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Twamley J, Hamer O, Hill J, Kenyon R, Twamley H, Casey R, Zhang J, Williams A, Clegg A. Exploring the perceptions of former ICU patients and clinical staff on barriers and facilitators to the implementation of virtual reality exposure therapy: A qualitative study. Nurs Crit Care 2024; 29:313-324. [PMID: 36458458 DOI: 10.1111/nicc.12868] [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: 07/22/2022] [Revised: 10/18/2022] [Accepted: 11/21/2022] [Indexed: 12/04/2022]
Abstract
BACKGROUND Virtual reality (VR) as a digital technology has developed rapidly, becoming more realistic, portable, sensory and easier to navigate. Although studies have found VR to be effective for many clinical applications, patients and clinicians have described several barriers to the successful implementation of this technology. To remove barriers for implementation of VR in health care, a greater understanding is needed of how VR can integrate into clinical environments, particularly complex settings such as an intensive care unit. AIM This study aimed to explore the perceived barriers and facilitators for the implementation of VR exposure therapy for intensive care patients and clinical staff. STUDY DESIGN A qualitative study using an Interpretative Description approach was undertaken. Semi-structured focus groups were conducted with 13 participants: nine patients and four health care professionals. Focus groups explored barriers and facilitators of using virtual reality (VR) exposure therapy in intensive care. Thematic analysis was employed to produce codes and themes. RESULTS In total, eight themes describing the perceived barriers and facilitators to implementing VR exposure therapy were identified. Four themes related to the perceived barriers of implementing VR exposure therapy in intensive care were identified: psychological, sensory, environmental and staff competency and confidence. There were a further four themes related to the perceived facilitators to the implementation of VR exposure therapy: staff training, patient capacity, orientation to technology and support during the intervention. CONCLUSIONS This study identified novel barriers and facilitators that could be expected when implementing VR exposure therapy for patients' post-intensive care unit stay. The findings suggest that psychological barriers of fear and apprehension were expected to provoke patient avoidance of exposure therapy. Perceived barriers for staff focused on preparedness to deliver the VR exposure therapy and a lack of technological competence. Both patients and staff stated that a comprehensive induction, orientation and training could facilitate VR exposure therapy, improving engagement. RELEVANCE TO CLINICAL PRACTICE This study has identified that with appropriate staff training, resources, and integration into current patient care pathways, VR exposure therapy may be a valuable intervention to support patient recovery following critical illness. Prior to undertaking VR exposure therapy, patients often need reassurance that side-effects can be managed, and that they can easily control their virtual exposure experience.
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Affiliation(s)
- Jacqueline Twamley
- Centre for Health Research and Innovation, NIHR Lancashire Clinical Research Facility, Chorley, UK
| | - Oliver Hamer
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
| | - James Hill
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
| | - Roger Kenyon
- Critical care survivor, University of Central Lancashire, Preston, UK
| | - Huw Twamley
- Intensive Care Department, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, UK
| | - Rob Casey
- Digital Therapy Solutions to empower Stroke, Dementia, Parkinson's Rehabilitation, DancingMind Pte Ltd, London, England, United Kingdom
| | | | - Alexandra Williams
- Intensive Care Department, Lancashire Teaching Hospitals NHS Foundation Trust, Chorley, Lancashire, United Kingdom
| | - Andrew Clegg
- Synthesis, Economic Evaluation and Decision Science (SEEDS) Group, University of Central Lancashire, Preston, UK
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Kanschik D, Bruno RR, Wolff G, Kelm M, Jung C. Virtual and augmented reality in intensive care medicine: a systematic review. Ann Intensive Care 2023; 13:81. [PMID: 37695464 PMCID: PMC10495307 DOI: 10.1186/s13613-023-01176-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2023] [Accepted: 08/22/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Virtual reality (VR) and augmented reality (AR) are rapidly developing technologies that offer a wide range of applications and enable users to experience digitally rendered content in both physical and virtual space. Although the number of studies about the different use of VR and AR increases year by year, a systematic overview of the applications of these innovative technologies in intensive care medicine is lacking. The aim of this systematic review was to provide a detailed summary of how VR and AR are currently being used in various areas of intensive care medicine. METHODS We systematically searched PubMed until 1st March 2023 to identify the currently existing evidence for different applications of VR and AR for both health care providers in the intensive care unit and children or adults, who were in an intensive care unit because of a critical illness. RESULTS After screening the literature, a total of 59 studies were included. Of note, a substantial number of publications consists of case reports, study plans or are lacking a control group. Furthermore, study designs are seldom comparable. However, there have been a variety of use cases for VR and AR that researchers have explored. They can help intensive care unit (ICU) personnel train, plan, and perform difficult procedures such as cardiopulmonary resuscitation, vascular punctures, endotracheal intubation or percutaneous dilatational tracheostomy. Patients might benefit from VR during invasive interventions and ICU stay by alleviating stress or pain. Furthermore, it enables contact with relatives and can also assist patients in their rehabilitation programs. CONCLUSION Both, VR and AR, offer multiple possibilities to improve current care, both from the perspective of the healthcare professional and the patient. It can be assumed that VR and AR will develop further and their application in health care will increase.
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Affiliation(s)
- Dominika Kanschik
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Raphael Romano Bruno
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Georg Wolff
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
| | - Malte Kelm
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Duesseldorf, Germany
| | - Christian Jung
- Department of Cardiology, Pulmonology, and Vascular Medicine, Medical Faculty, Heinrich-Heine-University, University Hospital Duesseldorf, Duesseldorf, Germany.
- Cardiovascular Research Institute Duesseldorf (CARID), Medical Faculty, Heinrich-Heine University, Duesseldorf, Duesseldorf, Germany.
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Zou J, Chen Q, Wang J, Gu M, Jiang X, Mao M. Effects of virtual reality for psychological health of ICU patients: a study protocol for systematic review and meta-analysis. BMJ Open 2023; 13:e073660. [PMID: 37479513 PMCID: PMC10364162 DOI: 10.1136/bmjopen-2023-073660] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/23/2023] Open
Abstract
INTRODUCTION Virtual reality (VR) has been shown to have a certain influence on the psychological health of intensive care unit (ICU) patients. However, its specific effects-particularly on psychological health problems, such as psychological well-being, quality of life (QOL) and patient satisfaction-remain unclear. METHOD AND ANALYSIS This study follows the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols guidelines. Electronic data search is carried out on PubMed, Web of Science, CINAHL, EBSCO, EMBASE, Cochrane Library, PsycINFO, China National Knowledge Infrastructure, Wan Fang, VIP and Chinese Biology Medicine Database. The inclusion criteria follow the PICO principle, wherein ICU patients who have been hospitalised for 24 hours or more are included. Studies using VR-based interventions to improve the psychological health of ICU patients, compared with waitlist controls or traditional therapy groups; outcome assessments containing psychological well-being, QOL and patient satisfaction; and those designed as randomised controlled trials (RCTs) and quasi-experimental research are included. Search time is from inception of each database to July 2023. No language restriction is considered. Studies for inclusion are screened by two independent reviewers for data extraction. Any dispute is resolved through discussion. Unresolved disputes are decided on by consulting a third author. For the risk of bias assessment in RCTs and non-RCTs, the Cochrane risk-of-bias tool for randomised trials and risk of bias in non-randomised studies of interventions tool are used, respectively. For meta-analysis, RevMan V.5.3 is used. ETHICS AND DISSEMINATION This protocol study does not include clinical research and thus does not require ethical approval. Research findings will be released in a peer-reviewed journal. PROSPERO REGISTRATION NUMBER CRD42023400428.
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Affiliation(s)
- Junjun Zou
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Qian Chen
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Jiajia Wang
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Mengqian Gu
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Xiaoquan Jiang
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
| | - Mingyue Mao
- Department of Nursing, Changshu No 1 People's Hospital, Changshu, Jiangsu, China
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Vlake JH, van Bommel J, Wils EJ, Korevaar TI, Taccone F, Schut AF, Elderman JH, Labout JA, Raben AM, Dijkstra A, Achterberg S, Jurriens AL, Van Mol MM, Gommers D, Van Genderen ME. Effect of intensive care unit-specific virtual reality (ICU-VR) to improve psychological well-being in ICU survivors: study protocol for an international, multicentre, randomised controlled trial-the HORIZON-IC study. BMJ Open 2022; 12:e061876. [PMID: 36127077 PMCID: PMC9490570 DOI: 10.1136/bmjopen-2022-061876] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION A substantial proportion of intensive care unit (ICU) survivors develop psychological impairments after ICU treatment, part of the postintensive care syndrome, resulting in a decreased quality of life. Recent data suggest that an ICU-specific virtual reality intervention (ICU-VR) for post-ICU patients is feasible and safe, improves satisfaction with ICU aftercare, and might improve psychological sequelae. In the present trial, we firstly aim to determine whether ICU-VR is effective in mitigating post-traumatic stress disorder (PTSD)-related symptoms and secondly to determine the optimal timing for initiation with ICU-VR. METHODS AND ANALYSIS This international, multicentre, randomised controlled trial will be conducted in 10 hospitals. Between December 2021 and April 2023, we aim to include 300 patients who have been admitted to the ICU ≥72 hours and were mechanically ventilated ≥24 hours. Patients will be followed for 12 consecutive months. Patients will be randomised in a 1:1:1 ratio to the early ICU-VR group, the late ICU-VR group, or the usual care group. All patients will receive usual care, including a mandatory ICU follow-up clinic visit 3 months after ICU discharge. Patients in the early ICU-VR group will receive ICU-VR within 2 weeks after ICU discharge. Patients in the late VR group will receive ICU-VR during the post-ICU follow-up visit. The primary objective is to assess the effect of ICU-VR on PTSD-related symptoms. Secondary objectives are to determine optimal timing for ICU-VR, to assess the effects on anxiety-related and depression-related symptoms and health-related quality of life, and to assess patient satisfaction with ICU aftercare and perspectives on ICU-VR. ETHICS AND DISSEMINATION The Medical Ethics Committee United, Nieuwegein, the Netherlands, approved this study and local approval was obtained from each participating centre (NL78555.100.21). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals. TRIAL REGISTRATION NUMBER NL9812.
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Affiliation(s)
- Johan Hendrik Vlake
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, Netherlands
| | | | - Evert-Jan Wils
- Intensive Care, Franciscus Gasthuis en Vlietland, Rotterdam, Zuid-Holland, Netherlands
| | - Tim Im Korevaar
- Internal Medicine, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
- Academic Centre for Thyroid Diseases, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Fabio Taccone
- Intensive Care, Hôpital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Anna Fc Schut
- Intensive Care, Ikazia Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Jan H Elderman
- Intensive Care, IJsselland Hospital, Capelle aan den IJssel, Zuid-Holland, Netherlands
| | - Joost Am Labout
- Intensive Care, Maasstad Hospital, Rotterdam, Zuid-Holland, Netherlands
| | - Adrienne Mtj Raben
- Intensive Care, Groene Hart Ziekenhuis, Gouda, Zuid-Holland, Netherlands
| | - Annemieke Dijkstra
- Intensive Care, Van Weel-Bethesda Hospital, Middelharnis, Goeree-Overflakkee, Netherlands
| | | | - Amber L Jurriens
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Margo Mc Van Mol
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
| | - Diederik Gommers
- Intensive Care, Erasmus MC, Rotterdam, Zuid-Holland, Netherlands
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Vlake JH, van Bommel J, Wils EJ, Bienvenu J, Hellemons ME, Korevaar TI, Schut AF, Labout JA, Schreuder LL, van Bavel MP, Gommers D, van Genderen ME. Intensive Care Unit-Specific Virtual Reality for Critically Ill Patients With COVID-19: Multicenter Randomized Controlled Trial. J Med Internet Res 2022; 24:e32368. [PMID: 34978530 PMCID: PMC8812141 DOI: 10.2196/32368] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 12/01/2021] [Accepted: 12/29/2021] [Indexed: 12/11/2022] Open
Abstract
Background Although psychological sequelae after intensive care unit (ICU) treatment are considered quite intrusive, robustly effective interventions to treat or prevent these long-term sequelae are lacking. Recently, it was demonstrated that ICU-specific virtual reality (ICU-VR) is a feasible and acceptable intervention with potential mental health benefits. However, its effect on mental health and ICU aftercare in COVID-19 ICU survivors is unknown. Objective This study aimed to explore the effects of ICU-VR on mental health and on patients’ perceived quality of, satisfaction with, and rating of ICU aftercare among COVID-19 ICU survivors. Methods This was a multicenter randomized controlled trial. Patients were randomized to either the ICU-VR (intervention) or the control group. All patients were invited to an COVID-19 post-ICU follow-up clinic 3 months after hospital discharge, during which patients in the intervention group received ICU-VR. One month and 3 months later (4 and 6 months after hospital discharge), mental health, quality of life, perceived quality, satisfaction with, and rating of ICU aftercare were scored using questionnaires. Results Eighty-nine patients (median age 58 years; 63 males, 70%) were included. The prevalence and severity of psychological distress were limited throughout follow-up, and no differences in psychological distress or quality of life were observed between the groups. ICU-VR improved satisfaction with (mean score 8.7, SD 1.6 vs 7.6, SD 1.6 [ICU-VR vs control]; t64=–2.82, P=.006) and overall rating of ICU aftercare (mean overall rating of aftercare 8.9, SD 0.9 vs 7.8, SD 1.7 [ICU-VR vs control]; t64=–3.25; P=.002) compared to controls. ICU-VR added to the quality of ICU aftercare according to 81% of the patients, and all patients would recommend ICU-VR to other ICU survivors. Conclusions ICU-VR is a feasible and acceptable innovative method to improve satisfaction with and rating of ICU aftercare and adds to its perceived quality. We observed a low prevalence of psychological distress after ICU treatment for COVID-19, and ICU-VR did not improve psychological recovery or quality of life. Future research is needed to confirm our results in other critical illness survivors to potentially facilitate ICU-VR’s widespread availability and application during follow-up. Trial Registration Netherlands Trial Register NL8835; https://www.trialregister.nl/trial/8835 International Registered Report Identifier (IRRID) RR2-10.1186/s13063-021-05271-z
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Affiliation(s)
- Johan H Vlake
- Department of Intensive Care, Erasmus MC, Rotterdam, Netherlands.,Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | | | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, Netherlands
| | - Joe Bienvenu
- Department of Psychiatry and Behavioral Sciences, John Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Tim Im Korevaar
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus MC, Rotterdam, Netherlands
| | - Anna Fc Schut
- Department of Intensive Care, Ikazia hospital, Rotterdam, Netherlands
| | - Joost Am Labout
- Department of Intensive Care, Maasstad hospital, Rotterdam, Netherlands
| | | | | | - Diederik Gommers
- Department of Intensive Care, Erasmus MC, Rotterdam, Netherlands
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Vlake JH, van Bommel J, Wils EJ, Korevaar T, Hellemons ME, Klijn E, Schut AF, Labout JA, Van Bavel MP, van Mol MM, Gommers D, van Genderen ME. Virtual reality for relatives of ICU patients to improve psychological sequelae: study protocol for a multicentre, randomised controlled trial. BMJ Open 2021; 11:e049704. [PMID: 34588250 PMCID: PMC8479939 DOI: 10.1136/bmjopen-2021-049704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
INTRODUCTION Intensive care unit (ICU) admission of a relative might lead to psychological distress and complicated grief (post-intensive care syndrome-family; PICS-F). Evidence suggests that increased distress during ICU stay increases risk of PICS-F, resulting in difficulty returning to their normal lives after the ICU experience. Effective interventions to improve PICS-F are currently lacking. In the present trial, we hypothesised that information provision using ICU-specific Virtual Reality for Family members/relatives (ICU-VR-F) may improve understanding of the ICU and subsequently improve psychological well-being and quality of life in relatives of patients admitted to the ICU. METHODS AND ANALYSIS This multicentre, clustered randomised controlled trial will be conducted from January to December 2021 in the mixed medical-surgical ICUs of four hospitals in Rotterdam, the Netherlands. We aim to include adult relatives of 160 ICU patients with an expected ICU length of stay over 72 hours. Participants will be randomised clustered per patient in a 1:1 ratio to either the intervention or control group. Participants allocated to the intervention group will receive ICU-VR-F, an information video that can be watched in VR, while the control group will receive usual care. Initiation of ICU-VR-F will be during their hospital visit unless participants cannot visit the hospital due to COVID-19 regulations, then VR can be watched digitally at home. The primary objective is to study the effect of ICU-VR-F on psychological well-being and quality of life up to 6 months after the patients' ICU discharge. The secondary outcome is the degree of understanding of ICU treatment and ICU modalities. ETHICS AND DISSEMINATION The Medical Ethics Committee of the Erasmus Medical Centre, Rotterdam, the Netherlands, approved the study and local approval was obtained from each participating centre (NL73670.078.20). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals. TRIAL REGISTRATION NUMBER Netherlands Trial Register (TrialRegister.nl, NL9220).
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Affiliation(s)
- Johan H Vlake
- Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jasper van Bommel
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Korevaar
- Department of Internal Medicine, Academic Centre for Thyroid Diseases, Erasmus Medical Centre, Rotterdam, The Netherlands
| | | | - Eva Klijn
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Anna Fc Schut
- Intensive Care, Ikazia Hospital, Rotterdam, The Netherlands
| | - Joost Am Labout
- Intensive Care, Maasstad Hospital, Rotterdam, The Netherlands
| | - Marten P Van Bavel
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Margo Mc van Mol
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Diederik Gommers
- Department of Intensive Care, Erasmus Medical Centre, Rotterdam, The Netherlands
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Virtual Reality to Improve Sequelae of the Postintensive Care Syndrome: A Multicenter, Randomized Controlled Feasibility Study. Crit Care Explor 2021; 3:e0538. [PMID: 34549192 PMCID: PMC8443843 DOI: 10.1097/cce.0000000000000538] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Supplemental Digital Content is available in the text. Psychologic sequelae after critical illness, part of the postintensive care syndrome, significantly decrease quality of life. A robustly effective treatment intervention is currently lacking. Virtual reality has beneficial effects on several non-ICU–related psychologic disorders. The aim of this study was to explore patient-related determinants of ICU-specific virtual reality, such as the timing of patients’ self-reported readiness to initiate virtual reality and the number of desired sessions and safety, and to explore the effects of ICU-specific virtual reality on mental health.
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