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Lier EJ, Smits MLM, van Boekel RLM, Vissers KCP, Maandag NJG, de Vries M, van Goor H. Virtual reality for postsurgical pain management: An explorative randomized controlled study. Surgery 2024:S0039-6060(24)00391-X. [PMID: 38987093 DOI: 10.1016/j.surg.2024.06.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2024] [Revised: 05/01/2024] [Accepted: 06/10/2024] [Indexed: 07/12/2024]
Abstract
BACKGROUND Virtual reality (VR) is a promising tool in a multimodal analgesic approach; however, evidence regarding virtual reality for postsurgical pain is limited. This study investigates the initial effectiveness and feasibility of self-administered virtual reality in postsurgical pain management. METHODS Patients reporting a postsurgical pain score ≥4 were randomized for control or VR, stratified for 3 interventions with varying levels of immersion and interaction. Subjects were instructed to use virtual reality as add-on treatment at least 3 times a day for 10 minutes on days 2 till 4 postoperatively. Primary outcome was the mean daily pain intensity. Results of pain scores were related to patient and intervention characteristics, to explore which characteristics interact with virtual reality effects. Secondary outcomes were analgesic use, anxiety, stress, and feasibility. RESULTS One hundred patients were included in the analyses: 37 in the control group and 63 for VR. VR did not demonstrate a significant effect on self-reported pain scores (P = .43), nor were specific patient or intervention characteristics associated with greater VR effects. Analgesic usage did not differ between groups. However, there was a trend toward greater cumulative percentages of patients achieving a 30% pain reduction, and significantly lower daily experienced stress (P = .01) and anxiety (P = .03) levels in VR intervention groups. VR was used less than prescribed, mainly because of illness and pain. Adverse events included disorientation, nausea, and fatigue. CONCLUSIONS This explorative study did not demonstrate initial effectiveness of VR as add-on pain treatment regarding pain and analgesic use; however, VR positively affected stress and anxiety. VR is safe and suitable for a wide target audience, and feasibility differed between interventions. Personalizing and improving VR technology may enhance its effectiveness.
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Affiliation(s)
- Elisabeth J Lier
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands; Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Merlijn L M Smits
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Regina L M van Boekel
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Kris C P Vissers
- Department of Anesthesiology, Pain and Palliative Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Natasja J G Maandag
- Department of Anesthesiology, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Marjan de Vries
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harry van Goor
- Department of Surgery, Radboud University Medical Center, Nijmegen, The Netherlands. https://twitter.com/Gooreducatie
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2
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García-González J, Martínez-Navarro A, Romero-Del Rey R, Requena-Mullor M, Zheng R, Lopez-Villen A, Alarcon-Rodriguez R. State-trait anxiety levels and vital signs of pregnant women following intervention with virtual reality during the nonstress test: A randomized controlled trial. J Affect Disord 2024; 355:308-314. [PMID: 38548203 DOI: 10.1016/j.jad.2024.03.148] [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: 05/26/2023] [Revised: 03/21/2024] [Accepted: 03/25/2024] [Indexed: 04/06/2024]
Abstract
BACKGROUND Pregnant women often experience anxiety due to pregnancy, negatively impacting their and their fetus' health. Non-pharmacological interventions, such as virtual reality (VR), could reduce anxiety levels, potentially impacting non-stress tests or the physiological responses of the pregnant woman and the fetus. METHODS A randomized clinical trial conducted between February and December 2022 involved 286 term pregnant women. They were divided into a VR intervention group (146 women) and a control group (140 women). The intervention consisted of 20 min of 3D glasses with images and sounds during a third-trimester nonstress test. Anxiety was measured using the Spielberg State-Trait Anxiety Inventory (STAI), alongside physiological parameters. RESULTS The VR group exhibited lower anxiety levels compared to controls (STAI score: Rosenthal's r: -0.54, p = 0.01; state anxiety: Rosenthal's r: -0.40, p = 0.001; trait anxiety: Rosenthal's r: -0.41, p = 0.001). Within the VR group, there was a significant reduction in trait anxiety (Rosenthal's r, 1.27; p < 0.001) and total anxiety (Rosenthal's r, 1.63; p < 0.001) post-intervention, along with decreased systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), and maternal heart rate (p = 0.02). LIMITATIONS Future research could explore additional pregnancy-related variables, such as postpartum anxiety. CONCLUSIONS The results confirm that the use of VR is beneficial for pregnant women and their fetuses, as it decreases anxiety levels, and improves physiological parameters such as blood pressure and maternal heart rate during the nonstress test. VR is a technique that is easy to integrate into the healthcare system due to its non-invasive and non-pharmacological nature.
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Affiliation(s)
- Jessica García-González
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
| | | | - Raúl Romero-Del Rey
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
| | - Ruirui Zheng
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain.
| | - Antonia Lopez-Villen
- Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain; Torrecárdenas Hospital, 04009 Almería, Spain
| | - Raquel Alarcon-Rodriguez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería. 04120, Almería, Spain; Research Group CTS-1127 Epidemiology and Public Health, University of Almeria, Almeria, Spain.
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3
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Rosielle K, van Haaps AP, Kuijper EAM, Tonch N, Karim DENB, Oskam MA, van den IJssel R, Mol BWJ, Lambalk CB, Dreyer K, Mijatovic V. No pain relief by virtual reality during hysterosalpingography (HSG): results from a randomized controlled trial. Hum Reprod 2024:deae133. [PMID: 38863305 DOI: 10.1093/humrep/deae133] [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: 01/22/2024] [Revised: 05/15/2024] [Indexed: 06/13/2024] Open
Abstract
STUDY QUESTION Is virtual reality (VR) an effective non-pharmacological tool to reduce procedural pain during hysterosalpingography (HSG)? SUMMARY ANSWER An HSG with VR does not reduce procedural pain scores compared to an HSG without VR. WHAT IS KNOWN ALREADY An HSG is often experienced as painful and uncomfortable. VR has been proven successful to reduce acute procedural pain during a variety of medical procedures and interventions. STUDY DESIGN, SIZE, DURATION We performed a two-centre open-label randomized controlled trial between January 2021 and October 2022. PARTICIPANTS/MATERIALS, SETTING, METHODS Women scheduled for HSG as part of their infertility work-up were screened for participation. After informed consent, women were randomized between HSG with or without VR. Due to the nature of the intervention, the study was not blinded. VR was administered by a head-mounted device displaying nature movies and/or relaxation exercises. The primary endpoint was procedural pain measured using VAS (scale 0.0-10.0 cm). Procedural pain was divided into overall pain score and peak pain score during the procedure. It was measured immediately after HSG. Secondary endpoints included patient satisfaction, VR preferences, and adverse effects of VR. MAIN RESULTS AND THE ROLE OF CHANCE We included a total of 134 women, 69 to the intervention group (HSG with VR) and 65 to the control group (HSG without VR). The mean VAS for peak pain was 6.80 cm (SD 2.25) in the intervention group versus 6.60 cm (SD 2.40) in the control group (mean difference 0.28 (95% CI -0.57, 1.12), P = 0.52). The mean VAS for overall pain was 5.00 cm (SD 2.10) in the intervention group versus 4.90 cm (SD 2.13) in the control group (mean difference 0.06 (95% CI -0.71, 0.84), P = 0.88). The expectation that VR would be a good distraction from pain during HSG was correlated with both overall and peak pain scores. When correcting for this expectation, we found that women in the intervention group reported significantly higher scores, both in peak (adjusted MD 0.58 (95% CI -0.81, 1.97), P = 0.021) and overall (adjusted MD 0.43 (95% CI -0.84, 1.71), P = 0.013) pain, compared to the control group. There were no differences in the prevalence of symptoms that were considered as adverse effects of VR. LIMITATIONS, REASONS FOR CAUTION The study was not blinded. Reasons for declining participation in the study were anxiety or wanting full control during HSG, which might have created selection bias. The distraction score possibly indicates that the level of VR immersiveness was not optimal due to the lack of sound and/or the type of VR applications. Future studies should investigate whether more immersive or interactive VR applications could decrease procedural pain scores during HSG. WIDER IMPLICATIONS OF THE FINDINGS Since VR does not reduce procedural pain, this additional tool should not be used during HSG. STUDY FUNDING/COMPETING INTEREST(S) There was no external funding for this study. KR and AvH report receiving a travel grant from Merck outside the scope of this study. BM is supported by a National Health and Medical Research Council (NHMRC) investigator grant (GNT1176437) and BM reports consultancy for Merck, Organon, and Norgine and travel and research funding from Merck. BM holds stock for ObsEva. CL reports receiving research grants from Merck, and Ferring. KD and VM report receiving travel and speaker's fees from Guerbet and research grants from Guerbet. VM also reports research grants from Merck and Ferring. The remaining authors have nothing to declare. TRIAL REGISTRATION NUMBER The trial is registered prospectively in the Netherlands Trial Register (trialregister.nl registration number NL9203, currently accessible on trialsearch.who.int). TRIAL REGISTRATION DATE 16-01-2021. DATE OF FIRST PATIENT’S ENROLMENT The first participant was enrolled on 19 January 2021.
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Affiliation(s)
- K Rosielle
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - A P van Haaps
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - E A M Kuijper
- Department of Gynaecology and Obstetrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - N Tonch
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
- Department of Reproductive Medicine, Amsterdam UMC Location Academic Medical Center, Amsterdam, The Netherlands
| | - D E N B Karim
- VUMC School of Medical Sciences, Amsterdam, The Netherlands
| | - M A Oskam
- VUMC School of Medical Sciences, Amsterdam, The Netherlands
| | | | - B W J Mol
- Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, Australia
- Department of Gynaecology and Obstetrics, Aberdeen Centre for Women's Health Research, School of Medicine, Medical Sciences and Nutrition, University of Aberdeen, Aberdeen, UK
| | - C B Lambalk
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - K Dreyer
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
| | - V Mijatovic
- Department of Reproductive Medicine, Amsterdam UMC Location Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Reproduction and Development, Amsterdam University Medical Centres, Amsterdam, The Netherlands
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Melillo A, Rachedi S, Caggianese G, Gallo L, Maiorano P, Gimigliano F, Lucidi F, De Pietro G, Guida M, Giordano A, Chirico A. Synchronization of a Virtual Reality Scenario to Uterine Contractions for Labor Pain Management: Development Study and Randomized Controlled Trial. Games Health J 2024. [PMID: 38860400 DOI: 10.1089/g4h.2023.0202] [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: 06/12/2024] Open
Abstract
Background: Labor is described as one of the most painful events women can experience through their lives, and labor pain shows unique features and rhythmic fluctuations. Purpose: The present study aims to evaluate virtual reality (VR) analgesic interventions for active labor with biofeedback-based VR technologies synchronized to uterine activity. Materials and Methods: We developed a VR system modeled on uterine contractions by connecting it to cardiotocographic equipment. We conducted a randomized controlled trial on a sample of 74 cases and 80 controls during active labor. Results: Results of the study showed a significant reduction of pain scores compared with both preintervention scores and to control group scores; a significant reduction of anxiety levels both compared with preintervention assessment and to control group and significant reduction in fear of labor experience compared with controls. Conclusion: VR may be considered as an effective nonpharmacological analgesic technique for the treatment of pain and anxiety and fear of childbirth experience during labor. The developed system could improve personalization of care, modulating the multisensory stimulation tailored to labor progression. Further studies are needed to compare the synchronized VR system to uterine activity and unsynchronized VR interventions.
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Affiliation(s)
- Antonio Melillo
- Department of Mental and Physical Health and Preventive Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Sarah Rachedi
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Giuseppe Caggianese
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Luigi Gallo
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Patrizia Maiorano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Francesca Gimigliano
- Department of Mental and Physical Health and Preventive Medicine, "Luigi Vanvitelli" University of Campania, Naples, Italy
| | - Fabio Lucidi
- Department of Social and Developmental Psychology, "Sapienza" University of Rome, Rome, Italy
| | - Giuseppe De Pietro
- Institute for High Performance Computing and Networking, National Research Council of Italy (ICAR-CNR), Naples, Italy
| | - Maurizio Guida
- Department of Neuroscience, Reproductive and Dentistry Sciences, University of Naples Federico II, Naples, Italy
| | - Antonio Giordano
- Sbarro Institute for Cancer Research and Molecular Medicine, Center for Biotechnology, College of Science and Technology, Temple University, Philadelphia, Pennsylvania, USA
- Department of Medical Biotechnology, University of Siena, Siena, Italy
| | - Andrea Chirico
- Department of Social and Developmental Psychology, "Sapienza" University of Rome, Rome, Italy
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5
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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 2024:00024665-990000000-00180. [PMID: 38701038 DOI: 10.1097/cin.0000000000001120] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [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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6
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Öz T, Demirci N. The effect of virtual reality glasses applied during intrauterine device insertion on pain, anxiety and satisfaction: Randomized controlled study. Scott Med J 2024; 69:37-44. [PMID: 38449359 DOI: 10.1177/00369330241234688] [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: 03/08/2024]
Abstract
BACKGROUND AND AIM This study was carried out to determine the effect of the use of "virtual reality glasses," on anxiety, pain, and satisfaction level in order to reduce anxiety and pain during intrauterine device (IUD) insertion, which is a painful and stressful procedure for women and to divert attention to increase satisfaction. METHODS This randomized controlled study in the gynecology clinic of a state hospital with 80 women who were accepted to participate in the study. Data were collected using structured patient information form, numerical pain rating scale, state-trait anxiety inventory, patient satisfaction evaluation form, and virtual reality glasses. RESULTS Post-procedural pain scores in the control group after IUD application were higher than post-procedural pain in the virtual reality group. Measurements of post-procedure anxiety in the control group were higher than measurements of post-procedural in the virtual reality group. Satisfaction levels of women with virtual reality glasses during IUD insertion were also found to be high. CONCLUSIONS It was determined that the use of virtual reality glasses, one of the methods of distraction during IUD insertion, was effective in reducing pain and anxiety and increasing patient satisfaction.
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Affiliation(s)
- Tuğba Öz
- Department of Obstetrics and Gynecology Nursing, Marmara University, Institute of Health Sciences, Istanbul/Türkiye
| | - Nurdan Demirci
- Department of Obstetrics and Gynecology Nursing, Faculty of Health Sciences, Marmara University, Istanbul/Türkiye
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7
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Baradwan S, Alshahrani MS, AlSghan R, Alyafi M, Elsayed RE, Abdel-Hakam FA, Moustafa AA, Hussien AE, Yahia OS, Shama AA, Magdy AA, Abdelhakim AM, Badran H. The effect of virtual reality on pain and anxiety management during outpatient hysteroscopy: a systematic review and meta-analysis of randomized controlled trials. Arch Gynecol Obstet 2024; 309:1267-1280. [PMID: 38165441 DOI: 10.1007/s00404-023-07319-8] [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: 07/01/2023] [Accepted: 11/26/2023] [Indexed: 01/03/2024]
Abstract
OBJECTIVE Our study aimed to evaluate the effectiveness of virtual reality (VR) intervention for pain and anxiety relief during outpatient hysteroscopy. METHODS Various databases were searched for available clinical trials from inception until June 2023. We selected randomized controlled trials (RCTs) that compared virtual reality intervention versus standard care among women undergoing outpatient hysteroscopy. We used Revman software to perform our meta-analysis. The primary outcome was the pain score during the procedure. The secondary outcomes were anxiety during the procedure and pain post-procedure. The Visual Analog Scale (VAS) was used to assess pain and anxiety. RESULTS Six RCTs were retrieved, involving a total of 457 patients. Virtual reality was associated with a significant reduction in pain score during the procedure in comparison with the control group (MD = - 1.43, 95% CI [- 1.69, - 1.16], p < 0.001). In addition, there was a significant decrease in anxiety during the procedure among the virtual reality group compared to the control group (p = 0.01). The pain score post-procedure significantly decreased within the virtual reality group (MD = - 1.52, 95% CI [- 1.78, - 1.26], p < 0.001). CONCLUSIONS Virtual reality technology is a simple, feasible, and effective intervention for reducing pain and anxiety during outpatient hysteroscopy. More trials are required to confirm our findings.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Majed Saeed Alshahrani
- Department of Obstetrics and Gynecology, Faculty of Medicine, Najran University, Najran, Saudi Arabia
| | - Rayan AlSghan
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, AlKharj, Saudi Arabia
| | - Mohammad Alyafi
- Department of Obstetrics and Gynecology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Rasha Ezzat Elsayed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Faiza Ahmed Abdel-Hakam
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ayman Esmail Hussien
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University for Girls, Cairo, Egypt
| | - Othman Saadeldien Yahia
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Ahmed Abdelaziz Shama
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | - Amr Ahmed Magdy
- Department of Anesthesia and Surgical Intensive Care and Pain Medicine, Faculty of Medicine, Tanta University, Tanta, Egypt
| | | | - Haitham Badran
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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8
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Espinosa-Leon JP, Mathura R, Chen G, Joseph M, Sadhwani T, Beydoun N, Hernandez ER, Riley T, Goodspeed V, O'Gara BP. Postoperative virtual reality for recovery after bariatric surgery: study protocol for a randomised clinical trial. BJA OPEN 2024; 9:100258. [PMID: 38333728 PMCID: PMC10851198 DOI: 10.1016/j.bjao.2024.100258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 01/09/2024] [Indexed: 02/10/2024]
Abstract
Background Enhanced Recovery After Surgery (ERAS) protocols for bariatric surgery improve clinical outcomes. However, the impact of ERAS protocols on patient satisfaction is unknown. Virtual reality has been implemented as an effective adjunct to standard analgesic regimens. This study seeks to find out if immersive virtual reality in the immediate postoperative period could improve the subjective quality of recovery and further reduce opioid requirements for bariatric surgery patients compared with ERAS care alone. Methods This is a single-centre, randomised clinical trial of patients recovering from laparoscopic bariatric surgery. Once in the post-anaesthesia care unit (PACU), participants will receive either an immersive virtual reality plus ERAS protocol or ERAS protocol alone. The primary outcome will be the Quality of Recovery-15 (QoR-15) score at PACU discharge. Secondary outcomes include PACU opioid requirements, length of PACU stay, PACU pain scores, QoR-15 score on postoperative day 1, hospital length of stay, opioid requirements, and opioid-related adverse effects until hospital discharge. Conclusions Positive findings from this study could introduce virtual reality as a non-pharmacological adjunct during PACU care that improves subjective recovery for patients undergoing bariatric surgery. Clinical trial registration NCT04754165.
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Affiliation(s)
- Juan P. Espinosa-Leon
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Ryan Mathura
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Guanqing Chen
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Melisa Joseph
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Trishna Sadhwani
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Najla Beydoun
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Edjay R. Hernandez
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
- University of North Dakota School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Tyler Riley
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
- The University of Central Florida College of Medicine, Orlando, FL, USA
| | - Valerie Goodspeed
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
| | - Brian P. O'Gara
- Beth Israel Deaconess Medical Center Department of Anesthesia, Critical Care, and Pain Medicine, Harvard Medical School, Boston, MA, USA
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9
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Teh JJ, Pascoe DJ, Hafeji S, Parchure R, Koczoski A, Rimmer MP, Khan KS, Al Wattar BH. Efficacy of virtual reality for pain relief in medical procedures: a systematic review and meta-analysis. BMC Med 2024; 22:64. [PMID: 38355563 PMCID: PMC10865524 DOI: 10.1186/s12916-024-03266-6] [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: 04/14/2023] [Accepted: 01/22/2024] [Indexed: 02/16/2024] Open
Abstract
BACKGROUND Effective pain control is crucial to optimise the success of medical procedures. Immersive virtual reality (VR) technology could offer an effective non-invasive, non-pharmacological option to distract patients and reduce their experience of pain. We aimed to evaluate the efficacy of Immersive virtual reality (VR) technology in reducing patient's pain perception during various medical procedures by conducting a systematic review and meta-analysis. METHODS We searched MEDLINE, EMBASE, CENTRAL, CINAHL, and SIGLE until December 2022 for all randomised clinical trials (RCT) evaluating any type of VR in patients undergoing any medical procedure. We conducted a random effect meta-analysis summarising standardised mean differences (SMD) with 95% confidence intervals (CI). We evaluated heterogeneity using I 2 and explored it using subgroup and meta-regression analyses. RESULTS In total, we included 92 RCTs (n = 7133 participants). There was a significant reduction in pain scores with VR across all medical procedures (n = 83, SMD - 0.78, 95% CI - 1.00 to - 0.57, I 2 = 93%, p = < 0.01). Subgroup analysis showed varied reduction in pain scores across trial designs [crossover (n = 13, SMD - 0.86, 95% CI - 1.23 to - 0.49, I 2 = 72%, p = < 0.01) vs parallel RCTs (n = 70, SMD - 0.77, 95% CI - 1.01 to - 0.52, I 2 = 90%, p = < 0.01)]; participant age groups [paediatric (n = 43, SMD - 0.91, 95% CI - 1.26 to - 0.56, I 2 = 87%, p = < 0.01) vs adults (n = 40, SMD - 0.66, 95% CI - 0.94 to - 0.39, I 2 = 89%, p = < 0.01)] or procedures [venepuncture (n = 32, SMD - 0.99, 95% CI - 1.52 to - 0.46, I 2 = 90%, p = < 0.01) vs childbirth (n = 7, SMD - 0.99, 95% CI - 1.59 to - 0.38, I 2 = 88%, p = < 0.01) vs minimally invasive medical procedures (n = 25, SMD - 0.51, 95% CI - 0.79 to - 0.23, I 2 = 85%, p = < 0.01) vs dressing changes in burn patients (n = 19, SMD - 0.8, 95% CI - 1.16 to - 0.45, I 2 = 87%, p = < 0.01)]. We explored heterogeneity using meta-regression which showed no significant impact of different covariates including crossover trials (p = 0.53), minimally invasive procedures (p = 0.37), and among paediatric participants (p = 0.27). Cumulative meta-analysis showed no change in overall effect estimates with the additional RCTs since 2018. CONCLUSIONS Immersive VR technology offers effective pain control across various medical procedures, albeit statistical heterogeneity. Further research is needed to inform the safe adoption of this technology across different medical disciplines.
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Affiliation(s)
- Jhia J Teh
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | | | - Safiya Hafeji
- Kings College Hospital, Denmark Hill, Brixton, London, UK
| | | | - Adam Koczoski
- Department of Metabolism, Digestion and Reproduction, Faculty of Medicine, Imperial College London, London, UK
| | - Michael P Rimmer
- MRC Centre for Reproductive Health, Institute of Regeneration and Repair, Edinburgh BioQuarter, University of Edinburgh, Edinburgh, UK.
- . Johns Hospital, Livingston, West Lothian, Scotland, UK.
| | - Khalid S Khan
- Department of Preventive Medicine and Public Health, University of Granada, 18071, Granada, Spain
- CIBER Epidemiología y Salud Pública (CIBERESP), Instituto de Salud Carlos III (ISCIII), Madrid, Spain
| | - Bassel H Al Wattar
- University College London, London, UK
- Beginnings Assisted Conception Unit, Epsom and St Helier University Hospitals, London, UK
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Özer E, Çetinkaya Şen Y, Canlı S, Güvenç G. Effects of Virtual Reality Interventions on the Parameters of Normal Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. A Meta-Analysis of Virtual Reality Interventions on the Parameters of Normal Labor. Pain Manag Nurs 2024; 25:93-99. [PMID: 37880013 DOI: 10.1016/j.pmn.2023.09.012] [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: 06/12/2023] [Revised: 09/20/2023] [Accepted: 09/24/2023] [Indexed: 10/27/2023]
Abstract
BACKGROUND Clinical and experimental studies on virtual reality have shown that this easy-to-use and non-invasive method is a safe and effective strategy during normal labor. AIM This study aims to analyze the effects of virtual reality (VR) interventions on some of the parameters of normal labor. DESIGN Systematic review and meta-analysis. METHOD Higher Education Council National Thesis Center, Scopus, PubMed, Google Scholar, and Science Direct databases were systematically searched for randomized controlled trials that administered VR to the intervention group but not to the control group and were published through January 2022. RevMan software was used to analyze the meta-analysis data. Pain, anxiety, satisfaction, and the duration of the first and second stages of labor were assessed as outcomes of normal labor. RESULTS Seven randomized controlled trials, with a total of 756 women in total, met the inclusion criteria. Virtual reality interventions significantly reduced pain scores when cervical dilatation was ≤4 cm (MD = -0.43, 95% expansion here (CI [-0.65, -0.21], p < .001) and ≥9 cm (SMD = -1.91, 95% CI [-2.56, -1.26], p < .001). Anxiety scores significantly decreased (SMD = -1.08, 95% CI [-1.75, 0.41], p < .001), and childbirth satisfaction significantly increased (MD = 11.24, 95% CI [2.17, 20.30], p < .001) in the VR intervention groups. Finally, when compared to the control groups, the duration of the first stage of labor (SMD = -0.53, 95% CI [-0.83, -0.22], p < .01) and the second stage of labor (MD = -0.39, 95% CI [-0.76, -0.02], p = .001) were significantly decreased in the VR intervention groups. CONCLUSIONS Virtual reality interventions are effective methods to reduce pain, anxiety, and the duration of the first and second stages of labor and to increase satisfaction with normal labor.
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Affiliation(s)
- Esra Özer
- Ankara Medipol University, Health Sciences Faculty, Ankara, Turkey.
| | - Yeşim Çetinkaya Şen
- Ankara University, Haymana Health Services Vocational School, Ankara, Turkey
| | - Serap Canlı
- Ankara University, Haymana Health Services Vocational School, Ankara, Turkey
| | - Gülten Güvenç
- University of Health Sciences, Gulhane Faculty of Nursing, Department of Obstetrics and Gynecology Nursing, Ankara, Turkey
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11
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Mahalan N, Smitha M. Effect of audio-visual therapy on pain and anxiety in labor: A randomized controlled trial. Eur J Obstet Gynecol Reprod Biol X 2023; 20:100240. [PMID: 37771959 PMCID: PMC10522975 DOI: 10.1016/j.eurox.2023.100240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Revised: 09/07/2023] [Accepted: 09/09/2023] [Indexed: 09/30/2023] Open
Abstract
Background Birth pain affects women at a physical and psychological level. Pain is subjective, and perception will vary among individuals depending on their health status, pain tolerance, and psychological state. Labor pain can drastically affect the birth process and delivery outcomes if not managed well, ranging from poor maternal satisfaction and impaired maternal-newborn bonding to prolonged labor and fetal distress. Since pharmacological pain relief methods harm the fetus, non-pharmacological pain relief methods are gaining popularity among laboring women and healthcare professionals. Objectives The study aimed to evaluate the effect of audio-visual therapy on labor pain and maternal anxiety. Methods A randomized, controlled, open-label, single-center trial was conducted among 76 primigravida women with no obstetrical complications during the active phase of labor (4-8 cm cervical dilatation). The participants were randomly assigned to an experimental group receiving 50 min of virtual reality intervention or a control group receiving standard care using a computer-generated random sequence. The data related to pain and anxiety were collected using the personal information form, anxiety assessment scale for pregnant women in labor, present behavioral intensity scale, numerical pain rating scale, and post-delivery birth satisfaction checklist. Results Groups were homogenous in terms of demographic and obstetric variables. The virtual reality intervention reduced the experimental group's reported pain intensity and anxiety score. However, no statistically significant difference was noted in maternal vital signs and labor and neonatal outcomes between the groups. Conclusion The virtual reality intervention reduced labor pain intensity and anxiety among laboring women compared to standard care.
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Affiliation(s)
- Nidhi Mahalan
- M.Sc. Nursing (Obstetrics and Gynecology), College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
| | - M.V. Smitha
- Associate Professor, College of Nursing, All India Institute of Medical Sciences, Bhubaneswar, Odisha 751019, India
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12
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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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13
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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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14
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Sewell T, Fung Y, Al-Kufaishi A, Clifford K, Quinn S. Does virtual reality technology reduce pain and anxiety during outpatient hysteroscopy? A randomised controlled trial. BJOG 2023; 130:1466-1472. [PMID: 37218438 DOI: 10.1111/1471-0528.17550] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2023] [Revised: 05/01/2023] [Accepted: 05/08/2023] [Indexed: 05/24/2023]
Abstract
OBJECTIVE To evaluate the effectiveness of virtual reality technology in reducing pain and anxiety during outpatient hysteroscopy. DESIGN A prospective randomised controlled trial. SETTING A London University Teaching Hospital. POPULATION Women aged 18-70 years undergoing outpatient hysteroscopy procedures. METHODS An unblinded randomised controlled trial was performed between March and October 2022 comparing standard outpatient hysteroscopy care with standard care with the addition of a virtual reality headset playing a virtual reality immersive scenario as a distraction technique. MAIN OUTCOME MEASURES Pain and anxiety numeric rating scores (NRS) from 0 to 11. RESULTS Eighty-three participants were randomly allocated to the control (n = 42) and virtual reality groups (n = 41). The virtual reality group experienced significantly less anxiety during the procedure than the control group (mean NRS 3.29 versus 4.73, mean difference 1.50; 95% confidence interval [CI] 0.12-2.88; P = 0.03). There was no difference in reported average pain (mean NRS 3.73. versus 4.24, mean difference 0.51; 95% CI -1.76 to 0.64; p = 0.41) or maximum pain scores (mean NRS 5.32 versus 5.07, mean difference 0.25; 95% CI -1.05 to 1.55; P = 0.71). CONCLUSIONS The use of virtual reality technology as an adjunct to standard care can reduce patient-reported anxiety but not pain during outpatient hysteroscopy procedures. Continued improvements in the technology and the development of increasingly immersive environments may continue to increase the potential to improve the patient experience in this setting.
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Affiliation(s)
- Thomas Sewell
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Yinka Fung
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Asmaa Al-Kufaishi
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Katy Clifford
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
| | - Stephen Quinn
- Department of Obstetrics and Gynaecology, St Mary's Hospital, London, UK
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15
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Kılıç S, Dereli Yılmaz S. Virtual Reality Headset Simulating a Nature Environment to Improve Health Outcomes in Pregnant Women: A Randomized-Controlled Trial. Clin Nurs Res 2023; 32:1104-1114. [PMID: 37408298 DOI: 10.1177/10547738231184923] [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: 07/07/2023]
Abstract
The single-blind randomized-controlled experimental study aimed to determine the effects of watching nature images through virtual reality (VR) headset on stress, anxiety, and attachment levels of pregnant women with preterm birth threats (PBTs). The participants were 131 primiparous pregnant women admitted to the perinatology clinic due to PBT between April 5, 2022 and July 20, 2022. The intervention group watched videos containing nature images accompanied by nature sounds in six sessions through VR headset three times daily for 2 days. Each session lasted for 5 min. The data were accumulated with the Information Form, Stress Subscale of Depression Anxiety Stress Scale-21, State Anxiety Inventory, Prenatal Attachment Inventory, and Information Form of Satisfaction Level of VR Headset. State anxiety and stress levels of pregnant women in intervention group were statistically significantly lower than those in controls. There was no difference in prenatal attachment levels concerning intragroup comparisons of intervention group.
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16
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Şolt Kırca A, Güdücü N, İkiz B. The Effect of Virtual Glasses Application on Pain and Anxiety During Episiotomy Repair: Randomized Controlled Trial. Pain Manag Nurs 2023; 24:e123-e130. [PMID: 37455184 DOI: 10.1016/j.pmn.2023.06.004] [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: 01/02/2023] [Revised: 06/16/2023] [Accepted: 06/21/2023] [Indexed: 07/18/2023]
Abstract
BACKGROUND In the literature, the efficacy of virtual glasses on acute pain and anxiety has been investigated, and no study has been found on its effect on pain and anxiety during episiotomy repair. AIMS To determine the efficacy of virtual glasses application in pain and anxiety during episiotomy repair. DESIGN Randomized controlled trial design was used. PARTICIPANTS The study included 120 women who were primiparous and pregnant: 40 in the control group and 80 in the experimental groups (virtual glasses and skin to skin contact). METHODS Data were collected using Descriptive Information Form, the Visual Analog Scale (VAS), and the State Anxiety Inventory. In experimental groups, virtual glasses and skin to skin contact were applied during episio tomy repair by the researcher, and they were not applied to the control group. The VAS and State Anxiety Inventory were used to assess pain and anxiety in all groups before and after application. In the statistical analysis of the data, the SPSS 23.0 packa ge program was used. In all tests, p < .005 wa s considered statistically significant. RESULTS Immediately post intervention, the women in the experimental groups had significantly decreased anxiety and pain during episiotomy repair. Comparing three methods, the virtual glasses significantly reduced anxiety and pain after application (p < .05). CONCLUSIONS Virtual glasses are more effective than skin to skin contact and control methods in decreasing pain and reducing anxiety during episiotomy repair. Additionally, virtual glasses may reduce the need for pharmacological medication due to this reduction in pain and anxiety during episiotomy repair.
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Affiliation(s)
- Ayça Şolt Kırca
- Kirklareli University School of Health Science, Midwifery Department, Kirklareli, Turkey.
| | - Neriman Güdücü
- Kirklareli University School of Health Science, Midwifery Department, Kirklareli, Turkey
| | - Bahar İkiz
- Kapaklı State Hospital, Çerkezköy, Turkey.
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17
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Fougère M, Greco-Vuilloud J, Arnous C, Abel F, Lowe C, Elie V, Marchand S. Sensory stimulations potentializing digital therapeutics pain control. FRONTIERS IN PAIN RESEARCH 2023; 4:1168377. [PMID: 37745799 PMCID: PMC10511651 DOI: 10.3389/fpain.2023.1168377] [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: 02/17/2023] [Accepted: 08/14/2023] [Indexed: 09/26/2023] Open
Abstract
For the past two decades, using Digital Therapeutics (DTx) to counter painful symptoms has emerged as a novel pain relief strategy. Several studies report that DTx significantly diminish pain while compensating for the limitations of pharmacological analgesics (e.g., addiction, side effects). Virtual reality (VR) is a major component of the most effective DTx for pain reduction. Notably, various stimuli (e.g., auditory, visual) appear to be frequently associated with VR in DTx. This review aims to compare the hypoalgesic power of specific stimuli with or without a VR environment. First, this review will briefly describe VR technology and known elements related to its hypoalgesic effect. Second, it will non-exhaustively list various stimuli known to have a hypoalgesic effect on pain independent of the immersive environment. Finally, this review will focus on studies that investigate a possible potentialized effect on pain reduction of these stimuli in a VR environment.
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Affiliation(s)
| | | | | | | | | | | | - Serge Marchand
- Lucine, Bordeaux, France
- Faculté de Médecine et des Sciences de la Santé, Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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18
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García-López FJ, Pastora-Bernal JM, Moreno-Morales N, Estebanez-Pérez MJ, Liñán-González A, Martín-Valero R. Virtual reality to improve low-back pain and pelvic pain during pregnancy: a pilot RCT for a multicenter randomized controlled trial. Front Med (Lausanne) 2023; 10:1206799. [PMID: 37731709 PMCID: PMC10507341 DOI: 10.3389/fmed.2023.1206799] [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: 04/16/2023] [Accepted: 08/14/2023] [Indexed: 09/22/2023] Open
Abstract
A significant proportion of women experience low back and pelvic pain during and after pregnancy, which can negatively impact their daily lives. Various factors are attributed to these complaints, and many affected women do not receive adequate healthcare. However, there is evidence to support the use of different physiotherapeutic interventions to alleviate these conditions. Virtual reality is a promising complementary treatment to physiotherapy, particularly in improving pain perception and avoidance. The primary objective of this study is to evaluate the efficacy of a four-week program combining VR and physiotherapy compared to standard physiotherapy in pregnant women with low back and pelvic pain, in terms of improving pain avoidance, intensity, disability, and functional level. The study also aims to investigate patient satisfaction with the VR intervention. This research will be conducted through a multi-center randomized controlled clinical trial involving pregnant patients residing in the provinces of Seville and Malaga with a diagnosis of low back and pelvic pain during pregnancy. The alternative hypothesis is that the implementation of a Virtual Reality program in combination with standard physiotherapy will result in better clinical outcomes compared to the current standard intervention, which could lead to the development of new policies and interventions for these pathologies and their consequences. Clinical trial registration: clinicaltrials.gov, identifier NCT05571358.
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Affiliation(s)
| | | | - Noelia Moreno-Morales
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Malaga, Spain
| | - María-José Estebanez-Pérez
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Malaga, Spain
- Department of Physiotherapy, Faculty of Health Science, Campus of Melilla, University of Granada, Melilla, Spain
| | - Antonio Liñán-González
- Department of Nursing, Faculty of Health Science, Campus of Melilla, University of Granada, Melilla, Spain
| | - Rocío Martín-Valero
- Department of Physiotherapy, Faculty of Health Science, University of Malaga, Malaga, Spain
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19
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Viderman D, Tapinova K, Dossov M, Seitenov S, Abdildin YG. Virtual reality for pain management: an umbrella review. Front Med (Lausanne) 2023; 10:1203670. [PMID: 37521355 PMCID: PMC10382225 DOI: 10.3389/fmed.2023.1203670] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/15/2023] [Indexed: 08/01/2023] Open
Abstract
Background and objective Virtual reality is a promising pain control strategy for various pain conditions. This umbrella review of systematic reviews and meta-analyses aims to evaluate the analgesic effects of virtual reality. Methods We searched for the relevant reviews in Scopus, PubMed and Cochrane library. Our primary outcome was pain, with secondary outcomes including disability, general health status, patient satisfaction, depression, balance, fear of movement, and adverse events. The quality of included articles was evaluated using the AMSTAR-2 tool. Results 21 systematic reviews and meta-analyses with 274 studies and 17,680 patients were included in this review. All the reviews concluded benefits of virtual reality in managing pain conditions, including chronic and pain. Discussion and conclusions This umbrella review demonstrates successful application of virtual reality in pain control, including perioperative, periprocedural, and chronic pain settings. Virtual reality can be used as an alternative therapy for pain management in children and adults.
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Affiliation(s)
- Dmitriy Viderman
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
- Department of Anesthesiology and Intensive Care, National Research Oncology Center, Astana, Kazakhstan
| | - Karina Tapinova
- School of Medicine, Nazarbayev University, Astana, Kazakhstan
| | - Mukhit Dossov
- Department of Anesthesiology and Critical Care, Presidential Hospital, Astana, Kazakhstan
| | - Serik Seitenov
- Department of Anesthesiology and Critical Care, Presidential Hospital, Astana, Kazakhstan
| | - Yerkin G. Abdildin
- School of Engineering and Digital Sciences, Nazarbayev University, Astana, Kazakhstan
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20
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Orhan M, Bülez A. The Effect of Virtual Reality Glasses Applied During the Episiotomy On Pain and Satisfaction: A Single Blind Randomized Controlled Study. J Pain Res 2023; 16:2227-2239. [PMID: 37404226 PMCID: PMC10317539 DOI: 10.2147/jpr.s412883] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 06/17/2023] [Indexed: 07/06/2023] Open
Abstract
Objective The research was conducted as a randomized controlled study to determine the effect of virtual reality glasses on the mother's pain and satisfaction during episiotomy. Methods The sample consisted of 50 pregnant women determined by randomization among primiparous pregnant women. Data were collected with the Mother Information Form and Visual Analog Scales Pain and Satisfaction Evaluation forms. 5 mL of lidocaine was administered to mothers in the intervention and control groups during episiotomy repair. Only the mothers in the intervention group watched a video with virtual reality glasses for an average of 10 minutes during the episiotomy procedure. SPSS 22.0 was used in the analysis. Results In the comparison between the groups, it was found that the mean pain score measured during episiotomy inner and episiotomy skin suturing was statistically significantly lower in the intervention group than in the control group; there was no significant difference between the intervention and control groups in the mean pain scores measured before and after episiotomy repair. It was determined that the mean satisfaction score of the intervention group was higher than that of the control group. Conclusion Virtual reality glasses reduced pain during episiotomy and increased satisfaction. According to the results, it is recommended to be used by midwives because it is an easily applicable non-pharmacological method and increases the mother's birth satisfaction.
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Affiliation(s)
- Merva Orhan
- Kahramanmaras Necip Fazil City Hospital, Obstetric Clinic, Kahramanmaraş, Turkey
| | - Aysel Bülez
- Kahramanmaras Sütcü Imam University, Faculty of Health Sciences, Midwifery Department, Kahramanmaraş, Turkey
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Pelazas-Hernández JA, Varillas-Delgado D, González-Casado T, Cristóbal-Quevedo I, Alonso-Bermejo A, Ronchas-Martínez M, Cristóbal-García I. The Effect of Virtual Reality on the Reduction of Pain in Women with an Indication for Outpatient Diagnostic Hysteroscopy: A Randomized Controlled Trial. J Clin Med 2023; 12:jcm12113645. [PMID: 37297840 DOI: 10.3390/jcm12113645] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Revised: 05/19/2023] [Accepted: 05/22/2023] [Indexed: 06/12/2023] Open
Abstract
Background: The cognitive distraction caused by Virtual Reality (VR) seems to cause a decrease both in pain and its perception as in the time spent thinking about possible pain, among anxiety about hysteroscopy procedure. The main objective of this investigation was to evaluate the efficacy of virtual reality for pain relief during outpatient hysteroscopy. Method: A total of 83 patients underwent outpatient diagnostic hysteroscopy in a single-centre, open-label, randomized control trial. Overall, 180 women with medical indication for an outpatient diagnostic hysteroscopy were randomized. Ten were excluded due to the impossibility of entering the endometrial cavity caused by a cervical canal that was not permeable, and 15 did not tolerate the pain at the beginning and during the procedure, excluding themselves from the final model. Finally, 154 were analysed per protocol to use VR (n = 82, study group) or standard treatment (n = 72, control group) assessing the differences between both groups by reduction in pain using Visual Analogue Scale score (VAS: 0-10 cm) and clinical data (arterial pressure, heart rate, and oxygen saturation) at the end of hysteroscopy, at 15 and 30 min after hysteroscopy. Results: Women with VR outpatient diagnostic hysteroscopy experienced less pain at final (VAS score 2.451 vs. 3.972, standard mean difference (SMD) -1.521, 95% CI -2.601 to -0.440; p = 0.006), at 15 min (VAS 1.769 vs. 3.300, SMD -1.531, 95% CI -2.557 to -0.504; p = 0.004), and at 30 min (VAS 1.621 vs. 2.719, SMD -1.099, 95% CI -2.166 to -0.031; p = 0.044) after the ending of the hysteroscopy, compared with no VR. Conclusions: The use of VR during outpatient diagnostic hysteroscopy proved effective in the reduction of pain in this randomized control trial. It shows wide potential role in ambulatory gynaecologic procedures to avoid repeating tests, perform surgeries without anaesthesia, and the use of medication and its side effects.
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Affiliation(s)
- Jesus A Pelazas-Hernández
- Department of Obstetrics and Gynaecology, El Escorial University Hospital, 28200 Madrid, Spain
- Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | | | - Teresa González-Casado
- Department of Obstetrics and Gynaecology, Sierra de Guadarrama Health Centre, 28440 Madrid, Spain
| | | | - Agustina Alonso-Bermejo
- Department of Obstetrics and Gynaecology, El Escorial University Hospital, 28200 Madrid, Spain
| | - Marina Ronchas-Martínez
- Department of Obstetrics and Gynaecology, El Escorial University Hospital, 28200 Madrid, Spain
| | - Ignacio Cristóbal-García
- Faculty of Medicine, Universidad Francisco de Vitoria, 28223 Madrid, Spain
- Department of Obstetrics and Gynaecology, San Carlos Clinic Hospital, 28040 Madrid, Spain
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22
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Musters A, Vandevenne AS, Franx A, Wassen MMLH. Virtual Reality Experience during Labour (VIREL); a qualitative study. BMC Pregnancy Childbirth 2023; 23:283. [PMID: 37095433 PMCID: PMC10123587 DOI: 10.1186/s12884-023-05432-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/07/2023] [Indexed: 04/26/2023] Open
Abstract
BACKGROUND There is increasing evidence that virtual reality (VR) is effective in the reduction of labour pain. The implementation of alternative methods like VR to reduce labour pain can contribute to reduce patient request for pharmacological pain management methods and associated side effects. The aim of this study is to examine women's experiences, preferences and satisfaction in regard to the use of VR during labour. METHODS A qualitative interview study was conducted in a non-university teaching hospital in The Netherlands. Two VR applications, respectively a guided meditation and an interactive game were tested in eligible women with a singleton pregnancy, scheduled for induction of labour. For the primary outcome, patients' VR experience and application preference (meditation vs. game) were examined using a post-intervention questionnaire and a semi-structured interview. Three categories (with sub-categories) were used to guide interviews: "The VR experience", "Pain reduction", and "Usability of the VR application". Labour pain before and directly after VR was evaluated using the NRS score. RESULTS Twenty-four women, of whom 14 were nulliparous and ten multiparous, were included and 12 of these women participated in semi-structured interviews. Using within-subject paired t-test comparisons, compared to pain pre-VR, patients reported a highly significant 26% decrease in mean NRS scores during VR meditation (pain pre-VR = 6.71 + - 1.65 vs. pain after VR = 4.96 + - 2.01) [p < 0.001]. Compared to pain before VR game, patients also reported a highly significant 19% decrease in mean NRS scores during VR game (pain before VR game = 6.89 + - 1.88 vs. pain after VR game = 5.61 + - 2.23) [p = 0.001]. CONCLUSION All women were highly satisfied with VR use during labour. Patients reported a highly significant reduction in pain during the interactive VR game and during meditation, patients preferred guided meditation. These results can contribute to the development of a potential promising new non-pharmacological tool to reduce labour pain. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT04858984, date of registration: 26/04/2021 (retrospectively registered).
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Affiliation(s)
- A Musters
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, P.O. Box 4446, Heerlen, 6401 CX, The Netherlands.
| | - A S Vandevenne
- Maastricht University, P.O. Box 616, Maastricht, 6200 MD, The Netherlands
| | - A Franx
- Department of Obstetrics and Gynaecology, Erasmus Medical Centre, P.O. Box 2060, Rotterdam, 3000 CB, The Netherlands
| | - M M L H Wassen
- Department of Obstetrics and Gynaecology, Zuyderland Medical Centre, P.O. Box 4446, Heerlen, 6401 CX, The Netherlands
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23
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Mohammadi H, Rasti J, Ebrahimi E. Virtual Reality, Fear of Pain and Labor Pain Intensity: A Randomized Controlled Trial. Anesth Pain Med 2023; 13:e130387. [PMID: 37489168 PMCID: PMC10363358 DOI: 10.5812/aapm-130387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 01/04/2023] [Accepted: 01/06/2023] [Indexed: 07/26/2023] Open
Abstract
Background Labor and delivery are physiological conditions that occur due to the contraction of the smooth muscles of the uterus. Labor pain is one of the most severe pains that anyone can experience, and its control is one of the most important goals of health care. Methods This study was performed on 130 healthy pregnant women who had gestational ages of 37 to 40 weeks and were randomly assigned to the intervention and control groups using the closed envelope technique. Then a virtual reality (VR) headset containing a game was provided to the study subjects in the intervention group. The Harman Fear of childbirth questionnaire and visual analog scale (VAS) were completed at different times across labor according to the study protocol. The minimum time for using the headset was 20 minutes until the end of the first stage of labor. Data were analyzed using the chi-square test, independent t-test, and repeated measures test via SPSS software version 20. Results The results showed a significant difference in pain score between the study groups. Despite expecting increasing pain intensity with labor progression, participants in the VR group reported less pain intensity and fear of labor pain compared to control subjects (F = 8.18, P < 0.05, between four and ten cervical dilatations). Conclusions Virtual reality interventions can be regarded as a new non-pharmaceutical strategy to control labor pain and fear of normal vaginal delivery in pregnant women.
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Affiliation(s)
- Halimeh Mohammadi
- Msc in Midwifery, Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
| | - Javad Rasti
- Assistant Professor, Biomedical Engineering Department, Faculty of Engineering, University of Isfahan, Isfahan, Iran
| | - Elham Ebrahimi
- Assistant Professor of Reproductive Health, Department of Reproductive Health, School of Nursing and Midwifery, Tehran University of Medical Sciences, Tehran, Iran
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Siivola M, Tiainen E, Ekholm E, Leinonen T, Malmi L. Virtual Reality Childbirth Education With 360° Videos. J Perinat Educ 2023; 32:35-47. [PMID: 36632515 PMCID: PMC9822558 DOI: 10.1891/jpe-2021-0021] [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: 01/07/2023] Open
Abstract
During the pandemic in Finland, most childbirth education (CBE) programs were canceled or transferred online. We aimed to improve the situation by developing a virtual reality (VR) CBE. This article describes the process of developing a VR CBE pilot program and the results from the preliminary user test. To create the VR experience, we used 360° videos as the main content. The program is usable with VR headsets, a computer, tablet, and smartphone. When using the program with a VR headset, the users felt they were in the birthing room; they did not feel motion sickness, nor did they have usability challenges. The users preferred using the program on their own, studying independently with a tablet or mobile device.
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25
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Estrella-Juarez F, Requena-Mullor M, Garcia-Gonzalez J, Lopez-Villen A, Alarcon-Rodriguez R. Effect of Virtual Reality and Music Therapy on the Physiologic Parameters of Pregnant Women and Fetuses and on Anxiety Levels: A Randomized Controlled Trial. J Midwifery Womens Health 2023; 68:35-43. [PMID: 36383473 DOI: 10.1111/jmwh.13413] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 08/10/2022] [Accepted: 08/12/2022] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Anxiety negatively affects pregnant women and their fetuses. It can cause misleading test readings in electronic fetal monitoring, affect the duration of the first stage of labor, and influence certain aspects related to childbirth. This study aimed to evaluate the effects of virtual reality and music therapy on anxiety levels, maternal and fetal physiologic parameters, and labor and birth outcomes. METHODS A total of 343 full-term pregnant women participated in a randomized controlled trial and were divided into 3 parallel groups: music therapy intervention (n = 104), virtual reality intervention (n = 124), and control (n = 115). The interventions were delivered during a nonstress test in the third trimester and during labor. Data were collected from April 2017 to May 2018. Measures included the Spielberger State-Trait Anxiety Inventory, maternal blood pressure, maternal and fetal heart rates, and labor and birth outcomes. The study was registered in the Australian New Zealand Clinical Trial Registry (ACTRN12621001647820). RESULTS Women in the music therapy and virtual reality groups had lower levels of anxiety after a nonstress test (P < .001), and the women were more likely to have a reactive nonstress test (P < .001) compared with the control group. After the nonstress test and intervention were complete, the music therapy and virtual reality groups had significant decreases in systolic blood pressure (P < .001), diastolic blood pressure (P < .001), and maternal heart rate (P = .003) compared with the control group. Furthermore, fetuses in the control group were more likely to experience nonreassuring fetal heart rate tracings compared with the music therapy and virtual reality groups, respectively (P = .004). DISCUSSION Our findings support the use of music and virtual reality during nonstress tests and labor as nonpharmacologic interventions to reduce anxiety, improve maternal and fetal physiologic parameters, and improve labor and birth outcomes. This research should be replicated in diverse perinatal settings.
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Affiliation(s)
| | - Mar Requena-Mullor
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | - Jessica Garcia-Gonzalez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
| | | | - Raquel Alarcon-Rodriguez
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, Almería, Spain
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26
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Wong MS, Gregory KD, Spiegel BMR, Khalil C. Patient perceptions of virtual reality for pain relief in labor: A qualitative study. FRONTIERS IN PAIN RESEARCH (LAUSANNE, SWITZERLAND) 2022; 3:1063751. [PMID: 36582195 PMCID: PMC9792960 DOI: 10.3389/fpain.2022.1063751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022]
Abstract
Introduction Labor represents the most common reason for hospitalization, and most patients will use some form of pain management during their labor. While some studies have suggested that virtual reality (VR) may be an effective option for managing pain, more study is necessary to understand the patient experience of VR. The aim of this study is to characterize the effect of VR on patient perceptions of coping in labor and their descriptions of the VR experience. Methodology A nested prospective, descriptive study within a randomized controlled trial of VR in laboring patients. We included nulliparous, term patients, having contractions at least every 5 min, a pain score on the Wong-Baker pain scale of 4-7, and who had been randomized to receive the 30 min virtual reality intervention in the trial. Subjects completed a childbirth self-efficacy inventory prior to the intervention. After the intervention, they completed a modified childbirth self-efficacy inventory related to VR and underwent a structured interview. Self-efficacy scores were compared using t-tests and qualitative, thematic analysis was performed using Dedoose. Results Twenty-one subjects received the VR intervention. Twenty subjects completed the post-intervention survey and structured interview; one declined due to discomfort. Subjects noted a significant increase in perceived degree to which VR could improve their self-efficacy in managing pain during labor. Thematic analysis revealed that subjects described the VR experience as allowing them to connect with their breathing, feeling more relaxed, and being distracted from pain. In total, 70% believed VR reduced their pain, 60% felt it reduced their anxiety, and 100% would recommend VR availability for laboring patients. Conclusion VR can improve patient self-efficacy for managing pain in labor. Future studies should focus on the content of the visualizations, optimized user experience and design, and effectiveness with ongoing exposure to VR content in labor.
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Affiliation(s)
- Melissa S. Wong
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Kimberly D. Gregory
- Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Department of Obstetrics and Gynecology, David Geffen School of Medicine at UCLA, Los Angeles, CA, United States,Department of Community Health Sciences, UCLA Fielding School of Public Health, Los Angeles, CA, United States
| | - Brennan M. R. Spiegel
- Division of Informatics, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States,Division of Digestive and Liver Diseases, Cedars-Sinai Medical Center, Los Angeles, CA, United States,Division of Health Services Research, Cedars-Sinai Medical Center, Los Angeles, CA, United States
| | - Carine Khalil
- Cedars-Sinai Center for Outcomes Research and Education (CS-CORE), Los Angeles, CA, United States,Le Laboratoire Interdisciplinaire de Recherche Appliquée en Economie de la Santé (LIRAES) Lab, Paris Descartes University, Paris, France
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27
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Xu N, Chen S, Liu Y, Jing Y, Gu P. The Effects of Virtual Reality in Maternal Delivery: Systematic Review and Meta-analysis. JMIR Serious Games 2022; 10:e36695. [DOI: 10.2196/36695] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 07/04/2022] [Accepted: 10/11/2022] [Indexed: 11/24/2022] Open
Abstract
Background
Extreme labor pain has negative effects; pharmacologic analgesic modalities are effective but are accompanied by adverse effects. Virtual reality (VR) works as a distracting nonpharmacologic intervention for pain and anxiety relief; however, the effects of VR use in laboring women is unknown.
Objective
Our study aimed to determine the safety and effectiveness of VR technology during labor and delivery and investigate whether it impacts labor and patient satisfaction.
Methods
In all, 7 databases (PubMed, Embase, Web of Science, the Cochrane Library, CINAHL, China National Knowledge Infrastructure, and Wan-Fang Database) were systematically searched for randomized controlled trials of VR use in pregnancy and childbirth from the time of database construction until November 24, 2021. Two researchers extracted data and evaluated study quality using the Cochrane Risk of Bias tool 2.0. Outcome measures were labor pain, anxiety, duration, satisfaction, and adverse events. Meta-analyses were performed where possible.
Results
A total of 12 studies with 1095 participants were included, of which 1 and 11 studies were rated as “Low risk” and “Some concerns” for risk of bias, respectively. Of the 12 studies, 11 reported labor pain, 7 reported labor anxiety, and 4 reported labor duration. Meta-analysis revealed that VR use could relieve pain during labor (mean difference –1.81, 95% CI –2.04 to –1.57; P<.001) and the active period (standardized mean difference [SMD] –0.41, 95% CI –0.68 to –0.14; P=.003); reduce anxiety (SMD –1.39, 95% CI –1.99 to –0.78; P<.001); and improve satisfaction with delivery (relative risk 1.32, 95% CI 1.10-1.59; P=.003). The effects of VR on the duration of the first (SMD –1.12, 95% CI –2.38 to 0.13; P=.08) and second (SMD –0.22, 95% CI –0.67 to 0.24; P=.35) stages of labor were not statistically significant.
Conclusions
VR is safe and effective in relieving maternal labor pain and anxiety; however, due to the heterogeneity among studies conducted to date, more rigorous, large-scale, and standardized randomized controlled trials are required to provide a higher-quality evidence base for the use of VR technology in maternal labor, with the aim of improving experience and outcomes.
Trial Registration
PROSPERO CRD42021295410; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=295410
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Affiliation(s)
- Fahad Alam
- From the Department of Anesthesia, Sunnybrook Health Sciences Centre.,Sunnybrook Simulation Centre, Toronto, Ontario, Canada.,Wilson Centre for Research in Medical Education, Temerty Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada.,Canadian Anesthesiologists' Society-Simulation and Education Section, Toronto, Ontario, Canada.,Collaborative Human ImmerSive Interaction Laboratory, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Clyde Matava
- Collaborative Human ImmerSive Interaction Laboratory, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia and Pain Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
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29
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Virtual reality and its use in post-operative pain following laparoscopy: a feasibility study. Sci Rep 2022; 12:13137. [PMID: 35907935 PMCID: PMC9338945 DOI: 10.1038/s41598-022-17183-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 07/21/2022] [Indexed: 11/21/2022] Open
Abstract
Pain following laparoscopic surgery remains a neglected healthcare issue. Virtual reality-mediated therapy’s (VRT) analgesic potential could address this. However, its effect in this setting remains unexplored. We aimed to establish the feasibility and safety of VRT as an adjunct analgesic following gynaecological laparoscopy and explore differences between active distraction and passive meditation content. 35 women were enrolled into an open crossover pilot and randomised to either intervention group 1 (active then passive content) or intervention group 2 (passive then active content) following surgery. VRT was administered in two 10-min segments with a 10-min washout period in between. Pain scores, opioid requirements and side effects were recorded before and after each segment whilst questionnaires evaluated acceptability. We observed a significant reduction in pain over time for the entire study population (F = 8.63, p < 0.0005) but no differences between intervention groups, in contrast to many studies demonstrating an increase in pain during this time. During segment one, intervention group 1 (n = 18) were administered significantly less opioid than intervention group 2 (n = 17) [0.0 (0.0–7.5) vs. 3.0(0.0–10.0), p = 0.04]. Intervention group 1 rated the VRT experience significantly higher than intervention group 2 (7.97 vs. 6.62. p = 0.017). 97.1% (n = 34) would recommend VRT to a friend and use it as the standard-of-care in future procedures. These results demonstrate that post-operative VRT is feasible and safe. However, adequately powered studies are needed to appropriately determine its efficacy.
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Zangirolami-Raimundo J, Noll PRES, Raimundo RD, Gonçalves GL, Urso EME, Bech GD, Frank YS, Abreu LCD, Baracat EC, Sorpreso ICE, Soares Júnior JM. Use of interventions involving virtual reality tasks during the climacteric: a systematic review. Climacteric 2022; 25:543-551. [PMID: 35771198 DOI: 10.1080/13697137.2022.2088275] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Technological advances have been impacting health care worldwide. Our study aimed to research the literature systematically to determine the impact of technological treatments versus conventional treatments on the quality of life of climacteric women. The study was registered on PROSPERO (CRD42021241638). We searched seven databases, including PRISMA, using mesh terms. After screening for eligibility, we selected five clinical trials, and applying the snowball technique we were able to include four more articles, totaling nine articles that used technology-based interventions (virtual reality games) during the climacteric. The total study population consisted of 298 climacteric women. Two studies evaluated a technology-based treatment for pelvic floor, one for urinary incontinence symptoms, three for postural balance, one for cardiorespiratory capacity, one for osteoporosis and one study for lower back pain. The studies showed that the technological treatments improved pelvic floor strength, balance, cardiorespiratory fitness and bone mineral density when compared to conventional treatments. Improvement was linked to adherence to training and a high level of satisfaction during the training sessions. Technology-based treatments appear to be a viable alternative to conventional treatments in improving the quality of health, with benefits for the cardiovascular, genitourinary and skeletal systems, and ultimately for the overall quality of life.
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Affiliation(s)
- J Zangirolami-Raimundo
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil.,Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - P R E S Noll
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - R D Raimundo
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - G L Gonçalves
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - E Mattos E Urso
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - G D Bech
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - Y S Frank
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil
| | - L C de Abreu
- Laboratório de Delineamento de Estudos e Escrita Científica, Departamento de Saúde da Coletividade, Centro Universitário FMABC, Santo André, Brazil.,Departamento de Educação Integrada em Saúde, Universidade Federal do Espírito Santo, Vitoria, Brazil
| | - E C Baracat
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - I C E Sorpreso
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
| | - J M Soares Júnior
- Disciplina de Ginecologia, Departamento de Obstetrícia e Ginecologia, Hospital das Clínicas, Faculdade de Medicina FMUSP, Universidade de São Paulo, São Paulo, Brazil
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Baker NA, Polhemus AH, Haan Ospina E, Feller H, Zenni M, Deacon M, DeGrado G, Basnet S, Driscoll M. The State of Science in the Use of Virtual Reality in the Treatment of Acute and Chronic Pain: A Systematic Scoping Review. Clin J Pain 2022; 38:424-441. [PMID: 35537072 DOI: 10.1097/ajp.0000000000001029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 12/06/2021] [Indexed: 12/14/2022]
Abstract
Previous reviews have reported virtual reality (VR) to be an effective method to treat pain. This scoping review examines the state of the science for VR and pain both generally and by pain type (acute and chronic) related to types of mechanisms, dosage, effectiveness, and adverse events (AEs). We searched online databases PubMed, Web of Science, PsychInfo, and CINAHL from 2010 to 2020 and included studies from peer reviewed journals that examined people with pain, (excluding pain-free participants) with a primary outcome measuring pain. We assessed studies for risk of bias using PEDro criteria. We described data through counts and percentages. Significant results were determined through P-values. We found 70 studies representing 4105 people; 46 acute pain studies (65.7%), 22 chronic pain studies (31.4%), and 2 (2.9%) "both." The most common VR mechanism was distraction (78.6%) then embodiment (17.1%). However, distraction was the mechanism for 97.8% acute pain studies while embodiment was more common for chronic pain (54.5%). Dosage of VR was inconsistently reported and varied considerably. VR treatment groups showed significant improvements in pain, particularly for intensity of pain (72.1%) and quality of pain (75.0%). Few studies examined AEs. Limitations of this review include only examining last 10 years of articles and that many studies were missing data. VR appears to be an effective intervention to address both acute and chronic pain. Research evaluating VR mechanisms, dosage, and AEs is warranted, as is further work in under-served populations (children for chronic pain and older adults) as the current evidence is largely limited to adult populations with pain.
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Affiliation(s)
- Nancy A Baker
- Department of Occupational Therapy, Tufts University, Medford MA
| | | | - Emma Haan Ospina
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Haley Feller
- John H. Stroger, Jr. Hospital of Cook County, Chicago, IL
| | - Miranda Zenni
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Megan Deacon
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Grace DeGrado
- Department of Occupational Therapy, Tufts University, Medford MA
| | - Sami Basnet
- Department of Occupational Therapy, Tufts University, Medford MA
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Taki F, Lurie J, Kaur G. An ethical plan for including forcibly displaced persons in omics and digital technology research. Nat Med 2022; 28:1116-1120. [PMID: 35513531 PMCID: PMC9464352 DOI: 10.1038/s41591-022-01801-7] [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: 11/09/2022]
Abstract
Forcibly displaced persons, such as refugees, are at an increased risk of physical and mental health conditions and so would benefit from novel healthcare technologies, research on which can be conducted under an ethical framework.
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Affiliation(s)
- Faten Taki
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA.
| | - Jacob Lurie
- NewYork-Presbyterian Hospital, New York, NY, USA
| | - Gunisha Kaur
- Department of Anesthesiology, Weill Cornell Medicine, New York, NY, USA
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Baradwan S, Khadawardi K, Badghish E, Alkhamis WH, Dahi AA, Abdallah KM, Kamel M, Sayd ZS, Mohamed MA, Ali HM, Elhalim AEMA, Mahmoud M, Mohamed AA, Mohamed DF, Shama AAA, Hagras AM, Ali HAA, Abdelhakim AM, Saleh M, Badawy MA, Bakry MS. The impact of virtual reality on pain management during normal labor: A systematic review and meta-analysis of randomized controlled trials. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 32:100720. [PMID: 35381438 DOI: 10.1016/j.srhc.2022.100720] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2021] [Revised: 02/28/2022] [Accepted: 03/18/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To evaluate the impact of virtual reality on pain management during normal labor. METHODS A systematic search was performed in September 2021 through PubMed, Cochrane Library, Scopus, and ISI web of science. We selected randomized clinical trials (RCTs) that compared virtual reality in the intervention group versus placebo or no intervention in the control group among laboring women during their normal delivery. Revman software was used for performing our meta-analysis. Our primary outcome was the pain score evaluated during the labor process by the Visual Analog Scale (VAS). Our secondary outcomes were anxiety and satisfaction scores during childbirth in addition to the duration of the first and second stages of labor. RESULTS Eight RCTs met our inclusion criteria with a total number of 466 patients. We found virtual reality was linked to a significant reduction in the VAS pain score during labor compared to the control group (MD = -1.40, 95% CI [-1.83, -0.96], p < 0.001). The anxiety score during labor was significantly reduced among the virtual reality group (SMD = -1.15, 95% CI [-2.18, -0.12], p = 0.03). Moreover, virtual reality significantly improved the satisfaction score during labor (MD = 15.58, 95% CI [4.93, 26.22], p = 0.004). However, there were no significant differences between virtual reality and control groups regarding the duration of the first and second stages of labor. CONCLUSIONS Virtual reality is an effective technique for reducing anxiety, increasing satisfaction, and improving pain management during normal labor.
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Affiliation(s)
- Saeed Baradwan
- Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Khalid Khadawardi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
| | - Ehab Badghish
- Department of Obstetrics and Gynecology, Maternity and Children Hospital, Makkah, Saudi Arabia
| | - Waleed H Alkhamis
- Department of Obstetrics and Gynecology, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Ali Abdelmoezz Dahi
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Khaled M Abdallah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Medhat Kamel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Zainab Shehata Sayd
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | - Hamdi Mohamed Ali
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | | | - Mohamed Mahmoud
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | - Asmaa Abdelaal Mohamed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | - Doaa Fathy Mohamed
- Department of Obstetrics and Gynecology, Faculty of Medicine for Girls, Al-Azhar University, Cairo, Egypt
| | | | - Ayman M Hagras
- Department of Urology, Faculty of Medicine, Tanta University Hospitals, Tanta, Egypt
| | - Hazem Abd Allah Ali
- Department of Anesthesia and Intensive Care and Pain Management, Faculty of Medicine, Al-Azhar University, Cairo, Egypt
| | | | - Mohamed Saleh
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mahmoud A Badawy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Al-Azhar University, Assiut, Egypt
| | - Mohamed Sobhy Bakry
- Department of Obstetrics and Gynecology, Faculty of Medicine, Fayoum University, Fayoum, Egypt
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Merlot B, Dispersyn G, Husson Z, Chanavaz-Lacheray I, Dennis T, Greco-Vuilloud J, Fougère M, Potvin S, Cotty-Eslous M, Roman H, Marchand S. Pain reduction with an immersive digital therapeutic in women suffering from endometriosis-related pelvic pain: a randomized, controlled, open-label, two-parallel-group, interventional pilot study (Preprint). J Med Internet Res 2022; 24:e39531. [PMID: 36129733 PMCID: PMC9536521 DOI: 10.2196/39531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/26/2022] [Accepted: 08/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background Objective Methods Results Conclusions Trial Registration
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Affiliation(s)
- Benjamin Merlot
- Franco European Multidisciplinary Endometriosis Institute (IFEMEndo), Bordeaux, France
| | | | - Zoé Husson
- Franco European Multidisciplinary Endometriosis Institute (IFEMEndo), Bordeaux, France
| | | | - Thomas Dennis
- Franco European Multidisciplinary Endometriosis Institute (IFEMEndo), Bordeaux, France
| | | | | | - Stéphane Potvin
- Centre de Recherche de l'Institut Universitaire en Santé Mentale de Montréal, Montréal, QC, Canada
| | | | - Horace Roman
- Franco European Multidisciplinary Endometriosis Institute (IFEMEndo), Bordeaux, France
| | - Serge Marchand
- Lucine, Bordeaux, France
- Faculté de Médecine et des Sciences de la Santé, Centre de Recherche Clinique du Centre Hospitalier Universitaire de Sherbrooke, Université de Sherbrooke, Sherbrooke, QC, Canada
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Sharpe EE, Rollins MD. Beyond the epidural: Alternatives to neuraxial labor analgesia. Best Pract Res Clin Anaesthesiol 2022; 36:37-51. [PMID: 35659959 DOI: 10.1016/j.bpa.2022.04.005] [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: 02/28/2022] [Revised: 03/28/2022] [Accepted: 04/12/2022] [Indexed: 11/26/2022]
Abstract
Labor creates an intense pain experienced by women across the world. Although neuraxial analgesia is the most effective treatment of labor pain, in many cases, it may not be undesired, not available, or have contraindications. In addition, satisfaction with labor analgesia is not only determined by the efficacy of analgesia but a woman's sense of agency and involvement in the childbirth experience are also key contributors. Providing safe choices for labor analgesia and support is central to creating a tailored, safe, and effective analgesic treatment plan with high maternal satisfaction. Healthcare provider knowledge of various nonneuraxial analgesic options, including efficacy, contraindications, safe clinical implementation, and side effects of various techniques is needed for optimal patient care and satisfaction. Future rigorous scientific studies addressing all of these labor analgesia options are needed to improve our understanding. This review summarizes the current published literature for commonly available non-neuraxial labor analgesic options.
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Affiliation(s)
- Emily E Sharpe
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Mark D Rollins
- Department of Anesthesia and Perioperative Medicine, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
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Schuermans J, Van Hootegem A, Van den Bossche M, Van Gendt M, Witvrouw E, Wezenbeek E. Extended reality in musculoskeletal rehabilitation and injury prevention - A systematic review. Phys Ther Sport 2022; 55:229-240. [DOI: 10.1016/j.ptsp.2022.04.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 04/29/2022] [Accepted: 04/29/2022] [Indexed: 10/18/2022]
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Carus EG, Albayrak N, Bildirici HM, Ozmen SG. Immersive virtual reality on childbirth experience for women: a randomized controlled trial. BMC Pregnancy Childbirth 2022; 22:354. [PMID: 35461248 PMCID: PMC9034564 DOI: 10.1186/s12884-022-04598-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2021] [Accepted: 03/16/2022] [Indexed: 11/10/2022] Open
Abstract
OBJECTIVE To evaluate the effectiveness of immersive virtual reality (VR) on patient satisfaction as a distractive tool and pain relief among laboring women. METHODS This was a randomized, controlled clinical trial with 42 laboring women allocated to VR intervention and control groups. Among women in the VR group, patient satisfaction with the use of VR was assessed by a Virtual Reality Satisfaction Survey, measured by a Visual Analog Scale (VAS) score and evaluated by questioning them about whether they would choose VR in future labor. As a primary outcome, patient satisfaction scores regarding the overall childbirth experience were compared between women in the two groups. A secondary outcome was pain assessed by a visual pain rating scale in the early and active phases of labor in women in both groups. Psychometric information was also collected from participants in each group using the Beck Anxiety Inventory and Beck Depression Inventory. RESULTS We observed a high level of patient satisfaction with the use of immersive VR during labor. The VAS revealed a mean satisfaction score of 87.7 ± 12.9 out of a maximum of 100. Twenty out of 21 (95%) women in the VR group stated that they would like to use VR again in future labor. VR improved pain scores in early labor and contributed positively to the overall childbirth experience. The mean pain score pre-VR was 2.6 ± 1.2 compared to 2.0 ± 1.3 post-VR (p < 0.01). Anxiety and depression scores were similar in participants in the intervention and control groups (p = 0.103 and p = 0.13, respectively). CONCLUSION Immersive VR application during labor was associated with higher patient satisfaction based on our study findings. VR also improved participants' pain scores in early labor before epidural administration. Immersive VR may find a place as an adjunct in labor and delivery units to improve lengthy labor experiences for women. Studies with larger groups of participants are needed to confirm these observations. TRIAL REGISTRATION ClinicalTrials.gov: NCT05032456.
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Affiliation(s)
- Elif Gizem Carus
- Graduate School of Health Sciences, Neuroscience Master's Program, Bahcesehir University, Istanbul, Turkey.
| | - Nazli Albayrak
- Department of Obstetrics and Gynecology, School of Medicine, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | | | - Selen Gur Ozmen
- Department of Physiotherapy and Rehabilitation, Faculty Of Health Sciences, Bahcesehir University, Istanbul, Turkey
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Seiler A, Schettle M, Amann M, Gaertner S, Wicki S, Christ SM, Theile G, Feuz M, Hertler C, Blum D. Virtual Reality Therapy in Palliative Care: A Case Series. J Palliat Care 2022:8258597221086767. [PMID: 35293818 DOI: 10.1177/08258597221086767] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Virtual reality (VR) opens a variety of therapeutic options to improve symptom burden in patients with advanced disease. Until to date, only few studies have evaluated the use of VR therapy in the context of palliative care. This case series aims to evaluate the feasibility and acceptability of VR therapy in a population of palliative care patients. METHODS In this single-site case series, we report on six palliative care patients undergoing VR therapy. The VR therapy consisted of a one-time session ranging between 20 to 60 minutes depending on the patient's needs and the content chosen for the VR sessions. A semi-structured survey was conducted and the Edmonton Symptom Assessment System (ESAS) and the Distress Thermometer were performed pre- and post-intervention. RESULTS Overall, VR therapy was well accepted by all patients. Five out of six patients reported having appreciated VR therapy. There were individual differences of perceived effects using VR therapy. The semi-structured survey revealed that some patients felt a temporary detachment from their body and that patients were able to experience the VR session as a break from omnipresent worries and the hospital environment ("I completely forgot where I am"). There was a considerable reduction in the total ESAS score post-treatment (T0 ESASTot = 27.2; T1 ESASTot = 18.8) and a slightly reduction in distress (T0 DTTot = 4.4; T1 DTTot = 3.8). However, two patients were more tired after the intervention.Significance of Results: Our preliminary results demonstrate that VR therapy is acceptable, feasible and safe for use within a palliative care population and appears to be a viable treatment option. Clinical trials are both warranted and necessary to confirm any therapeutic effects of VR therapy, as is the need to tailor VR systems better for use in palliative care settings.
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Affiliation(s)
- A Seiler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Department of Consultation-Liaison Psychiatry and Psychosomatic Medicine, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - M Schettle
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - M Amann
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Sophie Gaertner
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - Stefan Wicki
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
- Internal Medicine Centre, Hirslanden Klinik Aarau, Switzerland
| | - S M Christ
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - G Theile
- Clinic Susenberg, Zurich, Switzerland
| | - M Feuz
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - C Hertler
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
| | - D Blum
- Department of Radiation Oncology, Competence Center Palliative Care, University Hospital Zurich, Zurich, Switzerland
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Qin Z, Zhou C, Zhu Y, Wang Y, Cao H, Li W, Huang Z. Virtual Reality for Hypertension in Tooth Extraction: A Randomized Trial. J Dent Res 2021; 101:400-406. [PMID: 34825613 DOI: 10.1177/00220345211049393] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Tooth extraction is one of the most common causes of dental anxiety and pain, leading to the elevation of blood pressure (BP) and heart rate (HR). Such effects may be exaggerated and cause life-threatening accidents in patients with hypertension. Therefore, the pain and anxiety management of these patients is imperative. Virtual reality (VR) has been demonstrated to be a distraction method to relieve anxiety and pain in clinical operations. Thus, we hypothesized that VR can control the elevation of BP and HR in patients with hypertension. In this study, 96 eligible patients with controlled hypertension who needed tooth extraction were randomized to the VR or standard care group by stratified randomization of anxiety grade and gender. Their BP and HR were dynamically monitored. The corresponding systolic and diastolic BP and HR values were selected when systolic BP was at the highest point of the process. BP was converted into mean arterial pressure (MAP) for comparison per the following formula: MAP = (systolic BP + 2 × diastolic BP)/3. Statistical analyses were by intention to treat and conducted in SPSS. Nonparametric rank sum tests were used to compare the difference of ΔMAP and ΔHR between the VR and standard care groups. Multivariate linear regression was applied to evaluate the effect of VR on ΔMAP and ΔHR. The results showed that the VR technique significantly decreased the elevation of MAP (P < 0.001) and HR (P < 0.001), and this effect was found even after adjusting for baseline characteristics and additional surgical procedures (ΔMAP, P < 0.001, R2 = 0.276; ΔHR, P < 0.001, R2 = 0.152). VR did not increase the incidence of adverse events (P = 0.677). In conclusion, the VR technique was effective in controlling BP and HR within an acceptable range and can help manage BP and HR during tooth extraction for patients with hypertension (Chinese Clinical Trial Registry: ChiCTR2100042132).
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Affiliation(s)
- Z Qin
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of General Dentistry, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - C Zhou
- Department of Emergency, The Eighth Affiliated Hospital, Sun Yat-sen University, Shenzhen, China
| | - Y Zhu
- Clinical Research Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Y Wang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of General Dentistry, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - H Cao
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of General Dentistry, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - W Li
- Department of Critical Medicine, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Z Huang
- Department of Oral and Maxillofacial Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
- Department of General Dentistry, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
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Bordeleau M, Stamenkovic A, Tardif PA, Thomas J. The Use of Virtual Reality in Back Pain Rehabilitation: A Systematic Review and Meta-Analysis. THE JOURNAL OF PAIN 2021; 23:175-195. [PMID: 34425250 DOI: 10.1016/j.jpain.2021.08.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/07/2021] [Revised: 06/08/2021] [Accepted: 08/11/2021] [Indexed: 12/14/2022]
Abstract
This systematic review aimed to synthesize the existing evidence of extended reality (XR) on pain and motor function outcomes in patients with back pain. Following the Cochrane guidelines, relevant articles of any language were selected by 2 independent reviewers from CINAHL, Cochrane, Embase, Medline and Web of Knowledge databases. Of 2,050 unique citations, 24 articles were included in our review. These studies included a total of 900 back pain patients. Despite broader XR search, all interventions were virtual reality (VR) based and involved physical exercises (n = 17, 71%), hippotherapy (n = 4, 17%), motor imagery (n = 1, 4%), distraction (n = 1, 4%), and cognitive-behavior therapy (n = 1, 4%). Sixteen controlled studies were included in a meta-analysis which suggested that VR provides a significant improvement in terms of back pain intensity over control interventions (Mean Difference: -0.67; 95% CI: -1.12 to -0.23; I2 = 85%). Almost all included studies presented high risk of bias, highlighting the need to improve methodology in the examination of VR interventions. While the specific set of studies showed high heterogeneity across several methodological factors, a tentative conclusion could be drawn that VR was effective improving back pain intensity and tends to have a positive effect on improving other pain outcomes and motion function. PERSPECTIVE: Extended reality technologies have appeared as interesting nonpharmacological options for the treatment of back pain, with the potential to minimise the need for opioid medications. Our systematic review summarised existing applications of extended reality for back pain and proposed a few recommendations to direct further studies in the field.
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Affiliation(s)
- Martine Bordeleau
- Research Centre on Aging, Centre intégré universitaire de santé et de services sociaux de l'Estrie - Centre hospitalier universitaire de Sherbrooke (CIUSSS de l'Estrie - CHUS), Sherbrooke, Quebec, Canada.
| | - Alexander Stamenkovic
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
| | - Pier-Alexandre Tardif
- Population Health and Optimal Health Practices Unit, Trauma-Emergency-Critical Care Medicine, CHU de Québec-Université Laval Research Center, Université Laval, Quebec City, Quebec, Canada
| | - James Thomas
- Department of Physical Therapy, Virginia Commonwealth University, Richmond, Virginia
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Sridhar A, Shiliang Z, Woodson R, Kwan L. Non-pharmacological anxiety reduction with immersive virtual reality for first-trimester dilation and curettage: a pilot study. EUR J CONTRACEP REPR 2021; 25:480-483. [PMID: 33140989 DOI: 10.1080/13625187.2020.1836146] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVES Most women experience moderate to severe pain during first-trimester surgical termination of pregnancy despite the application of various analgesic techniques. Studies have shown that virtual reality (VR) is effective in reducing anxiety among a range of women in differing circumstances. Our study objectives were to assess the feasibility of using VR during first-trimester dilation and curettage under local anaesthesia and understand the effect of VR on procedure-related anxiety during first-trimester dilation and curettage. METHODS A pilot feasibility study was conducted in a convenience sample of 30 women (15 in the intervention group and 15 in the control group). Anxiety scores were recorded before, during and after the procedure. In-depth interviews were conducted after the procedure. RESULTS Participants reported that VR was either very effective (53%) or somewhat effective (40%) in relieving anxiety during and after the procedure. Eleven participants used the VR device for the entire procedure and four participants removed it during the procedure. The anxiety scores before the procedure were not significantly different between the groups. The intervention group had a median five point post-procedure decrease in anxiety score rated on a visual analogue scale, which was significantly different from that of the control group. Overall, participants had a positive experience but there were some technological frustrations. CONCLUSION Women undergoing dilation and curettage in the first trimester were able to use a VR device during the procedure. VR-induced distraction and relaxation helped to reduce anxiety in some participants both during and after the procedure.
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Affiliation(s)
- Aparna Sridhar
- Department of Obstetrics and Gynecology, University of California, Los Angeles, CA, USA.,David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Zhang Shiliang
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Ryan Woodson
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Lorna Kwan
- Department of Urology, University of California, Los Angeles, CA, USA
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Tharion JG, Kale S. Patient Satisfaction Through an Immersive Experience Using a Mobile Phone-Based Head-Mounted Display During Arthroscopic Knee Surgery Under Spinal Anesthesia: A Randomized Clinical Trial. Anesth Analg 2021; 133:940-948. [PMID: 34283040 DOI: 10.1213/ane.0000000000005666] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Patient satisfaction is an important element of high-quality health care. Virtual reality has been studied for its sedative and analgesic effects, as it immerses the patient into an artificial interactive environment. Deriving from this concept, we hypothesized that an immersive experience that engulfs the senses with noninteractive visual and auditory stimuli would have a positive effect on satisfaction and anxiety in patients undergoing spinal anesthesia. METHODS We enrolled and randomized 90 patients undergoing spinal anesthesia for arthroscopic knee surgery into an immersive experience arm and an intravenous midazolam sedation arm. The immersive experience was provided through a mobile phone-based head-mounted display showing binocular monoscopic video and noise-canceling headphones playing audio. The primary outcome measure was postoperative satisfaction, measured using a visual analog scale and compared using the Mann-Whitney U test; secondary outcomes included anxiety score (measured using the 6-item State-Trait Anxiety Inventory), hemodynamic stability, and additional sedative requirement. RESULTS The visual analog scale satisfaction score with immersive experience was significantly higher than with midazolam (median [interquartile range {IQR}] of 93 [82-98] and 80 [73-93], respectively, P = .004), with Hodges-Lehmann median difference estimate of 7 (95% confidence interval, 3-14). The change in anxiety scores from the preoperative to postoperative period between the groups was not significantly different (P = .08), with a Hodges-Lehmann median difference estimate of 3.3 (95% confidence interval, 0-6.7). All patients were hemodynamically stable, were without significant adverse events, and did not require additional sedatives. CONCLUSIONS We have found that an immersive experience is an effective and acceptable intraoperative alternative to pharmacological sedation in patients undergoing arthroscopic knee surgery under spinal anesthesia, with higher satisfaction levels and no detected difference in preoperative to postoperative anxiolytic effect.
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Affiliation(s)
- Joseph G Tharion
- From the Department of Anaesthesia, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
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Olbrecht VA, O'Conor KT, Williams SE, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Ding L, Yang G, King CD. Guided Relaxation-Based Virtual Reality for Acute Postoperative Pain and Anxiety in a Pediatric Population: Pilot Observational Study. J Med Internet Res 2021; 23:e26328. [PMID: 34048358 PMCID: PMC8314162 DOI: 10.2196/26328] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/02/2021] [Accepted: 05/04/2021] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Distraction-based therapies, such as virtual reality (VR), have been used to reduce pain during acutely painful procedures. However, distraction alone cannot produce prolonged pain reduction to manage sustained postoperative pain. Therefore, the integration of VR with other pain-reducing therapies, like guided relaxation, may enhance its clinical impact. OBJECTIVE The goal of this pilot study was to assess the impact of a single guided relaxation-based VR (VR-GR) session on postoperative pain and anxiety reduction in children. We also explored the influence of pain catastrophizing and anxiety sensitivity on this association. METHODS A total of 51 children and adolescents (7-21 years) with postoperative pain and followed by the Acute Pain Service at Cincinnati Children's Hospital were recruited over an 8-month period to undergo a single VR-GR session. Prior to VR, the patients completed 2 questionnaires: Pain Catastrophizing Scale for Children (PCS-C) and the Child Anxiety Sensitivity Index (CASI). The primary outcome was a change in pain intensity following the VR-GR session (immediately, 15 minutes, and 30 minutes). The secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS The VR-GR decreased pain intensity immediately (P<.001) and at 30 minutes (P=.04) after the VR session, but not at 15 minutes (P=.16) postsession. Reductions in pain unpleasantness were observed at all time intervals (P<.001 at all intervals). Anxiety was reduced immediately (P=.02) but not at 15 minutes (P=.08) or 30 minutes (P=.30) following VR-GR. Patients with higher CASI scores reported greater reductions in pain intensity (P=.04) and unpleasantness (P=.01) following VR-GR. Pain catastrophizing was not associated with changes in pain and anxiety. CONCLUSIONS A single, short VR-GR session showed transient reductions in pain intensity, pain unpleasantness, and anxiety in children and adolescents with acute postoperative pain. The results call for a future randomized controlled trial to assess the efficacy of VR-GR. TRIAL REGISTRATION ClinicalTrials.gov NCT04556747; https://clinicaltrials.gov/ct2/show/NCT04556747.
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Affiliation(s)
- Vanessa A Olbrecht
- Center for Understanding Pediatric Pain, Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Keith T O'Conor
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Sara E Williams
- Center for Understanding Pediatric Pain, Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Chloe O Boehmer
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Gilbert W Marchant
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Susan M Glynn
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Kristie J Geisler
- Department of Anesthesiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Lili Ding
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Gang Yang
- Division of Biostatistics and Epidemiology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
| | - Christopher D King
- Center for Understanding Pediatric Pain, Division of Behavioral Medicine and Clinical Psychology, Department of Pediatrics, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States
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Joo Y, Kim EK, Song HG, Jung H, Park H, Moon JY. Effectiveness of virtual reality immersion on procedure-related pain and anxiety in outpatient pain clinic: an exploratory randomized controlled trial. Korean J Pain 2021; 34:304-314. [PMID: 34193636 PMCID: PMC8255151 DOI: 10.3344/kjp.2021.34.3.304] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 12/15/2022] Open
Abstract
Background The study investigated virtual reality (VR) immersion in alleviating procedure-related pain in patients with chronic pain undergoing fluoroscopy-guided minimally-invasive intervention in a prone position at an outpatient clinic. Methods In this prospective randomized controlled study, 38 patients undergoing lumbar sympathetic ganglion block were randomized into either the VR or the control group. In the VR group, procedure-related pain was controlled via infiltration of local anesthetics while watching a 30-minute VR hypnotic program. In the control group, the skin infiltration alone was used, with the VR device switched off. The primary endpoint was an 11-point score on the numerical rating scale, indicating procedure-related pain. Patients’ satisfaction with pain control, anxiety levels, the need for additional local anesthetics during the procedure, hemodynamic stability, and any adverse events were assessed. Results Procedure-related pain was significantly lower in the VR group (3.7 ± 1.4) than in the control group (5.5 ± 1.7; P = 0.002). Post-procedural anxiety was lower in the VR group than in the control group (P = 0.025), with a significant reduction from pre-procedural anxiety (P < 0.001). Although patients’ satisfaction did not differ significantly (P = 0.158) between the groups, a higher number of patients required additional local anesthetics in the control group (n = 13) than in the VR group (n = 4; P = 0.001). No severe adverse events occurred in either group during the study. Conclusions VR immersion can be safely used as a novel adjunct to reduce procedural pain and anxiety during fluoroscopic pain intervention.
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Affiliation(s)
- Young Joo
- Department of Anesthesiology and Pain Medicine, CHA Ilsan Medical Center, CHA University School of Medicine, Goyang, Korea
| | - Eun-Kyung Kim
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Hyun-Gul Song
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Haesun Jung
- Department of Anesthesiology and Pain Medicine, Chung-Ang University Hospital, Seoul, Korea
| | - Hanssl Park
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jee Youn Moon
- Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul, Korea.,Department of Anesthesiology and Pain Medicine, Seoul National University College of Medicine, Seoul, Korea
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Takac M, Collett J, Conduit R, De Foe A. Addressing virtual reality misclassification: A hardware-based qualification matrix for virtual reality technology. Clin Psychol Psychother 2021; 28:538-556. [PMID: 34110659 DOI: 10.1002/cpp.2624] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Accepted: 05/22/2021] [Indexed: 01/19/2023]
Abstract
Through its unique sensory synchronized design, virtual reality (VR) provides a convincing, user-centred experience of highly controllable scenarios. Importantly, VR is a promising modality for healthcare, where treatment efficacy has been recognized for a range of conditions. It is equally valuable across wider research disciplines. However, there is a lack of suitable criteria and consistent terminology with which to define VR technology. A considerable number of studies have misclassified VR hardware (e.g. defining laptops as VR), hindering validity and research comparisons. This review addresses these limitations and establishes a standardized VR qualification framework. As a result of a comprehensive theoretical and literature review, the hardware-based VR qualification matrix is proposed. The matrix criteria consist of (1) three-dimensional (3D) synchronized sensory stimulation; (2) degrees of freedom tracking; and (3) visual suppression of physical stimuli. To validate the model and quantify the current scale/diversity of VR misclassification, a 2019 sectional review of health-related studies was conducted. Of the 115 studies examined against standardized criteria, 35.7% utilized VR, 31.3% misclassified VR, 18.3% were considered quasi-VR, and 14.8% omitted critical specifications. The proposed model demonstrates good validity and reliability for qualifying and classifying VR. Key Practitioner Messages Virtual reality (VR) therapy has gained rapid empirical support, although many practitioners do not understand the difference between genuine and less-realistic VR variations. That has resulted from an evident lack of suitable criteria to define VR across a range of studies and protocols. Our proposed hardware-based virtual reality qualification matrix addresses issues to do with misclassification, via the introduction of standardised criteria. Applying the matrix to existing literature has revealed that more than 30% of VR studies use hardware that does not fit the high standards of rigour required for immersion in a simulated space. The model is a practical tool researchers and practitioners can use to quality and verify VR standards across research studies.
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Olbrecht VA, O'Conor KT, Williams SE, Boehmer CO, Marchant GW, Glynn SM, Geisler KJ, Pickerill HM, Ding L, Yang G, King CD. Transient Reductions in Postoperative Pain and Anxiety using Virtual Reality in Children. PAIN MEDICINE 2021; 22:2426-2435. [PMID: 34175959 DOI: 10.1093/pm/pnab209] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Virtual reality (VR) is a promising method to manage pain. Distraction-based VR (VR-D) is thought to reduce pain by redirecting attention. While VR-D can reduce pain associated with acutely painful procedures, it is unclear if VR-D can reduce pain after surgery. We assessed the ability of a single VR-D session to decrease postoperative pain and anxiety and explored if pain catastrophizing and anxiety sensitivity influenced these outcomes in children following surgery. DESIGN Single-center, prospective, pilot study. SETTING Cincinnati Children's Hospital Medical Center (CCHMC). SUBJECTS 50 children (7-21 years) with postoperative pain followed by the Acute Pain Service. METHODS Patients received one VR-D session following surgery. Prior to the session, patients completed pain catastrophizing (PCS-C) and anxiety sensitivity (CASI) questionnaires. Primary outcome consisted of changes in pain intensity following VR-D (immediately, 15, and 30 minutes). Secondary outcomes included changes in pain unpleasantness and anxiety. RESULTS VR-D use was associated with a decrease in pain intensity immediately and 15-minutes after VR-D. Reductions in pain unpleasantness were observed up to 30 minutes following VR-D. VR-D was also associated with a reduction in anxiety immediately and at 15-minutes. While patients with higher pain catastrophizing had higher baseline pain intensity and unpleasantness, they did not show larger pain reductions following VR-D compared to those with lower pain catastrophizing. CONCLUSIONS VR-D may be beneficial in transiently reducing pain intensity, unpleasantness, and anxiety in children with postoperative pain. This study informs design of larger, randomized, controlled study assessing VR-D for acute postoperative pain and anxiety management.
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Affiliation(s)
- Vanessa A Olbrecht
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Keith T O'Conor
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Sara E Williams
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Chloe O Boehmer
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | - Gilbert W Marchant
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Susan M Glynn
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
| | | | | | - Lili Ding
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH.,University of Cincinnati College of Medicine, Cincinnati, OH
| | - Gang Yang
- Cincinnati Children's Hospital Medical Center, Cincinnati, OH
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Akin B, Yilmaz Kocak M, Küçükaydın Z, Güzel K. The Effect of Showing Images of the Foetus with the Virtual Reality Glass During Labour Process on Labour Pain, Birth Perception and Anxiety. J Clin Nurs 2021; 30:2301-2308. [PMID: 33960065 DOI: 10.1111/jocn.15768] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2021] [Revised: 02/24/2021] [Accepted: 03/09/2021] [Indexed: 01/18/2023]
Abstract
AIM AND OBJECTIVES This study was conducted to determine the effect of showing images of the foetus to the pregnant women with the virtual reality glass during labour process on labour pain, childbirth perception and anxiety level. BACKGROUND Virtual reality is an effective and inexpensive method that allows the creation of simulated scenarios in which it interacts with the virtual environment with multisensory stimuli. DESIGN This is a randomised controlled experimental study. This study was conducted with the guidelines of Consolidated Standards of Reporting Trials (CONSORT). The study was enrolled in the Clinical Trials database (NCT04664114). METHODS The study included 100 pregnant women (50 intervention group and 50 control group). Ultrasound images of the foetus were recorded on the 28th week of pregnancy of the women in the intervention group. These images were shown to the women with the virtual reality glass during labour process. Routine procedures were carried out for the women in the control group. The Visual Analog Scale (VAS) was applied to both groups when cervical dilatation was 4 cm and 9 cm. The Women's Perception for the Scale of Supportive Care Given During Labor (POBS) and the Perinatal Anxiety Screening Scale (PASS) were applied almost two hours after labour. RESULTS The VAS scores of the women in the intervention group with 9 cm dilatation and their PASS mean scores were significantly lower than women in the control group while their POBS score were significantly higher (p < 0.01). CONCLUSION The results of this study show that showing images of the foetus to women with virtual reality decreased labour pain and anxiety level. RELEVANCE TO CLINICAL PRACTICE It is known that supportive care given during labour is important both for the mother's and baby's health. Therefore, it is important that nurses and midwives, who spend the most time with women and provide the most support, reduce the pain and anxiety of the woman with nonpharmacological practices and make them feel positive feelings about delivery.
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Affiliation(s)
- Bihter Akin
- Faculty of Health Science, Midwifery Department, Selcuk University, Konya, Turkey
| | - Mine Yilmaz Kocak
- Faculty of Health Science, Midwifery Department, Selcuk University, Konya, Turkey
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Hajesmaeel-Gohari S, Sarpourian F, Shafiei E. Virtual reality applications to assist pregnant women: a scoping review. BMC Pregnancy Childbirth 2021; 21:249. [PMID: 33765969 PMCID: PMC7993522 DOI: 10.1186/s12884-021-03725-5] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2021] [Accepted: 03/16/2021] [Indexed: 12/04/2022] Open
Abstract
Background Virtual reality (VR) is a computer technology that simulates the real world to allow users to communicate with a similar but artificial environment. VR technologies can be used in pregnancy to help mothers gain a better understanding of this significant yet stressful event. The aim of this study was to find and summarize VR applications to help pregnant women during their pregnancy and delivery. Methods PubMed, Embase, and Web of Science databases were searched on November 11th, 2020 to access relevant studies. The following data were extracted from the collected studies: first author’s name, year of publication, country, type of study, sample size, study objective, VR components (hardware and software), data gathering method, and study outcomes. Through a descriptive summary and analysis, the results eventually presented. Results Nine studies were included in this study. Four studies (44.5%) had used VR technology to reduce the anxiety of pregnant women, four studies (44.5%) had applied VR for decreasing delivery pain, and one study (11%) used VR for exercise trainings. Five studies (56%) used VR headsets and three studies (33.5%) used VR glasses. Most studies showed that VR was a useful method to be used for different purposes in both pregnancy and delivery (n = 8, 89%). Conclusion The use of VR technology for pregnancy has been increasing in recent years. This technology has different applications in pregnancy, from reducing anxiety and pain to exercise training. However, more studies are required to reach a general common understanding about the efficacy of VR during pregnancy and delivery.
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Affiliation(s)
- Sadrieh Hajesmaeel-Gohari
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Fatemeh Sarpourian
- Department of Health Information Management, School of Management and Information Sciences, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Elaheh Shafiei
- Medical Informatics Research Center, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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Trost Z, France C, Anam M, Shum C. Virtual reality approaches to pain: toward a state of the science. Pain 2021; 162:325-331. [PMID: 32868750 DOI: 10.1097/j.pain.0000000000002060] [Citation(s) in RCA: 65] [Impact Index Per Article: 21.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 08/10/2020] [Indexed: 02/08/2023]
Affiliation(s)
- Zina Trost
- Virginia Commonwealth University, Richmond, VA, United States
| | | | - Monima Anam
- University of Alabama at Birmingham, Birmingham, AL, United States
| | - Corey Shum
- Immersive Experience Labs, LLC, Birmingham, AL, United States
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Ebrahimian A, Rahmani Bilandi R. Comparisons of the Effects of Watching Virtual Reality Videos and Chewing Gum on the Length of Delivery Stages and Maternal Childbirth Satisfaction: A Randomized Controlled Trial. IRANIAN JOURNAL OF MEDICAL SCIENCES 2021; 46:15-22. [PMID: 33487788 PMCID: PMC7812498 DOI: 10.30476/ijms.2019.82782.1119] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Background Maternal childbirth satisfaction is one of the important indicators of the quality of the care provided. The use of non-pharmacological therapies can make the childbirth process a pleasurable event for the mother. This study aimed to compare the effects of watching virtual reality videos and chewing gum on the length of delivery stages and maternal satisfaction. Methods This clinical trial study was performed on 93 women with first and second pregnancies, who were referred to Allameh Bohlool Hospital in Gonabad and Sajjadieh Hospital in Torbat-e-Jam, Iran, for childbirth between 2018 and 2019. Pregnant women were randomly assigned to three groups of chewing gum, virtual reality, and control. Interventions were performed twice: in the active (dilation of 4-5 cm) and second (dilation of 7-8 cm) phases of parturition for 20 minutes each. Data were collected using data-gathering forms, including a demographic characteristics form, a midwifery characteristics form, and the Mackey Childbirth Satisfaction Rating Scale. The data were analyzed using SPSS, version 22, via the Chi square tests, ANOVA, Kruskal-Wallis, and Tukey's post hoc tests. Results The difference in the mean maternal childbirth satisfaction score between the two intervention groups of virtual reality and chewing gum was not statistically significant (P=0.339), but the mean score in the intervention groups was higher than that of the control group (P<0.001(. There was no significant difference in the mean length of the active and second phases of parturition between the two intervention groups, but this value in the intervention groups was significantly lower than that of the control group. Conclusion The thought divergence interventions of chewing gum and watching virtual reality videos enhanced childbirth satisfaction, and curtailed parturition stages in our sample of pregnant women. Trial Registration Number: IRCT20181214041963N1.
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Affiliation(s)
- Atefeh Ebrahimian
- Department of Midwifery, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran.,Student Research Committee, Gonabad University of Medical Sciences, Gonabad, Iran
| | - Roqieh Rahmani Bilandi
- Social Development and Health Promotion Research Center, Department of Midwifery, School of Medicine, Gonabad University of Medical Sciences, Gonabad, Iran
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