The Use of Virtual Therapy in Cardiac Rehabilitation of Male Patients with Coronary Heart Disease: A Randomized Pilot Study

Psychologically-enhanced cardiac rehabilitation for psychological and functional improvement in patients with cardiovascular disease: a systematic review with meta-analysis and future research directions

OBJECTIVE

To systematically review the effectiveness of psychologically-enhanced cardiac rehabilitation (CR) in improving psychological and functional outcomes in patients with cardiovascular disease.

DATA SOURCES

A systematic search was performed in PubMed, Scopus, Cochrane Library, Embase, and Web of Science, up to January 31, 2024.

STUDY SELECTION

Two reviewers independently identified randomized clinical trials that evaluated the effectiveness of psychologically-enhanced CR in improving psychological and functional outcomes in patients with cardiovascular disease. The search yielded 1848 results. Finally, data from 14 studies (1531 participants) were included in the review.

DATA EXTRACTION AND DATA SYNTHESIS

Information regarding cardiac rehabilitation phase, duration of the intervention, group characteristics, measured outcomes, and the conclusions drawn by the authors was extracted. The Revised Cochrane risk-of-bias tool for Randomized Trials was used to evaluate the methodological quality.

RESULTS

Pooled results indicate that psychologically-enhanced CR is more effective than specific cardiac training alone in maintaining lower resting blood pressure, with a mean difference of -3.09 (95% CI: -5.18 to -1.00). Furthermore, psychologically-enhanced CR shows superiority in improving patients' quality of life compared to specific cardiac training alone, with a standardized mean difference of 0.15 (95% CI: 0.01 to 0.31). Analyses of depression and anxiety level, exercise tolerance, and blood lipid profile did not show significant differences between the two treatment conditions.

CONCLUSION

Psychologically-enhanced CR shows a positive effect on reducing resting blood pressure and improving the quality of life. However, the supportive methods were of limited effectiveness in addressing the psychological aspects of health.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022304063. CONTRIBUTION OF THE PAPER.

Virtual Reality and Stress Management: A Systematic Review

Amidst the growing prevalence of chronic stress and its potential negative impacts on mental health, this review explores the use of virtual reality (VR) as a stress management solution, aiming to assess its viability and effectiveness in this context. A comprehensive search was conducted on MEDLINE, PsycINFO, and Embase from inception until February 2024. Eligible studies were primary research papers that focused on the use of VR as an intervention to mitigate psychological stress and/or distress. We included studies where the assessment of stress levels primarily relied on self-report measures. A total of 50 studies involving 2885 participants were included in our systematic review. VR-based interventions varied across studies, implementing tools such as cognitive behavioural therapy, exposure therapy, mindfulness and relaxation, repetition tasks, and psychoeducation. The reviewed studies yielded mixed results; however, a strong indication was present in highlighting the promising potential of VR-based interventions. Many studies observed a decrease in psychiatric symptoms in participants and reported increased quality of life. Various studies also found VR to be a valuable tool in promoting stress reduction and relaxation. VR was proven useful in exposing participants to stressors in a safe, controlled way. These potential benefits appear to come with no risk of harm to the participants. Although the findings are heterogenous, there is sufficient evidence supporting the use of VR for stress management across a range of contexts and populations. Overall, VR appears to be a generally low-risk, feasible intervention for those struggling with stress.

Virtual and augmented reality in cardiovascular care in low and middle income country

The global health sector has witnessed an escalating integration of Virtual Reality (VR) and Augmented Reality (AR) technologies, particularly in high-income countries. The application of these cutting-edge technologies is gradually extending to Low- and Middle-Income Countries (LMICs), notably in the domain of cardiovascular care. AR and VR technologies are revolutionizing cardiovascular care by offering solutions for diagnosis, medical training, and surgical planning. AR and VR provide detailed and immersive visualizations of cardiac structures, aiding in diagnosis and intervention planning. In cardiovascular care, VR reduces patient-reported pain, eases anxiety, and accelerates post-procedural recovery. AR and VR are also valuable for life support training, creating immersive and controlled learning environments. AR and VR have the potential to significantly impact healthcare in low- and middle-income countries with enhanced accessibility and affordability. This review outlines the existing spectrum of VR and AR adoption and its burgeoning utility in the cardiovascular domain within LMICs.

Virtual Reality and Cardiac Diseases: A Systematic Review of Applications and Effects

Introduction

Cardiac diseases have grown significantly in recent years, causing many deaths globally. Cardiac diseases can impose a significant economic burden on societies. The development of virtual reality technology has attracted the attention of many researchers in recent years. This study aimed to investigate the applications and effects of virtual reality (VR) technology on cardiac diseases.

Methods

A comprehensive search was carried out in four databases, including Scopus, Medline (through PubMed), Web of Science, and IEEE Xplore to identify related articles published until May 25, 2022. Preferred Reporting Items for Systematic Reviews and Meta-Analyzes (PRISMA) guideline for systematic reviews was followed. All randomized trials that investigated the effects of virtual reality on cardiac diseases were included in this systematic review.

Results

Twenty-six studies were included in this systematic review. The results illustrated that virtual reality applications in cardiac diseases can be classified in three categories of physical rehabilitation, psychological rehabilitation, and education/training. This study revealed that the use of virtual reality in psychological and physical rehabilitation can reduce stress, emotional tension, Hospital Anxiety and Depression Scale (HADS) total score, anxiety, depression, pain, systolic blood pressure, and length of hospitalization. Finally, the use of virtual reality in education/training can enhance technical performance, increase the speed of procedures, and improve the user's skills, level of knowledge, and self-confidence as well as facilitate learning. Also, the most limitations mentioned in the studies included small sample size and lack of or short duration of follow-up.

Conclusions

The results showed that the positive effects of using virtual reality in cardiac diseases are much more than its negative effects. Considering that the most limitations mentioned in the studies were the small sample size and short duration of follow-up, it is necessary to conduct studies with adequate methodological quality to report their effects in the short term and long term.