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Micheluzzi V, Burrai F, Casula M, Serra G, Al Omary S, Merella P, Casu G. Effectiveness of virtual reality on pain and anxiety in patients undergoing cardiac procedures: A systematic review and meta-analysis of randomized controlled trials. Curr Probl Cardiol 2024; 49:102532. [PMID: 38503359 DOI: 10.1016/j.cpcardiol.2024.102532] [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: 03/14/2024] [Accepted: 03/15/2024] [Indexed: 03/21/2024]
Abstract
BACKGROUND Cardiac procedures often induce pain and anxiety in patients, adversely impacting recovery. Pharmachological approaches have limitations, prompting exploration of innovative digital solutions like virtual reality (VR). Although early evidence suggests a potential favourable benefit with VR, it remains unclear whether the implementation of this technology can improve pain and anxiety. We aimed to assess by a systematic review and meta-analysis the effectiveness of VR in alleviating anxiety and pain on patients undergoing cardiac procedures. METHODS Our study adhered to the PRISMA method and was registered in PROSPERO under the code CRD42024504563. The search was carried out in the PubMed, Web of Science, Scopus, and the Cochrane Library databases in January 2024. Four randomized controlled trials were included (a total of 382 patients). Risk of bias was employed to assess the quality of individual studies, and a random-effects model was utilized to examine the overall effect. RESULTS The results showed that VR, when compared to the standard of care, had a statistically significant impact on anxiety (SMD = -0.51, 95 % CI: -0.86 to -0.16, p = 0.004), with a heterogeneity I2 = 57 %. VR did not show a significant difference in terms of pain when compared to standard care (SMD= -0.34, 95 % CI: -0.75 to -0.07, p = 0.10). The included trials exhibited small sample sizes, substantial heterogeneity, and variations in VR technology types, lengths, and frequencies. CONCLUSIONS VR effectively lowers anxiety levels in patients undergoing cardiac procedures, however, did not show a statistically significant difference on pain.
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Affiliation(s)
| | - Francesco Burrai
- Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Marta Casula
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Giuseppe Serra
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Shadi Al Omary
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy
| | - Pierluigi Merella
- Clinical and interventional cardiology, University Hospital, Sassari, Italy
| | - Gavino Casu
- Clinical and interventional cardiology, University Hospital, Sassari, Italy; Department of Medicine, Surgery and Pharmacy, University of Sassari, Sassari, Italy.
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Shanthanna H, D'Souza RS, Johnson RL, YaDeau JT. How Real Are the Effects of Virtual Reality in Decreasing Acute Pain? Anesth Analg 2024; 138:746-750. [PMID: 38489794 DOI: 10.1213/ane.0000000000006698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/17/2024]
Affiliation(s)
- Harsha Shanthanna
- From the Departments of Anesthesia
- Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Ryan S D'Souza
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Rebecca L Johnson
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Rochester, Minnesota
| | - Jacques T YaDeau
- Department of Anesthesiology, Hospital for Special Surgery, Weill Medical College of Cornell University, New York, New York
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Martinez-Bernal D, Cross WF, Hasselberg M, Tapparello C, Stenz CFH, Kolokythas A. A brief virtual reality intervention for pre-operative anxiety in adults. Oral Surg Oral Med Oral Pathol Oral Radiol 2024; 137:209-214. [PMID: 38171998 DOI: 10.1016/j.oooo.2023.08.014] [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: 06/20/2023] [Revised: 08/08/2023] [Accepted: 08/11/2023] [Indexed: 01/05/2024]
Abstract
OBJECTIVE Virtual reality (VR) is a promising non-pharmacologic tool for managing health care anxiety. We assessed the feasibility and acceptability of a pre-operative VR intervention by adult patients and medical staff and measured anxiety in adult patients pre- and post-VR intervention. STUDY DESIGN We recruited 30 patients scheduled to undergo oral surgery and 8 medical staff as participants. The patients completed a verbal demographic survey and rated their anxiety before the VR intervention and at 1 minute and 2 minutes post-intervention. We administered the Acceptability of Intervention Measure to the patients to measure their perceptions of the VR intervention and the Feasibility of Intervention Measure to the medical staff to assess their perception of VR implementation. We performed an analysis of variance to compare pre-operative anxiety over time and assess demographic differences. RESULTS The patients showed high and consistent acceptability of the pre-operative use of VR among patients, but acceptability varied among medical staff. The patients experienced a statistically significant reduction of pre-operative anxiety (P = .003). CONCLUSION A brief VR pre-intervention is highly accepted by and very beneficial for patients undergoing oral surgery, positively affecting anxiety reduction. The perception of VR by health care providers needs to be explored to increase acceptability.
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Affiliation(s)
| | - Wendi F Cross
- Department of Psychiatry and Pediatrics, University of Rochester Medical Center, Rochester, NY, USA.
| | - Michael Hasselberg
- Chief Digital Health Officer, University of Rochester Medical Center, Rochester, NY, USA
| | - Cristiano Tapparello
- Department of Electrical and Computer Engineering, University of Rochester, Rochester, NY, USA
| | - Colette F H Stenz
- Department of Psychiatry, University of Rochester Medical Center, Rochester, NY, USA
| | - Antonia Kolokythas
- Department of Oral and Maxillofacial Surgery, University of Augusta, Augusta, GA, USA
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Rosa A, Franco R, Miranda M, Casella S, D’Amico C, Fiorillo L, Cervino G. The role of anxiety in patients with hereditary angioedema during oral treatment: a narrative review. FRONTIERS IN ORAL HEALTH 2023; 4:1257703. [PMID: 37927822 PMCID: PMC10620504 DOI: 10.3389/froh.2023.1257703] [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: 07/12/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Objective The present study investigated the clinical potential of managing anxiety during dental procedures to reduce acute attacks in patients with hereditary angioedema (HAE). HAE is a rare disease, little known to physicians and dentists, but with an increased hospitalization rate over the years. HAE is due to a deficiency/dysfunction of the C1 esterase inhibitor, leading to increased vascular permeability. Recommendations for HAE management include long-term and short-term prophylaxis and treatment of acute attacks, but the importance of anxiety control is underestimated. Materials and methods The authors reviewed the literature to provide the scientific community with an overview of possible protocols for managing anxiety in dental practice and their effectiveness. Management can be used in prosthetics, periodontal and implant surgery, endodontics, and oral surgery. Discussions Our analysis shows that although there are few articles in the indexed literature, protocols for managing anxiety in HAE patients in dentistry will become increasingly prevalent in the daily clinical practice of dentists due to its benefits. Conclusions The benefits and better control of intraoperative complications and risks may lead clinicians to use sedation, assessment, or anxiety control techniques in daily clinical practice to reduce such attacks. Clinical relevance: This study suggests that controlling and managing anxiety can help prevent and reduce acute angioedema attacks.
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Affiliation(s)
- Alessio Rosa
- Materials for Health, Environment and Energy, Department of Chemical Science and Technologies, Dentistry, University of Tor Vergata, Rome, Italy
| | - Rocco Franco
- Department of Life, Health and Environment Sciences, University of L’Aquila, L’Aquila, Italy
| | - Michele Miranda
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Sergio Casella
- Department of Clinical Sciences and Translational Medicine, University of Rome “Tor Vergata”, Rome, Italy
| | - Cesare D’Amico
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
| | - Luca Fiorillo
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
- Department of Public Health Dentistry, Dr. D.Y. Patil Dental College and Hospital, Dr. D.Y. Patil Vidyapeeth, Pimpri, Pune, India
- Multidisciplinary Department of Medical-Surgical and Odontostomatological Specialties, University of Campania “Luigi Vanvitelli”, Naples, Italy
| | - Gabriele Cervino
- Department of Biomedical and Dental Sciences, Morphological and Functional Images, University of Messina, Messina, Italy
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Graf S, Feldmann H, Hunold LS, Steinkraus KC, Nasir N, Michalski CW, Dörr-Harim C, Hüttner FJ. Use of virtual reality in port implantation to reduce perioperative anxiety and pain: protocol for a randomised controlled pilot trial at a single German university hospital (VIP-trial; DRKS00028508). BMJ Open 2023; 13:e074738. [PMID: 37709332 PMCID: PMC10503368 DOI: 10.1136/bmjopen-2023-074738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2023] [Accepted: 08/30/2023] [Indexed: 09/16/2023] Open
Abstract
INTRODUCTION Intravenous access port implantation is commonly performed under local anaesthesia, which offers advantages such as increased patient satisfaction and resource savings compared with general anaesthesia. However, patients may experience increased perioperative stress and anxiety in the operating room setting without general anaesthesia. Virtual reality (VR) distraction or hypnosis during surgery under local anaesthesia may help patients to auditorily and visually separate from their real environment and engage with a virtual environment through hypnorelaxing guidance. Previous studies suggested that VR hypnosedation may reduce the use of sedatives or general anaesthesia, and may offer additional benefits such as reducing postoperative pain and nausea, and promoting faster patient discharge. METHODS AND ANALYSIS The VIP trial is a randomised controlled pilot trial comparing the usage of VR during port implantation with the current standard of care (local anaesthesia and analgosedation if needed). A total of 120 adult patients are included after screening for eligibility and obtaining informed consent. Patients are randomised preoperatively in a 1:1 ratio to the trial groups. The main outcomes are change of perioperative anxiety and pain. Further outcomes include patient satisfaction and tolerability, perioperative analgesia and sedation, occurrence of postoperative nausea, vomiting and VR sickness symptoms, surgeon's satisfaction, procedure duration, postoperative complications until postoperative day 30 and patient willingness to hypothetically undergo port implantation again under the same conditions. ETHICS AND DISSEMINATION The VIP trial has been approved by the Ethics Committee of the Medical Faculty of Ulm University (reference number 03/22). If the intervention demonstrates that VR can effectively reduce perioperative anxiety and pain, it may become a novel standard of care to minimise the need for analgosedation or general anaesthesia in port implantation procedures and improve patient outcomes. The results will be submitted to a peer-reviewed journal in the field and will be presented at applicable conferences to ensure rigorous evaluation and access for the academic community. TRIAL REGISTRATION NUMBER German Clinical Trials Register: DRKS00028508; registration date 15 March 2022; Universal Trial Number: U1111-1275-4995.
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Affiliation(s)
- Sandra Graf
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Hannah Feldmann
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
| | - Lisa S Hunold
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Kira C Steinkraus
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
| | - Nadir Nasir
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
| | - Christoph W Michalski
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Colette Dörr-Harim
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Department of General, Visceral and Transplantation Surgery, Heidelberg University, Heidelberg, Germany
| | - Felix J Hüttner
- Department of General and Visceral Surgery, Ulm University Hospital, Ulm, Germany
- Clinical Trial Centre ulmCARES, Department of Surgery, Ulm University Hospital, Ulm, Germany
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