Designing and developing a nature-based virtual reality with heart rate variability biofeedback for surgical anxiety and pain management: evidence from total knee arthroplasty patients

Telehealth and Virtual Reality Technologies in Chronic Pain Management: A Narrative Review

PURPOSE OF REVIEW

This review provides medical practitioners with an overview of the present and emergent roles of telehealth and associated virtual reality (VR) applications in chronic pain (CP) management, particularly in the post-COVID-19 healthcare landscape.

RECENT FINDINGS

Accumulated evidence points to the efficacy of now well-established telehealth modalities, such as videoconferencing, short messaging service (SMS), and mobile health (mHealth) applications in complementing remote CP care. More recently, and although still in early phases of clinical implementation, a wide range of VR-based interventions have demonstrated potential for improving the asynchronous remote management of CP. Additionally, VR-associated technologies at the leading edge of science and engineering, such as VR-assisted biofeedback, haptic technology, high-definition three-dimensional (HD3D) conferencing, VR-enabled interactions in a Metaverse, and the use of wearable monitoring devices, herald a new era for remote, synchronous patient-physician interactions. These advancements hold the potential to facilitate remote physical examinations, personalized remote care, and innovative interventions such as ultra-realistic biofeedback. Despite the promise of VR-associated technologies, several limitations remain, including the paucity of robust long-term effectiveness data, heterogeneity of reported pain-related outcomes, challenges with scalability and insurance coverage, and demographic-specific barriers to patient acceptability. Future research efforts should be directed toward mitigating these limitations to facilitate the integration of telehealth-associated VR into the conventional management of CP. Despite ongoing barriers to widespread adoption, recent evidence suggests that VR-based interventions hold an increasing potential to complement and enhance the remote delivery of CP care.

Effects of Using Guided Deep Breathing Exercises in a Virtual Natural Environment to Reduce Stress during Pediatric Treatment

There exists a need for new methods to address treatment anxiety in pediatrics-at the same time, deep breathing exercises and virtual natural environments have both been known to have stress-reducing qualities. This article reports the combined effect of these two methods in a pediatric setting. A feasibility study was conducted in a local hospital. The study had a within-subjects design, and it included 21 child patients aged 8 to 12 years old, who used a virtual reality (VR) relaxation application developed for this purpose during an intravenous cannulation procedure related to their treatment. The key findings highlight a statistically very significant stress reduction associated with the utilized VR intervention, demonstrated by heart rate variability measurements (SDNN, p < 0.001; RMSSD, p = 0.002; Stress Index, p < 0.001; LF/HF ratio, p = 0.010). This effect was consistent regardless of the level of general anxiety or the level of needle phobia of the patient, and no adverse effects were observed. The results show the strong potential of using deep breathing exercises in virtual natural environments for addressing treatment anxiety related to invasive pediatric procedures.

Design and User Experience of VirNE Application: Deep Breathing Exercise in a Virtual Natural Environment to Reduce Treatment Anxiety in Pediatrics

Treatment anxiety is a serious problem among child patients. A few studies have addressed this issue with virtual reality solutions, with promising results; however, the applications used have generally been designed for entertainment instead of this purpose. This article studies the potential of using deep breathing exercises in a virtual natural environment to address this issue, with a focus on design approach and user experience. It presents the VirNE-Virtual Natural Environments relaxation application, which is based on known stress-reduction methods, and a feasibility study conducted with it in a local hospital. The study had a within-subjects design, and it included 21 eight to twelve-year-old child patients, who used the application during an intravenous cannulation procedure related to their treatment. The study found good user acceptance and user experience both among the child patients and pediatricians, with the perceived usefulness of the method being higher among the patients with increased levels of anxiety or needle phobia. In addition, a clear stress-reducing effect was found. This offers proof-of-concept for the multidisciplinary design approach based on existing scientific knowledge regarding the desired effect for pediatric virtual reality applications for this use context.