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Amar Taksande
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Anirudh Kommareddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
| | - Naramreddy Sudheesh Reddy
- Pediatrics, Jawaharlal Nehru Medical College, Datta Meghe Institute of Higher Education and Research, Wardha, IND
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26
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Saby A, Alvarez A, Smolins D, Petros J, Nguyen L, Trujillo M, Aygün O. Effects of Embodiment in Virtual Reality for Treatment of Chronic Pain: Pilot Open-Label Study. JMIR Form Res 2024; 8:e34162. [PMID: 38363591 PMCID: PMC10907942 DOI: 10.2196/34162] [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: 10/22/2021] [Revised: 07/13/2022] [Accepted: 09/21/2023] [Indexed: 02/17/2024] Open
Abstract
BACKGROUND Chronic pain has long been a major health burden that has been addressed through numerous forms of pharmacological and nonpharmacological treatment. One of the tenets of modern medicine is to minimize risk while providing efficacy. Further, because of its noninvasive nature, virtual reality (VR) provides an attractive platform for potentially developing novel therapeutic modalities. OBJECTIVE The purpose of this study was to determine the feasibility of a novel VR-based digital therapy for the treatment of chronic pain. METHODS An open-label study assessed the feasibility of using virtual embodiment in VR to treat chronic pain. In total, 24 patients with chronic pain were recruited from local pain clinics and completed 8 sessions of a novel digital therapeutic that combines virtual embodiment with graded motor imagery to deliver functional rehabilitation exercises over the course of 4 weeks. Pain intensity as measured by a visual analog scale before and after each virtual embodiment training session was used as the primary outcome measure. Additionally, a battery of patient-reported pain questionnaires (Fear-Avoidance Beliefs Questionnaire, Oswestry Low Back Pain Disability Questionnaire, Pain Catastrophizing Scale, and Patient Health Questionnaire) were administered before and after 8 sessions of virtual embodiment training as exploratory outcome measures to assess if the measures are appropriate and warrant a larger randomized controlled trial. RESULTS A 2-way ANOVA on session × pre- versus postvirtual embodiment training revealed that individual virtual embodiment training sessions significantly reduced the intensity of pain as measured by the visual analog scale (P<.001). Perceived disability due to lower back pain as measured by the Oswestry Low Back Pain Disability Questionnaire significantly improved (P=.003) over the 4-week course of virtual embodiment regimen. Improvement was also observed on the helplessness subscale of the Pain Catastrophizing Scale (P=.02). CONCLUSIONS This study provides evidence that functional rehabilitation exercises delivered in VR are safe and may have positive effects on alleviating the symptoms of chronic pain. Additionally, the virtual embodiment intervention may improve perceived disability and helplessness of patients with chronic pain after 8 sessions. The results support the justification for a larger randomized controlled trial to assess the extent to which virtual embodiment training can exert an effect on symptoms associated with chronic pain. TRIAL REGISTRATION ClinicalTrials.gov NCT04060875; https://clinicaltrials.gov/ct2/show/NCT04060875.
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Affiliation(s)
- Adam Saby
- Department of Emergency Medicine, Occupational Health Division, University of California Los Angeles, Los Angeles, CA, United States
| | | | | | - James Petros
- Allied Pain and Spine, San Jose, CA, United States
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27
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Namazinia M, Mohajer S, Abbaspour S, Lopez V, Sarboozi-Hoseinabadi T. Effects of virtual reality on pain induced by arteriovenous fistula needle insertion in patients undergoing hemodialysis: A randomized clinical trial. J Vasc Access 2024:11297298231225755. [PMID: 38326286 DOI: 10.1177/11297298231225755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Chronic kidney disease (CKD) is characterized by irreversible damage to renal function. For patients undergoing replacement therapies like hemodialysis (HD), the pain caused by arteriovenous fistula (AVF) cannulation becomes a significant aspect of their daily lives. This study aimed to examine the impact of virtual reality (VR) distraction techniques on the pain experienced during AVF needle insertion in patients undergoing HD. MATERIALS AND METHODS This randomized clinical trial (RCT) recruited a total of 60 patients undergoing HD from the 9 Dey Hospital in Torbat Heydariyeh, Iran, between March and August 2022. These patients were then divided into two groups: the intervention group and the control group. The intervention group received distraction techniques using the Shinecon 4th Gen Virtual Reality Headset, while the control group received routine care services. To assess the level of pain experienced during AVF cannulation, the Visual Analog Scale (VAS) was utilized. The collected data were analyzed using SPSS20. Various statistical tests, including the Chi-square test, Mann-Whitney U test, Multiple linear regression, and independent-samples t-test, were employed for data analysis. Additionally, Cohen's d was used to determine the effect size of the intervention. RESULTS The analysis of the data revealed a statistically significant difference in the mean (SD) pain scores between the control group (7.6 ± 0.8) and the intervention group (5.1 ± 0.9) (p < 0.002 after Bonferroni correction). Furthermore, it was observed that a majority of patients in the intervention group reported experiencing moderate pain, whereas the control group experienced more severe pain. CONCLUSIONS The study findings demonstrated that the use of virtual reality (VR) was effective in reducing the intensity of pain experienced during AVF needle insertion in patients undergoing HD. Based on these results, it is recommended to incorporate VR as a routine practice in the HD department of the hospital. TRIAL REGISTRATION This study, with the code no. IRCT20180429039463N3, was registered on the Iranian Registry of Clinical Trials on 28/03/2022.
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Affiliation(s)
- Mohammad Namazinia
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| | - Samira Mohajer
- Nursing and Midwifery Care Research Center, Mashhad University of Medical Sciences, Mashhad, Razavi Khorasan, Iran
- Department of Nursing Science, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Seddigheh Abbaspour
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
| | - Violeta Lopez
- School of Nursing, Midwifery and Social Sciences, Central Queensland University, Rockhampton, QLD, Australia
| | - Tahere Sarboozi-Hoseinabadi
- Department of Nursing, School of Nursing and Midwifery, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
- Health Sciences Research Center, Torbat Heydariyeh University of Medical Sciences, Torbat Heydariyeh, Razavi Khorasan, Iran
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Kanad N, Özalp Gerçeker G, Eker İ, Şen Susam H. The effect of virtual reality on pain, fear and emotional appearance during blood draw in pediatric patients at the hematology-oncology outpatient clinic: A randomized controlled study. Eur J Oncol Nurs 2024; 68:102495. [PMID: 38184927 DOI: 10.1016/j.ejon.2023.102495] [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: 04/10/2023] [Revised: 12/12/2023] [Accepted: 12/15/2023] [Indexed: 01/09/2024]
Abstract
OBJECTIVE Invasive attempts can be very painful and stressful for pediatric patients. Virtual Reality (VR) can be used to distract patients undergoing such procedures in pediatric hematology oncology patients. METHODS A parallel trial design approach was adopted for this randomized controlled trial, guided by the CONSORT checklist. The study sample (n = 69) was divided into a VR group (n = 34) and a control group (n = 35) using stratified randomization. For the blood draw attempt, no distraction method was applied to the control group, while the children in the VR group were distracted from the procedure with the Epic Roller Coasters VR application. The primary variable assessed was pain, while secondary variables were fear and emotional appearance. The scores of emotional appearance, fear, and pain were compared with a Mann-Whitney U Test. RESULTS The pre-procedure emotional appearance score was 11.3 ± 4.3 in the VR group and 11.0 ± 5.0 in the control group, and the post-procedure score was 6.5 ± 3.3 in the VR group and 11.8 ± 5.3 in the control group, indicating a difference in emotional appearance after the procedure. VR group had lower negative emotional appearance, lower pain, and lower fear scores after procedure compared to the control group. CONCLUSION VR can be considered an effective approach to reducing the negative emotional appearance and for relieving pain and fear in children aged 4-12 years undergoing blood draw procedures in pediatric hematology and oncology outpatient unit (ClinicalTrials.gov: NCT05675358).
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Affiliation(s)
- Nazmi Kanad
- Quality Management Unit, Health Application, and Research Center, Afyonkarahisar Health Sciences University, Turkey; Dokuz Eylul University Health Sciences Institute, Izmir, Turkey
| | - Gülçin Özalp Gerçeker
- Pediatric Nursing Department, Dokuz Eylul University Faculty of Nursing, Izmir, Turkey.
| | - İbrahim Eker
- Department of Pediatric Hematology-oncology, Afyonkarahisar Health Sciences University, Turkey
| | - Hilal Şen Susam
- Department of Pediatric Hematology-oncology, Afyonkarahisar Health Sciences University, Turkey
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Slatman S, Groenveld T, Ostelo R, van Goor H, Staal JB, Knoop J. Development of a Multimodal, Personalized Intervention of Virtual Reality Integrated Within Physiotherapy for Patients With Complex Chronic Low-Back Pain. JOURNAL OF MEDICAL EXTENDED REALITY 2024; 1:30-43. [PMID: 38505475 PMCID: PMC10945762 DOI: 10.1089/jmxr.2023.0002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 03/21/2024]
Abstract
Background Chronic low-back pain (CLBP) is the leading cause of years lived with disability. Physiotherapy is the most common treatment option for CLBP, but effects are often unsatisfactory. Virtual reality (VR) offers possibilities to enhance the effectiveness of physiotherapy treatment. Primary aim was to develop and test a personalized VR intervention integrated within a physiotherapy treatment for patients with CLBP. Methods This study describes an intervention development process using mixed methods design that followed the Medical Research Council (MRC) framework. This involved a cocreation process with patients, physiotherapists, and researchers. A draft intervention was constructed based on a literature review and focus groups, and subsequently tested in a feasibility study and evaluated in focus groups. Focus group data were analyzed using thematic analysis. This intervention development process resulted in a final intervention. Results Focus group data showed that VR and physiotherapy can strengthen each other when they are well integrated, and that VR needs to be administered under the right conditions including flawless technology, physiotherapists with sufficient affinity and training, and the right expectations from patients. The draft intervention was considered feasible after evaluation by four patients and three physiotherapists and was further complemented by expanding the training for physiotherapists and improving the protocols for physiotherapists and patients. The final intervention consisted of a 12-week physiotherapy treatment with three integrated VR modules: pain education, physical exercise, and relaxation. Conclusion Using the MRC framework in cocreation with the end users, a personalized VR intervention integrated within a physiotherapy treatment for patients with CLBP was developed. This intervention was found to be feasible and will subsequently be evaluated for (cost-)effectiveness in a cluster randomized controlled trial.
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Affiliation(s)
- Syl Slatman
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Department of Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Biomedical Signals and Systems Group, Faculty of Electrical Engineering, Mathematics and Computer Science, University of Twente, Enschede, The Netherlands
| | - Tjitske Groenveld
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Raymond Ostelo
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
- Department of Epidemiology and Data Science, Amsterdam UMC location Vrije Universiteit and Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - J. Bart Staal
- Department of Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of IQ Healthcare, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Jesper Knoop
- Department of Musculoskeletal Rehabilitation Research Group, School for Allied Health, HAN University of Applied Sciences, Nijmegen, The Netherlands
- Department of Health Sciences, Faculty of Science and Amsterdam Movement Science Research Institute, Vrije Universiteit, Amsterdam, The Netherlands
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Alhusamiah B, Aldiqs M, Zeilani RS. The Effectiveness of Immersive Virtual Reality as A Complementary Approach and a New Direction in Cancer Related Fatigue Management. Integr Cancer Ther 2024; 23:15347354241280272. [PMID: 39305200 PMCID: PMC11421400 DOI: 10.1177/15347354241280272] [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] [Indexed: 09/26/2024] Open
Abstract
Background: Recent advancements in the field of medical technology have illuminated that the implementation of virtual reality interventions can be highly effective in managing cancer-related fatigue. Moreover, this innovative intervention has demonstrated a substantial improvement in patients' overall well-being and daily functioning. Thus, it represents a promising alternative to traditional pharmacological treatments by effectively addressing symptoms and enhancing quality of life. Therefore, the integration of this approach signifies a significant advancement in patient care. Nevertheless, despite the ongoing efforts to diversify non-pharmacological treatments, pharmacological interventions are still the predominant method for managing cancer-related fatigue. Aim: This systematic review aimed to evaluate the effectiveness of immersive virtual reality in cancer-related fatigue management, and to explore the main side effects of immersive virtual reality. Methods: This systematic review was conducted according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) standards. Several online databases were used to find eligible studies in peer-reviewed journals relevant to the study keywords. Specifically, the included studies were systematic reviews and clinical trials that used immersive virtual reality-based intervention among adult patients with cancer and suffering from cancer-related fatigue. As well as were published in the English language from 2014 to 2024. As well as, three researchers independently contributed to study selections, data extraction, and study evaluations from different aspects: including quality assessment, risk of bias, and study synthesis. Results: After an extensive and comprehensive search, a total of ten published studies were included in this review study; 6 articles were quantitative clinical trial studies, and the other 4 were systematic review and meta-analysis studies. The quality of 6 included clinical trials was assessed using the Effective Public Health Practice Project (EPHPP) Quality Assessment Tool for quantitative studies, the overall result showed that 33.3% of studies rated with moderate quality, no study was rated with low quality, and (66.7%) studies rated as high-quality studies. As well, the quality assessment of all review studies showed that all included systematic reviews and meta-analyses with a low risk of bias and high to moderate power of evidence. The result of this extensive and comprehensive review showed that immersive virtual reality has a significant effect in reducing cancer-related fatigue, however, still, there is a significant variation in the employment of immersive Virtual Reality protocols for cancer symptom management worldwide. Conclusion: Immersive virtual reality is an effective non-pharmacological intervention in reducing and controlling cancer-related fatigue among patients with various types of cancer, as well as being an affordable, cost-effective approach. Nevertheless, there remains a notable gap in the existing literature concerning virtual reality protocols, associated side effects, and the underlying mechanisms by which immersive virtual reality alleviates fatigue. Therefore, further research studies are warranted to address these gaps and advance our understanding in these areas.
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Affiliation(s)
| | - Mohannad Aldiqs
- Al-Ahliyya Amman University, Faculty of Nursing, Amman, Jordan
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Rowe G, Allahham A, Edgar DW, Rurak BK, Fear MW, Wood FM, Vallence AM. Functional Brain Changes Following Burn Injury: A Narrative Review. Neurorehabil Neural Repair 2024; 38:62-72. [PMID: 38044625 PMCID: PMC10798013 DOI: 10.1177/15459683231215331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/05/2023]
Abstract
BACKGROUND Burn injuries cause significant motor and sensory dysfunctions that can negatively impact burn survivors' quality of life. The underlying mechanisms of these burn-induced dysfunctions have primarily been associated with damage to the peripheral neural architecture, however, evidence points to a systemic influence of burn injury. Central nervous system (CNS) reorganizations due to inflammation, afferent dysfunction, and pain could contribute to persistent motor and sensory dysfunction in burn survivors. Recent evidence shows that the capacity for neuroplasticity is associated with self-reported functional recovery in burn survivors. OBJECTIVE This review first outlines motor and sensory dysfunctions following burn injury and critically examines recent literature investigating the mechanisms mediating CNS reorganization following burn injury. The review then provides recommendations for future research and interventions targeting the CNS such as non-invasive brain stimulation to improve functional recovery. CONCLUSIONS Directing focus to the CNS following burn injury, alongside the development of non-invasive methods to induce functionally beneficial neuroplasticity in the CNS, could advance treatments and transform clinical practice to improve quality of life in burn survivors.
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Affiliation(s)
- Grant Rowe
- School of Psychology, College of Health and Education, Murdoch University, Murdoch, WA, Australia
| | - Amira Allahham
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
| | - Dale W. Edgar
- Fiona Wood Foundation, Murdoch, WA, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, Murdoch, WA, Australia
- Institute for Health Research, The University of Notre Dame Australia, Fremantle, WA, Australia
| | - Brittany K. Rurak
- School of Psychology, College of Health and Education, Murdoch University, Murdoch, WA, Australia
| | - Mark W. Fear
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- Fiona Wood Foundation, Murdoch, WA, Australia
| | - Fiona M. Wood
- Burn Injury Research Unit, School of Biomedical Sciences, University of Western Australia, Crawley, WA, Australia
- Fiona Wood Foundation, Murdoch, WA, Australia
- Burn Service of Western Australia, Fiona Stanley Hospital, MNH (B) Main Hospital, Level 4, Burns Unit, Murdoch, WA, Australia
| | - Ann-Maree Vallence
- School of Psychology, College of Health and Education, Murdoch University, Murdoch, WA, Australia
- Centre for Healthy Ageing, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
- Centre for Molecular Medicine and Innovative Therapeutics, Health Futures Institute, Murdoch University, Murdoch, WA, Australia
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Cangemi DJ, Montenegro M, Spiegel BMR, Lacy ABE. Virtual Reality Improves Symptoms of Functional Dyspepsia: Results of a Randomized, Double-Blind, Sham-Controlled, Pilot Study. Am J Gastroenterol 2024; 119:210-213. [PMID: 37655713 DOI: 10.14309/ajg.0000000000002492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/29/2023] [Indexed: 09/02/2023]
Abstract
INTRODUCTION We investigated the efficacy and safety of virtual reality (VR) for functional dyspepsia. METHODS Patients were randomized 2:1 between active vs sham VR. Symptoms were assessed using the Patient Assessment of Gastrointestinal Disorders-Symptom Severity Index (PAGI-SYM) over 2-week. RESULTS Patients in the active VR group had greater numerical improvement in PAGI-SYM scores (mean difference -0.7; P < 0.001) compared with sham VR (mean difference -0.4; P = 0.032). Active VR led to significant improvements for all PAGI-SYM subscales, except lower abdominal pain, whereas sham only improved heartburn/regurgitation and nausea/vomiting. Half of the total patients reported nonserious adverse effects, although only 1 patient withdrew from the study because of adverse effects. DISCUSSION VR is safe and results in significant symptom improvement in functional dyspepsia. Larger trials are warranted.
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Affiliation(s)
- David J Cangemi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Marilia Montenegro
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
| | - Brennan M R Spiegel
- Division of Health Sciences Research, Department of Medicine, Cedars-Sinai Health System, Los Angeles, California, USA
| | - And Brian E Lacy
- Division of Gastroenterology and Hepatology, Mayo Clinic, Jacksonville, Florida, USA
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Fallon V, Davies SM, Silverio S, Creagh L. Virtual reality interventions designed to support parents during and throughout the first year after birth: A scoping review. Digit Health 2024; 10:20552076241245373. [PMID: 38655377 PMCID: PMC11036923 DOI: 10.1177/20552076241245373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 03/15/2024] [Indexed: 04/26/2024] Open
Abstract
Objective Virtual reality (VR) has become increasingly popular in clinical and health settings where it has been used for a wide range of purposes. A recent scoping review explored VR applications to assist pregnant women and found that VR was a useful method to be used for a range of different purposes in both pregnancy and labour. However, no such review exists for the period after birth. Method We aimed to search for studies that used VR to support parents during birth and in the first year postpartum (Population) in different settings (Context), and finally provided data on the characteristics, reported effectiveness and experience of VR interventions (Concept). Two hundred and fifty-one studies were identified, of which ten were eligible. Two authors independently extracted data including study design, participants and results. Results Findings indicate that VR has been used effectively in this context to alleviate depression anxiety, and multiple domains of pain and to improve childbirth satisfaction. The majority of the studies explored the use of VR technology on outcomes such as pain and anxiety during labour and birth. The studies included used a broad range of VR hardware and software. All of the studies reported positive experiences of using VR. Conclusions Across these studies, VR was found to be effective in terms of both physiological and psychological outcomes. There are many unexplored maternal and infant focused applications of VR which warrant further investigation as emerging evidence indicates this is becoming an increasingly accessible method to improve maternal and infant health outcomes from pregnancy through to parenthood.
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Affiliation(s)
- Victoria Fallon
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Sian M Davies
- Department of Psychology, Institute of Population Health, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
- School of Psychology, Faculty of Health, Liverpool John Moores University, Liverpool, UK
| | - Sergio Silverio
- School of Life Course and Population Sciences, Faculty of Life Sciences and Medicine, London, UK
| | - Lisa Creagh
- Lisa Creagh Limited t/a The Holding Time Project, Plus Accounting, Brighton, East Sussex, UK
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Rodriguez ST, Makarewicz N, Wang EY, Zuniga-Hernandez M, Titzler J, Jackson C, Suen MY, Rosales O, Caruso TJ. Virtual reality facilitated exercise improves pain perception: A crossover study. J Clin Anesth 2023; 91:111257. [PMID: 37708601 DOI: 10.1016/j.jclinane.2023.111257] [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: 04/07/2023] [Revised: 07/26/2023] [Accepted: 09/06/2023] [Indexed: 09/16/2023]
Abstract
STUDY OBJECTIVE Both virtual reality (VR) and exercise are recognized for their analgesic and anxiolytic properties. The purpose of this study is to evaluate the ability of VR-facilitated exercise to modulate pain. DESIGN Within-subject cross-over clinical trial. SETTING The Stanford Chariot Program conducted this study at Lucile Packard Children's Hospital Stanford (LCPHS). PATIENTS Healthy participants meeting inclusion criteria were recruited by volunteer solicitation from LCPHS. INTERVENTIONS Participants were randomized by hand dominance and subjected to a standardized cold pressor test with no VR or exercise. After a 5-min wash-out period, participants repeated the test on their other hand while experiencing a VR-facilitated exercise condition. Pain sensitivity, pain tolerance, and sympathetic activation data were collected during both conditions. MEASUREMENTS Pain sensitivity was scored 0-10 and collected every 30 s. Pain tolerance was recorded as the duration a participant could endure the painful stimuli. Sympathetic activation was measured by skin conductance response density (SCRD) and recorded in 30 s epochs by a biosensor. In all analyses, data were nested by participant. MAIN RESULTS Forty-one participants completed both interventions. Pain sensitivity was reduced in the VR-facilitated exercise condition (p < 0.0001). There was no difference in pain tolerance between conditions. While both conditions resulted in an increase in sympathetic activity, SCRD was higher at all time points in the VR-facilitated exercise condition. CONCLUSIONS The reduction in pain sensitivity indicates VR-facilitated exercise results in improved pain perception. VR-facilitated exercise may be especially useful for patients with chronic pain or other conditions requiring physical therapy, where pain may be exacerbated by exercise.
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Affiliation(s)
- Samuel T Rodriguez
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Nathan Makarewicz
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA; Stanford University School of Medicine, Stanford, CA, USA
| | - Ellen Y Wang
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Michelle Zuniga-Hernandez
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Janet Titzler
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Christian Jackson
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Man Yee Suen
- Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA
| | - Oswaldo Rosales
- Stanford University Graduate School of Education, Stanford, CA, USA
| | - Thomas J Caruso
- Stanford Chariot Program, Lucile Packard Children's Hospital Stanford, Palo Alto, CA, USA; Department of Anesthesiology, Perioperative, and Pain Medicine, Division of Pediatric Anesthesiology, Stanford School of Medicine, Stanford, CA, USA.
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Korkmaz E, Guler S. The Effect of Video Streaming With Virtual Reality on Anxiety and Pain During Bone Marrow Aspiration and Biopsy Procedure. Pain Manag Nurs 2023; 24:634-640. [PMID: 37246094 DOI: 10.1016/j.pmn.2023.04.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 04/09/2023] [Accepted: 04/29/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Pain and anxiety are among the most common symptoms in patients undergoing invasive procedures. Increased pain levels tend to worsen anxiety, and anxiety often leads to more frequent or severe pain. AIMS The study was conducted to determine the efficacy of virtual reality goggles (VRG) on pain and anxiety during bone marrow aspiration and biopsy (BMAB) procedure. DESIGN A randomized controlled experimental study. SETTINGS The outpatient unit of an adult hematology clinic of a tertiary care university hospital. PARTICIPANTS/SUBJECTS The study was conducted in patients aged 18 years and older who underwent a BMAB procedure. Thirty-five patients in the experimental (VRG) group and 40 patients in the control group. METHODS Patient identification form, visual analogue scale (VAS), state and trait anxiety inventory (STAI), and VRG were used to collect the data. RESULTS Postprocedural state anxiety mean scores were found to be statistically significantly higher in the control group than in the VRG group (p = .022). A statistically significant difference was found between groups in terms of procedure-related pain (p = .002). The postprocedural mean pain scores were found to be statistically significantly higher in the control group than in the VRG group (p < .001). A statistically significant but moderate positive correlation was found between the postprocedural pain and preprocedural state anxiety variable (r = 0.477). A statistically significant and strong positive correlation was found between the postprocedural pain and the postprocedural state anxiety variable (r = 0.657). A statistically significant but moderate positive relationship was found between preprocedural and postprocedural state anxiety variables (r = 0.519). CONCLUSIONS We determined that video streaming with VRG reduces pain and anxiety felt by adult patients during the BMAB procedure. VRG can be recommended to use in controlling pain and anxiety in patients undergoing a BMAB procedure.
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Affiliation(s)
- Emine Korkmaz
- University of Health Sciences, Kayseri City Training and Research Hospital, Division of Certified Training Coordinator, Kayseri, Turkey.
| | - Sevil Guler
- Erciyes University, Faculty of Health Sciences, Department of Nursing, Kayseri, Turkey
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Schrempf MC, Zanker J, Arndt TT, Vlasenko D, Anthuber M, Müller G, Sommer F, Wolf S. Immersive Virtual Reality Fitness Games to Improve Recovery After Colorectal Surgery: A Randomized Single Blind Controlled Pilot Trial. Games Health J 2023; 12:450-458. [PMID: 37428543 DOI: 10.1089/g4h.2023.0004] [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] [Indexed: 07/11/2023] Open
Abstract
Introduction: Early mobilization after surgery is crucial for reducing postoperative complications and restoring patients' fitness and ability to care for themselves. Immersive, activity-promoting fitness games in virtual reality (VR) can be used as a low-cost motivational adjunct to standard physiotherapy to promote recovery after surgery. In addition, they have potentially positive effects on mood and well-being, which are often compromised after colorectal surgery. The purpose of this pilot study was to evaluate the feasibility and clinical outcomes of a VR-based intervention that provides additional mobilization. Methods: Patients undergoing curative surgery for colorectal cancer were randomly assigned to an intervention group or a control group. Participants in the intervention group (VR group) received daily bedside fitness exercises using immersive, activity-promoting, virtual reality fitness games in addition to standard care during their postoperative hospital stay. Results: A total of 62 patients were randomized. The feasibility outcomes were in line with the predefined goals. In the VR group, an improvement in overall mood (+0.76 points; 95% confidence interval [CI] 0.39 to 1.12; P < 0.001) and a shift toward positive feelings were observed. The median length of hospital stay was 7.0 days in the VR group compared with 9.0 days in the control group, but the difference (2.0 days) did not reach statistical significance (95% CI -0.0001 to 3.00; P = 0.076). Surgical outcomes, health status, and measures of distress did not differ between groups. Conclusions: The study demonstrated the feasibility of a VR intervention that improved overall mood and showed a desirable effect on feelings and length of hospital stay after colorectal surgery. The results should stimulate further research investigating the potential of VR as an adjunct to physiotherapy to enhance mobilization after surgery.
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Affiliation(s)
- Matthias C Schrempf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Johannes Zanker
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Tim Tobias Arndt
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Dmytro Vlasenko
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Matthias Anthuber
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Gernot Müller
- Department of Computational Statistics and Data Analysis, Institute of Mathematics, University of Augsburg, Augsburg, Germany
| | - Florian Sommer
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
| | - Sebastian Wolf
- Department of General, Visceral and Transplantation Surgery, University Hospital Augsburg, Augsburg, Germany
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Yang X, Zhong S, Yang S, He M, Xu X, He S, Fan G, Liu L. Global Scientific Trends in Virtual Reality for Pain Treatment From 2000 to 2022: Bibliometric Analysis. JMIR Serious Games 2023; 11:e48354. [PMID: 37991981 PMCID: PMC10686536 DOI: 10.2196/48354] [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: 04/20/2023] [Revised: 09/04/2023] [Accepted: 09/20/2023] [Indexed: 11/24/2023] Open
Abstract
Background Virtual reality (VR) is a computer simulation technique that has been increasingly applied in pain management over the past 2 decades. Objective In this study, we used bibliometrics to explore the literature on VR and pain control, with the aim of identifying research progress and predicting future research hot spots. Methods We extracted literature on VR and pain control published between 2000 and 2022 from the Web of Science Core Collections and conducted bibliometric analyses. We analyzed the publication and citation trends in the past 2 decades, as well as publication and citation analyses of different countries, institutions, journals, and authors. For references, we conducted cocitation and burst analyses. For keywords, we conducted co-occurrence, clustering, timeline view, and citation burst analyses. Results Based on 1176 publications, we found that there was a continuous increase in publication and citation volumes, especially in the last 5 years. The United States was the most representative country, and the University of Washington was the most representative institution, with both having the most publications and citations. The most popular journal in this field was Burns, and Hoffman HG was the most productive author, leading many studies on patients with burn pain. The reference with the most citation burst was a study on the verification of new hardware in pain control. The keywords with the highest citation bursts related to various situations of pain such as "burn pain," "wound care," "low back pain," and "phantom limb." Conclusions VR has been applied in various clinical situations for pain management, among which burns and pediatric surgery have achieved satisfactory results. We infer that VR will be extended to more clinical pain situations in the future, such as pain control in wound care, low back pain, and phantom limb pain. New research hot spots will include the development of software and hardware to improve the immersive experience of VR for pain control. However, our work was based solely on English literature from the Web of Science database. For future studies, we recommend that researchers explore literature from multiple databases to enhance the scope of their research.
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Affiliation(s)
- Xun Yang
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
| | - Sen Zhong
- Department of Orthopedic, School of Medicine, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Sheng Yang
- Department of Orthopedic, School of Medicine, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Meng He
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
| | - Xu Xu
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
| | - Shisheng He
- Department of Orthopedic, School of Medicine, Spinal Pain Research Institute, Shanghai Tenth People’s Hospital, Tongji University, Shanghai, China
| | - Guoxin Fan
- Department of Pain Medicine, National Key Clinical Pain Medicine of China, Huazhong University of Science and Technology Union Shenzhen Hospital, Shenzhen, China
| | - Lijun Liu
- Department of Traumatic Orthopedics, Shenzhen Second People’s Hospital (The First Affiliated Hospital, Shenzhen University; Shenzhen Translational Medicine Institute), Shenzhen, China
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Park J, Wiese LAK, Holt J. Online Chair Yoga and Digital Learning for Rural Underserved Older Adults at Risk for Alzheimer's Disease and Related Dementias. Clin Gerontol 2023:1-17. [PMID: 37941382 DOI: 10.1080/07317115.2023.2277333] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2023]
Abstract
OBJECTIVES We evaluated the feasibility and preliminary efficacy of a home-based online chair yoga (OCY) program for racially and ethnically diverse rural community-dwelling older adults. METHODS We randomly assigned participants to OCY or a computer brain game (CBG). After a computer literacy training led by high school students, participants engaged in remotely supervised OCY or CBG in twice-weekly 45-minute sessions for 12 weeks. Outcome data (pain interference, cognitive function, mobility, computer skills) were collected at baseline, post-intervention, and 3-month follow-up. RESULTS A total of 32 eligible residents with mean age of 71 years participated in this intervention study. The interventions were feasible (100% recruitment rate, 96.8% retention rate, 100% safety rate). There were significant improvements in pain interference, cognitive function, mobility, and computer skills from baseline to follow-up among participants in both OCY and CBG but no significant differences in outcomes between groups. CONCLUSIONS Preliminary results indicated that the CBG was as effective as online OCY in clinical outcomes in these participants. However, this should be confirmed in future studies. CLINICAL IMPLICATIONS This telehealth-based intervention is feasible for older adults in rural and digitally underserved communities and could provide a strategy for delivering health-promoting interventions for home-bound older adults at risk for Alzheimer's disease and related dementias (ADRD) and connect caregivers to online resources.
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Affiliation(s)
- Juyoung Park
- Phyllis and Harvey Sandler School of Social Work, Florida Atlantic University, Boca Raton, Florida, USA
| | - Lisa Ann Kirk Wiese
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
| | - Janet Holt
- Christine E. Lynn College of Nursing, Florida Atlantic University, Boca Raton, Florida, USA
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Rygh L, Johal S, Johnson H, Karlson CW. Virtual Reality for Pediatric Oncology Port-A-Cath Access: A Pilot Effectiveness Study. JOURNAL OF PEDIATRIC HEMATOLOGY/ONCOLOGY NURSING 2023; 40:379-385. [PMID: 37386775 DOI: 10.1177/27527530221147875] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/01/2023]
Abstract
Introduction: Port-a-cath procedures are among the most distressing aspects of pediatric cancer treatment. The current study aimed to examine the usability of virtual reality (VR) interventions for children undergoing chemotherapy port-access procedures. Methods: Families (N = 20) of children with cancer, 4-17 years old (M = 8.70 years, SD = 3.71), were recruited. Patients and parents rated patients' dizziness, nausea, pain, and distress, and participants were shown how to use VR prior to the use of the procedure. After port-a-cath access, patients and parents rated pain and distress during the intervention. Semistructured interviews were conducted to examine the usability of the intervention. Result: A significant difference was identified for change in children's pain score for younger children, F(2, 11) = 4.16, p < .05. A significant decrease in fear scores was observed on child and parent reports. The VR headset was used during the procedure by 87.5% of the participants, while the rest used it before but took it off during the procedure, and 85.7% wished to use it again. No concerns were reported by 84.6% of the nurses and 92.3% reported no interference with their workflow. Discussion: More research is needed to fully understand the benefits of VR interventions during children's chemotherapy port procedures. The findings of this pilot study suggest that the use of commercially available VR intervention may reduce children's fear and pain levels during the port-a-cath procedure, especially for younger children.
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Affiliation(s)
- Louisa Rygh
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Clinical Psychology, Jackson State University, Jackson, MS, USA
| | - Sonal Johal
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
| | - Hana Johnson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
- Department of Biology, Prairie View A&M University, Prairie View, TX, USA
| | - Cynthia W Karlson
- Division of Hematology/Oncology, Department of Pediatrics, University of Mississippi Medical Center, Jackson, MS, USA
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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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Nambi G, Alghadier M, Ebrahim EE, Eltayeb MM, Aldhafian OR, Mohamed SHP, Khanam H, Kashoo FZ, Albarakati AJA, Abdelbasset WK. Role of virtual reality distraction technique to improve chest burns with acute respiratory distress syndrome (ARDS) following smoke inhalation in middle-aged adults - A randomized controlled study. Burns 2023; 49:1643-1653. [PMID: 37270393 DOI: 10.1016/j.burns.2023.05.017] [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: 01/24/2023] [Revised: 05/14/2023] [Accepted: 05/18/2023] [Indexed: 06/05/2023]
Abstract
BACKGROUND Burns of the chest region constitute a common burn and develops skin contractures around the thorax region. Inhalation of toxic gases and chemical irritants during the fire leads to Acute Respiratory Distress Syndrome (ARDS). Breathing exercises are painful but are needed to help counteract contractures and increase lung capacity. These patients are usually in pain and extremely anxious about chest physiotherapy. Virtual reality distraction is one such technique that is gaining immense popularity when compared to other pain distraction techniques. However, studies examining the efficacy of the virtual reality distraction technique in this population are lacking. OBJECTIVES To find and compare the effects of the virtual reality distraction technique as a pain alleviation tool for reducing pain during chest physiotherapy in chest burns patients with ARDS in middle-aged adults. METHODS A randomized controlled study was conducted at the physiotherapy department between 1st Sep 2020 and 30th Dec 2022. The eligible sixty subjects were randomized into two groups: The virtual reality distraction group (n = 30) received virtual reality distraction technique and the control group (n = 30) received progressive relaxation technique before chest physiotherapy as a pain distraction technique. All the participants received chest physiotherapy as a common treatment (treatment as usual). Primary (Visual Analogue Scale - VAS) and secondary (forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), FEV1/FVC, peak expiratory flow (PEF), residual volume (RV), functional residual capacity (FRC), total lung capacity (TLC), RV/TLC, and diffusing capacity for carbon monoxide of the lungs (DLCO) outcome measures were measured at baseline, after four weeks, eight weeks and at six months follow up. The effects between the two groups were analyzed using the independent t-test and chi-square test. The intra-group effect was analyzed with a repeated measure ANOVA test. RESULTS Baseline demographic characters and study variables show homogenous distribution between the groups (p > 0.05). Four weeks following two different training protocols virtual reality distraction group shows more significant changes in pain intensity, FVC, FEV1, FEV1/FVC, PEF, RV, FRC, TLC, RV/TLC, and DLCO (p = 0.001) but not in RV (p = 0.541). The similar improvements were noted in the 8 weeks and 6 months follow up. CONCLUSION The reports of the study concluded that virtual reality distraction is an effective and useful technique in reducing pain and increasing lung capacity in chest burn patient with ARDS following smoke inhalation in community-dwelling middle-aged adults. In the virtual reality distraction group, the patients reported significantly less pain and clinically meaningful changes in pulmonary functions as compared to the control group (physiotherapy + relaxation).
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Affiliation(s)
- Gopal Nambi
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia.
| | - Mshari Alghadier
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Elturabi Elsayed Ebrahim
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Mudathir Mohamedahmed Eltayeb
- Department of Nursing, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Osama R Aldhafian
- Department of Surgery, College of Medicine, Prince Sattam bin Abdulaziz University, Al Kharj, Saudi Arabia
| | | | - Humaira Khanam
- Department of Physical Therapy and Health Rehabilitation, College of Applied Medical Sciences, Prince Sattam Bin Abdulaziz University, Al Kharj, Saudi Arabia
| | - Faizan Z Kashoo
- Department of Physical therapy and Health Rehabilitation, College of Applied Medical Sciences, Majmaah University, Al Majmaah, Saudi Arabia
| | - Alaa Jameel A Albarakati
- Department of Surgery, College of Medicine, Umm Al-Qura University, Al-Qunfudah Branch, Makkah, Saudi Arabia
| | - Walid Kamal Abdelbasset
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah, United Arab Emirates
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Bougeard M, Hauret I, Pelletier-Visa M, Plan-Paquet A, Givron P, Badin M, Pereira B, Lanhers C, Coudeyre E. Use of immersive virtual reality for stress reduction during botulinum toxin injection for spasticity (RVTOX): a study protocol of a randomised control trial. BMJ Open 2023; 13:e066726. [PMID: 37903608 PMCID: PMC10619105 DOI: 10.1136/bmjopen-2022-066726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Accepted: 08/17/2023] [Indexed: 11/01/2023] Open
Abstract
INTRODUCTION Botulinum toxin injection is a common way to help reduce spasticity in the body caused by central neurological damage such as cerebral stroke, multiple sclerosis or traumatic brain injury. The pain felt during the injection causes most patients to experience significant stress for further injections, the level of which is variable between patients.Immersive virtual reality is a digital technique that simulates the three-dimensional spatial and sound environment around a person said to be immersed in this virtualised world. The effectiveness of virtual reality comes from the intensity of this multisensory immersion, known as the feeling of presence (ie, subjective experience of being in one place or one environment, even when you are physically in another one).Only one research article in paediatrics has shown that immersive reality technique has a positive impact on the level of pain and agitation suffered during botulinum toxin injections. The purpose of this study is therefore to evaluate with sufficient assurance the following research hypothesis: virtual reality can help adults cope with the stress and pain of botulinum toxin treatment injection. METHODS AND ANALYSIS The research hypothesis will be tested using a randomised stepped-wedge method versus a non-invasive technique (headset with virtual reality session) to its control (headset with no image nor audio).The design leads to considering the injection as a statistical unit as all participants will undergo the standard condition, the control technique and virtual reality technique. ETHICS AND DISSEMINATION Patients will be fully and fairly informed in terms of their understanding of the objectives and constraints of the study and the possible risks involved. They will also be entitled to refuse the study and/or withdraw, and this refusal will have no impact on their follow-up as part of their pathology. Dissemination of the results of this study will be through peer-reviewed publications, and national and international conferences.Ethics were approved by the Comité de Protection des Personnes Nord-Ouest in January 2022. TRIAL REGISTRATION NUMBER NCT05364203.
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Affiliation(s)
- Marie Bougeard
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Isabelle Hauret
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | | | - Anne Plan-Paquet
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Pascale Givron
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Marin Badin
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Bruno Pereira
- Direction de la recherche clinique et de l'innovation, University Hospital CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Charlotte Lanhers
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
| | - Emmanuel Coudeyre
- Physical Rehabilitation Medicine, CHU Clermont-Ferrand, Clermont-Ferrand, France
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Rosa A, Pujia AM, Docimo R, Arcuri C. Managing Dental Phobia in Children with the Use of Virtual Reality: A Systematic Review of the Current Literature. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1763. [PMID: 38002854 PMCID: PMC10670820 DOI: 10.3390/children10111763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/19/2023] [Accepted: 10/26/2023] [Indexed: 11/26/2023]
Abstract
BACKGROUND It is common today to encounter anxiety in patients facing dental treatment. Virtual reality (VR) is presented as a high-performing and innovative procedure because it can distract patients undergoing dental procedures or prepare them for such treatments. In addition, this meta-analysis has gathered evidence on VR and its ability to reduce dental anxiety in pediatric patients undergoing different treatments. METHODS The major Scopus, PubMed, EMBASE and Web of Science databases were searched for scientific articles published up to 2023. Studies in which VR was used for children and adults as a measure against anxiety during dental treatments were included. VR was defined as a three-dimensional place where patients experience a sense of immersion as they find themselves in attractive and interactive environments that detach them from reality. Anxiety and pain were examined and measured during dental treatments in which VR was used by comparing them with standard care situations. RESULTS Twenty-five studies were identified, of which eleven met the inclusion criteria. The effect of VR was studied mainly in the pediatric population as a distractive method. Only two studies (not significant) on an adult population were considered. CONCLUSIONS this review shows that VR is an excellent distraction method that is effective in reducing anxiety before dental treatment; however, due to the few studies in this area, further research on VR as a tool to prepare patients for dental treatment is needed.
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Affiliation(s)
- Alessio Rosa
- Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, 00133 Rome, Italy
| | - Alberto Maria Pujia
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Raffaella Docimo
- Department of Experimental Medicine and Surgery, University of Rome “Tor Vergata”, 00133 Rome, Italy
| | - Claudio Arcuri
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, 00133 Rome, Italy
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Humbert A, Kohls E, Baldofski S, Epple C, Rummel-Kluge C. Acceptability, feasibility, and user satisfaction of a virtual reality relaxation intervention in a psychiatric outpatient setting during the COVID-19 pandemic. Front Psychiatry 2023; 14:1271702. [PMID: 37953932 PMCID: PMC10634536 DOI: 10.3389/fpsyt.2023.1271702] [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: 08/02/2023] [Accepted: 10/12/2023] [Indexed: 11/14/2023] Open
Abstract
Background The COVID-19 pandemic was particularly difficult for individuals with mental disorders. Due to governmental restrictions, face-to-face offers for psychiatric outpatients like therapies, psychoeducational groups or relaxation courses were limited. Virtual reality (VR) might be a new possibility to support these patients by providing them with a home-based relaxation tool. Objective The aim of this study was to evaluate the acceptability, feasibility, and user satisfaction of a supportive therapy-accompanying, relaxation VR intervention in psychiatric outpatients during the COVID-19 pandemic in Germany. Methods The four-weeks VR intervention consisted of regular watching of relaxing videos in the participants' home environment. Sociodemographics, feasibility (frequency of use, user-friendliness), satisfaction (Client Satisfaction Questionnaire-8), depressive symptoms (Patient Health Questionnaire-9), quality of life (abbreviated World Health Organization Quality of Life assessment), and credibility and expectancy (Credibility Expectancy Questionnaire-8) were measured in an intention-to-treat (ITT) analysis and a per-protocol (PP) analysis of completers. Results In total, N = 40 patients participated in the study. Most of the participants in the ITT analysis (n = 30, 75.0%) used the VR device three or 4 weeks. A majority of the N = 29 completers (PP: n = 18, 62.1%) used it all 4 weeks. Most participants used the device two or more times a week (ITT: n = 30, 83.3%; PP: n = 26, 89.7%) and described the user-friendliness as rather or very easy (ITT: n = 33, 91.7%; PP: n = 26, 89.7%). User satisfaction was high (ITT: 19.42, SD = 4.08; PP: M = 20.00, SD = 4.19) and did not correlate with participants' sex or age (all p < 0.05). Depressive symptoms and psychological quality of life improved significantly from pre-to post-intervention (ITT and PP, all p < 0.05). Higher pre-intervention credibility significantly correlated with a better outcome of satisfaction (ITT and PP), depressive symptoms, physical, psychological, and social quality of life (PP; all p < 0.05). Conclusion A supportive therapy-accompanying VR relaxation intervention is feasible and acceptable in a psychiatric outpatient setting. Due to the high satisfaction and user-friendliness, VR can be an easy to implement relaxation tool to support psychiatric outpatients. Clinical trial registration https://clinicaltrials.gov/, DRKS00027911.
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Affiliation(s)
- Annika Humbert
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | - Elisabeth Kohls
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
| | - Sabrina Baldofski
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
| | | | - Christine Rummel-Kluge
- Department of Psychiatry and Psychotherapy, Medical Faculty, Leipzig University, Leipzig, Germany
- Department of Psychiatry and Psychotherapy, Leipzig University Medical Center, Leipzig, Germany
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Flores-Cortes M, Guerra-Armas J, Pineda-Galan C, La Touche R, Luque-Suarez A. Sensorimotor Uncertainty of Immersive Virtual Reality Environments for People in Pain: Scoping Review. Brain Sci 2023; 13:1461. [PMID: 37891829 PMCID: PMC10604973 DOI: 10.3390/brainsci13101461] [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: 09/14/2023] [Revised: 10/10/2023] [Accepted: 10/13/2023] [Indexed: 10/29/2023] Open
Abstract
INTRODUCTION Decision making and action execution both rely on sensory information, and their primary objective is to minimise uncertainty. Virtual reality (VR) introduces uncertainty due to the imprecision of perceptual information. The concept of "sensorimotor uncertainty" is a pivotal element in the interplay between perception and action within the VR environment. The role of immersive VR in the four stages of motor behaviour decision making in people with pain has been previously discussed. These four processing levels are the basis to understand the uncertainty that a patient experiences when using VR: sensory information, current state, transition rules, and the outcome obtained. METHODS This review examines the different types of uncertainty that a patient may experience when they are immersed in a virtual reality environment in a context of pain. Randomised clinical trials, a secondary analysis of randomised clinical trials, and pilot randomised clinical trials related to the scope of Sensorimotor Uncertainty in Immersive Virtual Reality were included after searching. RESULTS Fifty studies were included in this review. They were divided into four categories regarding the type of uncertainty the intervention created and the stage of the decision-making model. CONCLUSIONS Immersive virtual reality makes it possible to alter sensorimotor uncertainty, but studies of higher methodological quality are needed on this topic, as well as an exploration into the patient profile for pain management using immersive VR.
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Affiliation(s)
- Mar Flores-Cortes
- Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
| | | | | | - Roy La Touche
- Instituto de Dolor Craneofacial y Neuromusculoesquelético (INDCRAN), 28008 Madrid, Spain
- Departamento de Fisioterapia, Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
- Motion in Brains Research Group, Institute of Neuroscience and Sciences of the Movement (INCIMOV), Centro Superior de Estudios Universitarios La Salle, Universidad Autónoma de Madrid, 28023 Madrid, Spain
| | - Alejandro Luque-Suarez
- Faculty of Health Sciences, University of Malaga, 29071 Malaga, Spain
- Instituto de Investigacion Biomedica de Malaga (IBIMA), 29071 Malaga, Spain
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Naef AC, Gerber SM, Single M, Müri RM, Haenggi M, Jakob SM, Jeitziner MM, Nef T. Effects of immersive virtual reality on sensory overload in a random sample of critically ill patients. Front Med (Lausanne) 2023; 10:1268659. [PMID: 37859854 PMCID: PMC10582722 DOI: 10.3389/fmed.2023.1268659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Accepted: 09/14/2023] [Indexed: 10/21/2023] Open
Abstract
Background Sensory overload and sensory deprivation have both been associated with negative health outcomes in critically ill patients. While there is a lack of any clear treatment or prevention strategies, immersive virtual reality is a promising tool for addressing such problems, but which has not been repetitively tested in random samples. Therefore, this study aimed to determine how critically ill patients react to repeated sessions of immersive virtual reality. Methods This exploratory study was conducted in the mixed medical-surgical intermediate care unit of the University Hospital of Bern (Inselspital). Participants (N = 45; 20 women, 25 men; age = 57.73 ± 15.92 years) received two immersive virtual reality sessions via a head-mounted display and noise-canceling headphones within 24 h during their stay in the unit. Each session lasted 30-min and showed a 360-degree nature landscape. Physiological data were collected as part of the participants' standard care, while environmental awareness, cybersickness, and general acceptance were assessed using a questionnaire designed by our team (1 = not at all, 10 = extremely). Results During both virtual reality sessions, there was a significant negative linear relationship found between the heart rate and stimulation duration [first session: r(43) = -0.78, p < 0.001; second session: r(38) = -0.81, p < 0.001] and between the blood pressure and stimulation duration [first session: r(39) = -0.78, p < 0.001; second session: r(30) = -0.78, p < 0.001]. The participants had a high comfort score [median (interquartile range {IQR}) = 8 (7, 10); mean = 8.06 ± 2.31], did not report being unwell [median (IQR) = 1 (1, 1); mean = 1.11 ± 0.62], and were not aware of their real-world surroundings [median (IQR) = 1 (1, 5); mean = 2.99 ± 3.22]. Conclusion The subjectively reported decrease in environmental awareness as well as the decrease in the heart rate and blood pressure over time highlights the ability of immersive virtual reality to help critically ill patients overcome sensory overload and sensory deprivation. Immersive virtual reality can successfully and repetitively be provided to a randomly selected sample of critically ill patients over a prolonged duration.
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Affiliation(s)
- Aileen C. Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center For Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Stephan M. Gerber
- Gerontechnology and Rehabilitation Group, ARTORG Center For Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Michael Single
- Gerontechnology and Rehabilitation Group, ARTORG Center For Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - René M. Müri
- Gerontechnology and Rehabilitation Group, ARTORG Center For Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Matthias Haenggi
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan M. Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Department of Public Health (DPH), Faculty of Medicine, Institute of Nursing Science (INS), University of Basel, Basel, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center For Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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Logan DE, Khanna K, Randall E, O’Donnell S, Reks T, McLennan L. Centering Patient and Clinician Voices in Developing Tools to Address Pain Related School Impairment: A Phase I Study of a Virtual Reality School Simulation for Children and Adolescents with Chronic Pain. CHILDREN (BASEL, SWITZERLAND) 2023; 10:1644. [PMID: 37892307 PMCID: PMC10604946 DOI: 10.3390/children10101644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 09/19/2023] [Accepted: 09/28/2023] [Indexed: 10/29/2023]
Abstract
Building on growing evidence supporting virtual reality (VR) interventions for pain management, this study describes the process of developing vReal-School (vRS), a VR-based school simulation for children and adolescents with chronic pain and associated school impairment. Following guidelines for developing user-centered VR interventions, initial phases of intervention development focus on understanding and incorporating patient and clinician perspectives when designing this digital health tool. Phase I entailed focus groups with patients undergoing intensive interdisciplinary pain treatment (IIPT). A total of 19 participants across four focus groups shared their experiences related to dealing with pain at school and provided initial feedback on the concept of a VR-based school simulation. In phase II, we pilot-tested a vRS prototype and collected patient and clinician feedback via mixed method approaches. Phase I results highlight four themes related to pain in school, including physical/environmental challenges and solutions, academic challenges and solutions, peer interaction challenges and solutions, and teacher interaction challenges and solutions. These themes guided the development of our vRS prototype. Nine patients and eleven treating clinicians then engaged with the vRS prototype and provided feedback via semi-structured interviews and validated self-report measures. The results indicate high levels of patient engagement/immersion (mean total score of 17.0 on the Child Presence Measure). Qualitative feedback from both groups identified positive aspects of vRS, including finding the simulation realistic and easy to use and offering ways to address school functioning goals that are not otherwise feasible in the IIPT setting. Areas for improvement included integrating more physical movement as well as increasing the number of scenarios and the level of demands of the tasks available. Both patients and clinicians found vRS to be useful in the IIPT context and relevant to treatment goals. This user input will guide subsequent iterations of intervention development.
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Affiliation(s)
- Deirdre E. Logan
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Karina Khanna
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Edin Randall
- Department of Psychiatry, Harvard Medical School, Boston, MA 02115, USA
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Shealyn O’Donnell
- Mayo Family Pediatric Pain Rehabilitation Center, Boston Children’s Hospital, Boston, MA 02115, USA
| | - Talis Reks
- Massachusetts Institute of Technology, Cambridge, MA 02139, USA
| | - Logan McLennan
- Tufts University School of Arts and Sciences, Medford, MA 02153, USA;
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Ito A, Hiyoshi F, Kanie A, Maruyama A, Oba MS, Kito S. Feasibility Study of Virtual Reality-Based Cognitive Behavioral Therapy for Patients With Depression: Protocol for an Open Trial and Therapeutic Intervention. JMIR Res Protoc 2023; 12:e49698. [PMID: 37751242 PMCID: PMC10565619 DOI: 10.2196/49698] [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: 06/11/2023] [Revised: 07/26/2023] [Accepted: 08/16/2023] [Indexed: 09/27/2023] Open
Abstract
BACKGROUND The clinical usefulness of cognitive behavioral therapy (CBT) for patients with depression who do not remit with pharmacotherapy has been recognized. However, the longer time burden on health care providers associated with conducting CBT and the lack of a system for providing CBT lead to inadequate CBT provision to patients who wish to receive it. OBJECTIVE We aim to evaluate the feasibility of introducing virtual reality (VR) into CBT for patients with depression. METHODS This is a single-center, interventional, exploratory, single-arm, nonrandomized, open, pre-post-comparative feasibility study of an unapproved medical device program to evaluate the acceptability, preliminary efficacy, and safety of the study device. Eligible patients meet the diagnostic criteria of the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition) for major depressive disorder, have a 17-item Hamilton Depression Rating Scale (HAMD-17) score of ≥12, and are aged 18-65 years. The sample will comprise 12 patients. VR-based CBT (CBT-VR) sessions will be conducted once a week in an outpatient setting. CBT-VR has been developed in accordance with 6 stages and 16 sessions in the current CBT therapist manual. VR contents and other components correspond to the themes of these 16 sessions. The flow of CBT-VR treatment is similar to that of normal CBT; however, this product replaces the in-person portion of CBT. The primary end point will be the change in the HAMD-17 score from baseline up to 16 sessions. Secondary end points will be treatment retention; psychiatrist consultation time; satisfaction with the equipment or program; ease of use; homework compliance; change in the HAMD-17 score from baseline up to 8 sessions; change in Montgomery-Åsberg Depression Rating Scale (MADRS), Quick Inventory of Depressive Symptomatology Self-Report (QIDS-SR), EQ-5D-5L, and Clinical Global Impressions (CGI) scores from baseline up to 8 and 16 sessions; and change in remission and response rates and HAMD-17, MADRS, QIDS-SR, and EQ-5D-5L scores from baseline to 3 and 6 months post intervention (or discontinuation). CBT-VR's feasibility will be assessed at baseline, after 8 sessions, after 16 sessions, or treatment discontinuation, by measuring the time required for testing and medical care during each session and with a patient questionnaire. After intervention discontinuation, a follow-up evaluation will be conducted unless the patient withdraws consent or otherwise discontinues participation in the study after 3 and 6 months. RESULTS Participant recruitment started on November 30, 2022, and data collection is ongoing as of September 2023. CONCLUSIONS This study is the first step in testing the acceptability, feasibility, and preliminary efficacy and safety of CBT-VR for patients with depression without controls in an open-label trial. If its feasibility for depression treatment is confirmed, we intend to proceed to a large-scale validation study. TRIAL REGISTRATION Japan Registry of Clinical Trials jRCTs032220481; https://jrct.niph.go.jp/en-latest-detail/jRCTs032220481. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49698.
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Affiliation(s)
- Ai Ito
- Department of Clinical Psychology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Japan
| | - Fumikazu Hiyoshi
- Department of Clinical Psychology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Japan
- Brain Bioregulatory Science, Cooperative Graduate School, The Jikei University Graduate School of Medicine, Minato-ku, Japan
| | - Ayako Kanie
- Jolly Good Inc, Chuo-ku, Japan
- Department of Child Neropsyhchitatry, The University of Tokyo Hosoital, Bunkyo-ku, Japan
- National Center for Cognitive Behavior Therapy and Research, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Japan
| | | | - Mari S Oba
- Department of Clinical Data Science, Clinical Research and Education Premotion Division, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Japan
| | - Shinsuke Kito
- Department of Clinical Psychology, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Japan
- Neuromodulation Therapy and Research Center, National Center Hospital, National Center of Neurology and Psychiatry, Kodaira-shi, Japan
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Naef AC, Jeitziner MM, Jakob SM, Müri RM, Nef T. Creating Custom Immersive 360-Degree Videos for Use in Clinical and Nonclinical Settings: Tutorial. JMIR MEDICAL EDUCATION 2023; 9:e42154. [PMID: 37707883 PMCID: PMC10540026 DOI: 10.2196/42154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Revised: 04/04/2023] [Accepted: 08/21/2023] [Indexed: 09/15/2023]
Abstract
The use of virtual reality (VR) stimulation in clinical settings has increased in recent years. In particular, there has been increasing interest in the use of VR stimulation for a variety of purposes, including medical training, pain therapy, and relaxation. Unfortunately, there is still a limited amount of real-world 360-degree content that is both available and suitable for these applications. Therefore, this tutorial paper describes a pipeline for the creation of custom VR content. It covers the planning and designing of content; the selection of appropriate equipment; the creation and processing of footage; and the deployment, visualization, and evaluation of the VR experience. This paper aims to provide a set of guidelines, based on first-hand experience, that readers can use to help create their own 360-degree videos. By discussing and elaborating upon the challenges associated with making 360-degree content, this tutorial can help researchers and health care professionals anticipate and avoid common pitfalls during their own content creation process.
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Affiliation(s)
- Aileen C Naef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Marie-Madlen Jeitziner
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
- Institute of Nursing Science, Department of Public Health, Faculty of Medicine, University of Basel, Basel, Switzerland
| | - Stephan M Jakob
- Department of Intensive Care Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - René M Müri
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Tobias Nef
- Gerontechnology and Rehabilitation Group, ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Department of Neurology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
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50
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Ahmad M, Bani Mohammad E, Tayyem E, Al Gamal E, Atout M. Pain and anxiety in patients with breast cancer treated with morphine versus tramal with virtual reality. Health Care Women Int 2023; 45:782-795. [PMID: 37703384 DOI: 10.1080/07399332.2023.2257627] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2022] [Revised: 09/07/2023] [Accepted: 09/07/2023] [Indexed: 09/15/2023]
Abstract
The treatment of pain and anxiety in cancer patients includes both pharmaceutical and non-pharmacological approaches. The researchers of this study aimed to compare the effectiveness of morphine versus Tramal with virtual reality therapy (VR) in reducing pain and anxiety in female patients with breast cancer. The sample was composed of 80 women with breast cancer who where treated at a specialized cancer center in Jordan. A quasi-experimental design was used in the study intervention. When used with VR, the tramal analgesics did not differe significactly from the effect of morphine in reducing the pain and anxiety. However, both groups had a significant drop in the level of pain and anxiety. When combined with VR, the use of weak opioids such as Tramal will have nearly the same effect as strong opioids such as Morphine in reducing pain and anxiety in breast cancer patients.
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Affiliation(s)
- Muayyad Ahmad
- Clinical Nursing Department School of Nursing, The University of Jordan, Amman, Jordan
| | | | - Eman Tayyem
- Nursing Department, Arab American University of Palestine Jenin, Jenin, State of Palestine
| | - Ekhlas Al Gamal
- Psychiatric and Mental Health Nursing Department of Community Health Nursing School of Nursing, The University of Jordan, Amman, Jordan
| | - Maha Atout
- Faculty of Nursing, Philadelphia University, Jarash, Jordan
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