The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials

Usefulness of a virtual reality educational program for reducing preoperative anxiety in children: A randomised, single-centre clinical trial

BACKGROUND

Preoperative anxiety (PA) is common in children and has detrimental effects on surgical outcome. Strategies based on virtual reality (VR) have recently been introduced to address this problem.

OBJECTIVE

This study evaluated the usefulness of a virtual reality educational program (VREP) for reducing preoperative anxiety in elective low-complexity paediatric surgery.

DESIGN

Randomised clinical trial.

SETTING

Single tertiary centre in Barcelona, Spain. Between January 2019 and June 2022.

PATIENTS

Children aged 3-13 years of age, American Society of Anesthesiologists (ASA) I-II, scheduled for elective low-complexity surgery were enrolled in the study.

INTERVENTION

Children were randomised into a control group (received oral/written information about the anaesthetic-surgical process, and patients and their parents remained in a playroom waiting for the surgery) or VREP (viewed a VR-based educational video on the surgical process, 7-10 days prior to surgery) using the MATLAB application.

MAIN OUTCOME MEASURE

PA using the modified Yale Preoperative Anxiety Scale (mYPAS) during separation from parents.

RESULTS

In total, 241 children aged 3-12 years of age were studied (120 patients with VREP and 121 controls). Randomisation eliminated the differences between the groups, except for a greater male presence in the VREP group (83.3% vs. 71.1%; P = 0.023). The mYPAS yielded was lower in the VREP group (29.2% vs. 83.5%; P < 0.001). Sex did not influence VREP-mediated decrease in PA (P < 0.001). In turn, VREP patients were more cooperative (Induction Compliance Checklist [ICC] score 0 points vs. 2 points; P < 0.001) during anaesthesia induction, presented less delirium (Pediatric Anesthesia Emergence Delirium [PAED] score 1 point vs. 3 points; P = 0.001) on leaving the recovery room, and experienced less pain upon arrival in the hospital ward (Wong-Baker Faces Pain Rating Scale: 0-points vs. 1 point; P < 0.001).

CONCLUSIONS

The VREP-based prevention strategy reduced preoperative anxiety in children undergoing elective low-complexity surgery.

TRIAL REGISTRATION

NCT03578393.

State-trait anxiety levels and vital signs of pregnant women following intervention with virtual reality during the nonstress test: A randomized controlled trial

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.

Use of virtual reality in children in a broad range of medical settings: a systematic narrative review of recent meta-analyses

Virtual reality (VR) is an emerging method that can be used in many scenarios involving children. VR has been increasingly studied as it has become cheaper, more widely available, and of better quality. In this review of current meta-analyses on the use of VR in children in the medical setting, we examined its role in 5 broad settings where it is used to alleviate pain and anxiety as well as in therapeutic scenarios. The study scope was purposefully broad to highlight a wide range of cases. We searched the ScienceDirect, SpringerLink, Cochrane Library, PubMed, and PMC databases for meta-analyses using VR in pediatric populations in medical settings. The National Institutes of Health quality assessment tool and Quality of Reporting of Meta-analyses statement checklist were used to verify study quality. Six hundred fifty-three articles were retrieved; after the application of the inclusion and exclusion criteria, 11 remained. These meta-analyses included cerebral palsy (4 meta-analyses), attention deficit/hyperactivity disorder (2 meta-analyses), burn care (1 meta-analysis), preoperative anxiety (2 meta-analyses), and needle-involving procedures (2 meta-analyses). The meta-analyses showed broadly positive results, with VR being useful in the areas in which it was applied. This study had several limitations. The meta-analyses consistently highlighted a high level of heterogeneity, making it challenging to draw clear conclusions. Most meta-analyses across all fields yielded encouraging results. However, further studies are required to confirm these findings. Guidelines must be established for future experiments to provide a standard and uniform procedure for reducing the heterogeneity of experimental methods.

Can virtual reality enhance the patient experience during awake invasive procedures? A systematic review of randomized controlled trials

ABSTRACT

Procedural anxiety and pain negatively affect surgical outcomes and the patient experience during awake, invasive procedures (AIPs). This systematic review aims to evaluate the effect of using virtual reality (VR) to enhance the intraprocedural patient experience during AIPs. PRISMA, Cochrane, and SWiM Reporting Items guidelines were followed. PubMed, EMBASE, CENTRAL, and medRxiv databases were systematically searched for randomised controlled trials (RCTs) investigating the use of immersive VR headsets to enhance the patient experience in adults undergoing AIPs. Sixteen studies were included. The VR and control groups comprised 685 and 677 patients, respectively. Patients underwent endoscopic procedures in 9 studies ("endoscopic") and interventions that involved a skin incision in 7 studies ("incision"). Eleven (of 13) studies demonstrated a favourable effect on procedural anxiety with VR use compared with standard intraprocedural care (85% [95% CI: 46%-100%], P = 0.011). Ten (of 13) studies demonstrated a favourable effect on pain with VR use (77% [95% CI: 38%-100%], P = 0.046). Seven (of 9) studies demonstrated a favourable VR effect on patient satisfaction (78% (95% CI: 44%-100%), P = 0.070). The effect of VR on physiological markers of anxiety and pain and requirements for additional pro re nata (PRN) analgesia and sedation were not clear. No significant differences in patient experience were identified between the "incision" and "endoscopic" subgroups. This review demonstrates that VR can feasibly be used to enhance the patient experience during AIPs by attenuating subjective perceptions of procedural anxiety and pain. However, further RCTs are required to elucidate the effect of VR on more objective measures of the patient experience.

A brief virtual reality intervention for pre-operative anxiety in adults

OBJECTIVE

Virtual reality (VR) is a promising non-pharmacologic tool for managing health care anxiety. We assessed the feasibility and acceptability of a pre-operative VR intervention by adult patients and medical staff and measured anxiety in adult patients pre- and post-VR intervention.

STUDY DESIGN

We recruited 30 patients scheduled to undergo oral surgery and 8 medical staff as participants. The patients completed a verbal demographic survey and rated their anxiety before the VR intervention and at 1 minute and 2 minutes post-intervention. We administered the Acceptability of Intervention Measure to the patients to measure their perceptions of the VR intervention and the Feasibility of Intervention Measure to the medical staff to assess their perception of VR implementation. We performed an analysis of variance to compare pre-operative anxiety over time and assess demographic differences.

RESULTS

The patients showed high and consistent acceptability of the pre-operative use of VR among patients, but acceptability varied among medical staff. The patients experienced a statistically significant reduction of pre-operative anxiety (P = .003).

CONCLUSION

A brief VR pre-intervention is highly accepted by and very beneficial for patients undergoing oral surgery, positively affecting anxiety reduction. The perception of VR by health care providers needs to be explored to increase acceptability.

An analysis of virtual reality in abdominal surgery-A scoping review

BACKGROUND

The integration of virtual reality (VR) in surgery has gained prominence as VR applications have increased in popularity.

METHODS

A scoping review was undertaken, gathering the most relevant sources, utilising a detailed literature search of medical and academic databases including EMBASE, PubMed, Cochrane, IEEE, Google Scholar, and the Google search engine.

RESULTS

Of the 18 articles included, 7 focused on VR in colon surgery, 5 addressed VR in pancreas surgery, and the remaining 6 concentrated on VR in liver surgery. All the articles concluded that VR has a promising future in abdominal surgery by facilitating precision, visualisation, and surgeon training.

CONCLUSIONS

Adopting VR technology in abdominal surgery has the potential to improve preoperative planning, decrease perioperative anxiety among patients, and facilitate the training of surgeons, residents, and medical students. Additional supporting studies are necessary before VR can be widely implemented in surgical care delivery.

The effect of augmented reality on preoperative anxiety in children and adolescents: A randomized controlled trial

BACKGROUND AND AIMS

Virtual reality has been shown to be an effective non-pharmacological intervention for reducing anxiety of pediatric patients. A newer immersive technology, that of augmented reality, offers some practical advantages over virtual reality, and also seems to show beneficial effects on anxiety. The main objective of this study was to determine whether augmented reality could reduce preoperative anxiety in pediatric patients undergoing elective day surgeries. A secondary outcome was to document the level of satisfaction from pediatric patients toward augmented reality intervention.

METHODS

Children and adolescents aged between 5 and 17 years old scheduled for elective day surgery under general anesthesia were randomly divided into two groups. Patients in the control group received standard care, whereas patients in the augmented reality group were accompanied by two virtual characters who taught them relaxation techniques and provided emotional and informational support. Anxiety was measured at the time of admission and at the time of induction using the short version of the modified Yale Preoperative Anxiety Scale.

RESULTS

The analysis included 37 pediatric patients in the augmented reality group and 64 in the control group. Anxiety scores were statistically significantly lower in the augmented reality group than those in the control group at the time of admission (median difference [95% CI]: 6.3 [0-10.4], p = .01), while no difference was observed between groups at the time of induction (median difference [95% CI]: -4.2 [-5.2-4.2], p = .58). Most patients in the augmented reality group wished to wear the glasses again and reported to be very satisfied with the intervention.

CONCLUSION

To our knowledge, this study is the first large randomized controlled trial to provide empirical evidence of reduction in anxiety for children and adolescents using augmented reality prior to induction of general anesthesia.

Preoperative Virtual Reality to Expose Patients With Breast Cancer to the Operating Room Environment: Feasibility and Pilot Case Series Study

BACKGROUND

Clinically elevated preoperative distress and anxiety are common among patients undergoing cancer surgery. Preoperative interventions have been developed to mitigate this distress and anxiety but are inconsistent in efficacy and feasibility for broad implementation.

OBJECTIVE

This preliminary pilot study aims to assess the feasibility and utility of a newly developed virtual reality (VR) intervention to expose patients awaiting breast cancer surgery to the operating room environment and a simulation of anesthetic induction.

METHODS

Patients undergoing breast cancer surgery (N=7) were assigned to the VR intervention or control (treatment as usual) group and completed self-report measures of distress and anxiety before surgery, on the day of surgery, and after surgery (5 and 30 d postoperatively). Those in the intervention group trialed the VR simulation 1 to 2 weeks preoperatively and provided qualitative and quantitative feedback. We assessed the feasibility of recruitment capability and study design and evaluated participants' impressions of the intervention using self-report rating scales and open-ended questions. We also descriptively examined distress and anxiety levels throughout the duration of the study.

RESULTS

Recruitment occurred between December 2021 and December 2022 and progressed slowly (rate: 1 participant/7 wk on average; some hesitancy because of stress and being overwhelmed). All participants who consented to participate completed the entire study. All participants were female and aged 56 (SD 10.56) years on average. In total, 57% (4/7) of the participants were assigned to the intervention group. On average, intervention participants spent 12 minutes engaged in the VR simulation. In general, the intervention was rated favorably (eg, clear information, enjoyable, and attractive presentation; mean% agreement 95.00-96.25, SD 4.79-10.00) and as helpful (mean% agreement 87.50, SD 25.00). Participants described the intervention as realistic (eg, "It was realistic to my past surgical experiences"), impacting their degree of preparedness and expectations for surgery (eg, "The sounds and sights and procedures give you a test run; they prepare you for the actual day"), and having a calming or relaxing effect (eg, "You feel more relaxed for the surgery").

CONCLUSIONS

This preoperative VR intervention demonstrated preliminary feasibility among a sample of patients undergoing breast cancer surgery. Results and participant feedback will inform modifications to the VR intervention and the study design of a large-scale randomized controlled trial to examine the efficacy of this intervention.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04544618; https://clinicaltrials.gov/study/NCT04544618.

A scenario-based web app to facilitate patient education in lung tumor patients undergoing video-assisted thoracoscopic surgery: Development and usability testing

Background

Patient education (PE) is essential for improving patients' knowledge, anxiety, and satisfaction, and supporting their postoperative recovery. However, the advantages of video-assisted thoracoscopic surgery (VATS)-smaller incisions and faster recovery-can result in shorter hospital stays, making PE more challenging to implement effectively. Multimedia PE can potentially enhance PE, but its effectiveness for patients undergoing VATS is unclear.

Objective

This study developed a scenario-based PE web app for lung tumor patients undergoing VATS (SPE-VATS) to facilitate the PE process and evaluated its usability through a clinical trial.

Methods

The SPE-VATS provided the experimental group (EG: 32 participants) with interactive scenario, query guidance, diagnostic analysis, experience sharing, and active reminder, while the control group (CG: 32 participants) used pamphlets and videos. The usability of SPE-VATS in terms of postoperative anxiety reduction and patient satisfaction with the app was evaluated using self-reported questionnaires based on the state-trait anxiety inventory, technology acceptance model, system usability scale, and task load index.

Results

There was no statistically significant difference in postoperative anxiety reduction between the EG and CG, possibly because 90% of the participants underwent a low-risk surgical type, and VATS is known to be advantageous in alleviating surgical anxiety. However, females and higher educated EG participants showed a non-significant but favorable reduction than their CG counterparts. Moreover, the EG was highly satisfied with the app (rated 4.2 to 4.4 out of 5.0), with no significant gender and education level difference. They particularly valued the interactive scenario, experience sharing, and diagnostic analysis features of SPE-VATS.

Conclusions

The SPE-VATS demonstrated its usability and high patient satisfaction, particularly for female and higher educated patients. Low-risk patient predominance and VATS's advantages may explain non-significant postoperative anxiety reduction, warranting further studies on high-risk patients to evaluate the impact of SPE-VATS on clinical practice.

Immersive virtual reality in orthopaedics-a narrative review

PURPOSE

This narrative review explores the applications and benefits of immersive virtual reality (VR) in orthopaedics, with a focus on surgical training, patient functional recovery, and pain management.

METHODS

The review examines existing literature and research studies on immersive VR in orthopaedics, analyzing both experimental and clinical studies.

RESULTS

Immersive VR provides a realistic simulation environment for orthopaedic surgery training, enhancing surgical skills, reducing errors, and improving overall performance. In post-surgical recovery and rehabilitation, immersive VR environments can facilitate motor learning and functional recovery through virtual embodiment, motor imagery during action observation, and virtual training. Additionally VR-based functional recovery programs can improve patient adherence and outcomes. Moreover, VR has the potential to revolutionize pain management, offering a non-invasive, drug-free alternative. Virtual reality analgesia acts by a variety of means including engagement and diverting patients' attention, anxiety reduction, and specific virtual-body transformations.

CONCLUSION

Immersive virtual reality holds significant promise in orthopaedics, demonstrating potential for improved surgical training, patient functional recovery, and pain management but further research is needed to fully exploit the benefits of VR technology in these areas.

Virtual Reality-Based Intervention to Reduce Preoperative Anxiety in Adults Undergoing Elective Surgery: A Randomized Clinical Trial

IMPORTANCE

Preoperative anxiety is common among adult patients undergoing elective surgery and is associated with negative outcomes. Virtual reality (VR)-based interventions have been considered simpler, safer, and more effective for reducing anxiety in patients undergoing surgery than conventional care.

OBJECTIVE

To examine the effectiveness of a VR-based intervention with preoperative education in reducing preoperative anxiety among adult patients undergoing elective surgery.

DESIGN, SETTING, AND PARTICIPANTS

An assessor-blinded prospective randomized clinical trial was conducted to recruit adult patients aged 18 years or older who were scheduled for their first elective surgery procedure under general anesthesia within the next 2 to 4 weeks at a preanesthesia assessment clinic in Hong Kong from July to December 2022.

INTERVENTIONS

Participants were randomly assigned to either an intervention group (an 8-minute immersive 360° VR video tour in the operating theater via a head-mounted display console) or a control group (standard care).

MAIN OUTCOMES AND MEASURES

The primary outcome of preoperative anxiety was measured using the Amsterdam Preoperative Anxiety and Information Scale (range, 6-30; higher scores indicate greater anxiety), and the secondary outcomes (ie, stress, preparedness, and pain) were assessed by Visual Analog Scale at 3 time points: baseline at beginning of clinical session (T0), at the end of the clinical session immediately after the intervention (T1), and before the surgery (T2). Pain, satisfaction levels, and postoperative length of stay were evaluated after the surgery (T3). Simulation sickness was assessed after the intervention by use of the Simulation Sickness Questionnaire. A generalized estimating equations model was applied to compare changes in outcomes over time.

RESULTS

A total of 74 participants (mean [SD] age, 46.34 [14.52] years; 38 men [51.4%] and 36 women [48.6%]) were recruited and randomized to the control group (37 participants) and intervention group (37 participants). Compared with the control group, the VR-based intervention group showed significantly decreased preoperative anxiety at T1 (β, -5.46; 95% CI, -7.60 to -3.32; P < .001) and T2 (β, -5.57; 95% CI, -7.73 to -3.41; P < .001), lower stress at T1 (β, -10.68; 95% CI, -16.00 to -5.36; P < .001) and T2 (β, -5.16; 95% CI, -9.87 to -0.45; P = .03), and higher preparedness at T1 (β, 6.60; 95% CI, 0.97 to 12.19; P = .02). Satisfaction levels were significantly increased in the intervention group vs the control group (mean [SD] score, 81.35 [9.24] vs 65.28 [8.16]; difference, 16.07; 95% CI, 12.00 to 20.15; P < .001). No significant differences in pain and postoperative length of stay were found.

CONCLUSIONS AND RELEVANCE

The findings of this study suggest that a VR-based intervention is a feasible and effective way to reduce preoperative anxiety in adult patients undergoing elective surgery. Given the promising results of this study, further study in the form of large-scale, multicenter, randomized clinical trials with broader implementation is warranted.

TRIAL REGISTRATION

Chinese Clinical Trial Registry Identifier: ChiCTR2100051690.

Effectiveness of virtual reality in reducing preoperative anxiety in adults: A systematic review and meta-analysis

AIM

To evaluate the impact of a virtual reality (VR) intervention on adult patients' preoperative anxiety, heart rate, respiration rate and blood pressure.

DESIGN

A systematic review and meta-analysis of randomized controlled trials (RCTs).

DATA SOURCES

A librarian-designed search of the Cochrane Library, PubMed, Web of Science, EMBASE, CINAHL, CBM, CNKI and Wanfang databases was conducted to identify research studies in English or Chinese on RCTs from their inception to 31 May 2022. Detailed search strategies and the checklist are provieded in Supplementary files S1 and S2.

REVIEW METHODS

Two researchers independently screened eligible studies. The Cochrane Handbook for Systematic Reviews of Interventions was used to assess the risk of bias in the included studies. A fixed- or random-effects meta-analysis model was used to determine the pooled mean difference based on the results of the heterogeneity test.

RESULTS

This study included 11 articles with a total of 892 participants. VR distraction comprised five studies, and VR exposure consisted of six studies. The results indicated that VR could reduce preoperative anxiety in adult patients and VR exposure seems to be more effective. The results also indicated that VR intervention can effectively reduce patients' heart rate and blood pressure compared to traditional intervention methods, but had no significant effect on respiration rate.

CONCLUSION

VR technology could relieve preoperative anxiety in adult patients through distraction or exposure. More well-designed RCTs containing a wider range of surgical types are needed to verify our findings before we can make strong recommendations.

IMPACT

Our systematic review and meta-analysis show a positive effect of VR distraction and exposure interventions in reducing preoperative anxiety in adult patients. We suggest incorporating VR into preoperative procedures as an auxiliary way to reduce negative emotions in eligible patients.

NO PATIENT OR PUBLIC CONTRIBUTION

Our paper is a systematic review and meta-analysis and such details do not apply to our work.

Efficacy of nonpharmacologic interventions in preoperative anxiety: A systematic review of systematic reviews

AIMS AND OBJECTIVES

Evidence suggests that preparing patients for surgery using nonpharmacological strategies reduces their anxiety. However, there is no consensus on what the best practices are. This study aims to answer the question: Are interventions using nonpharmacological therapies effective in reducing preoperative anxiety?

BACKGROUND

Preoperative anxiety causes physiological and psychological adverse effects, with a negative effect on postoperative recovery.

INTRODUCTION

According to the World Health Organization, between 266 and 360 million surgical procedures are performed annually worldwide, and it is estimated that more than 50% of patients will experience some degree of preoperative anxiety.

DESIGN

Systematic review of systematic reviews with results of interventions aimed at mitigating preoperative anxiety.

METHODS

A search was conducted for systematic reviews with meta-analyses published between 2012 and 2021 in Medline, Scopus, Web of Science and Cochrane Library. Quality was assessed using the AMSTAR-2 scale. The protocol was registered in PROSPERO.

RESULTS

A total of 1016 studies were examined, of which 17 systematic reviews were selected, yielding 188 controlled trials with 16,884 participants. In adults, the most common intervention included music, followed by massage, in children virtual reality and clowns. Almost all controlled trials reported a reduction in preoperative anxiety after the intervention, of which almost half had statistically significant results.

CONCLUSION

Interventions that include music, massage and virtual reality reduce preoperative anxiety and have shown that they are cost-effective, minimally invasive and with a low risk of adverse effects. Preoperative anxiety can be reduced through a short-term intervention involving nursing professionals as an alternative or complement to drugs.

RELEVANCE TO CLINICAL PRACTICE

This review suggests that nursing professionals, in collaboration with other health professionals, should continue to conduct research on the reduction in preoperative anxiety. Further research in this area is needed, to reduce heterogeneity and consolidate the results.

NO PATIENT OR PUBLIC CONTRIBUTION

Not applied to our study, as it is a systematic review of systematic reviews.

The effect of virtual reality on fetal movement, fetal heart rate, maternal satisfaction, fatigue, and anxiety levels and vital signs of pregnant women during non-stress test: A randomized controlled trial

The study was conducted to investigate the effect of virtual reality on fetal movement, fetal heart rate, maternal satisfaction, fatigue and anxiety levels.

The data of this randomized control experimental design study were collected using the State Anxiety Inventory, the Visual Analogue for Fatigue and the Newcastle-Satisfaction-Nursing-Care-Scale. A total of 88 pregnant women were included in the study. While the pregnant women in the experimental group watched a nature video with virtual reality during the Non-Stress Test procedure, those in the control group underwent the routine Non-Stress Test. The anxiety scores, the maternal satisfaction scores significantly higher in the experimental group. The virtual reality application is effective in reducing fatigue. There was a significant difference only in the experimental group in terms of systolic blood pressure, pulse values, the number of fetal movements and accelerations. It is recommended to have pregnant women use virtual reality during the Non-Stress Test procedure.

Effects of virtual reality on preoperative anxiety in children: A systematic review and meta-analysis of randomised controlled trials

AIMS

To synthesise and evaluate the effectiveness of virtual reality interventions in preoperative children.

BACKGROUND

Children consider operations as a predictable threat and stressful event. Children's anxiety before an operation increases as the time draws closer. Children could understand the operating room environment and process before the operation using virtual reality, which may reduce their anxiety before an operation.

DESIGN

A systematic review and meta-analysis of randomised controlled trials following the Cochrane method were conducted.

METHOD

CINAHL, Cochrane Library, Embase, Joanna Briggs Institute, MEDLINE and PubMed databases were searched for randomised controlled trials published before February 2021. A random-effects model meta-analysis to calculate pooled prevalence and 95% confidence intervals was performed. Conduction of the review adheres to the PRISMA checklist.

RESULTS

Of 257 articles screened, six interventions involving 529 participants aged 4-12 years were included in the analysis. All study evidence levels were B2/Level 2, the quality was medium to high on the modified Jadad scale, with a low risk of bias. The results revealed that virtual reality significantly reduced preoperative anxiety in children (SMD: -0.91, 95% CI: -1.43 to -0.39, p = .0006). Furthermore, virtual reality significantly improved children's compliance with anaesthesia (SMD: 3.49, 95% CI: 1.32 to 9.21, p = .01).

CONCLUSION

Children who used virtual reality before an operation felt more familiar with the operating room environment and understood the preoperative preparation procedures. Virtual reality effectively reduced children's anxiety and improved their compliance with anaesthesia.

RELEVANCE TO CLINICAL PRACTICE

This systematic review and meta-analysis investigated the effect of virtual reality on preoperative anxiety in children and the findings supported its positive effects. The results could provide a reference for incorporating virtual reality into preoperative preparation guidelines.

Children's perceptions of interactive virtual-reality interventions implemented before and after intravenous cannulation

BACKGROUND

Although some studies have reported evidence of the effectiveness of virtual-reality interventions implemented for children undergoing intravenous (IV) cannulation, children's perceptions of virtual-reality interventions implemented during IV cannulation warrant further exploration.

AIMS

To explore the school-aged children's perceptions of interactive virtual-reality interventions implemented before and after IV cannulation.

METHODS

A qualitative descriptive study was adopted. Sixty-nine children aged 6-12 years from two medical centers were recruited and interviewed from June to September 2020. After the completion of the immersive virtual-reality scene of IV cannulation before undergoing actual IV cannulation and the emotionally cathartic virtual-reality play after the placement process, individual interviews were conducted with the children in the paediatric wards. Inductive content analysis was performed to analyse children's perceptions. The study complied with the Consolidated Criteria for Reporting Qualitative Research.

RESULTS

Three categories related to children's perception of interactive virtual-reality interventions implemented before and after IV cannulation were identified: (1) feelings towards and coping strategies employed during IV cannulation; (2) mental preparation through immersion in the virtual-reality scene; and (3) healing effects of immersive cathartic play.

CONCLUSIONS

The findings indicate that interactive virtual-reality interventions can help hospitalised children mentally prepare for medical procedures, obtain knowledge regarding such procedures, and overcome their fear of needles. The children's reported perceptions of the virtual-reality interventions indicated that the interventions were age-appropriate, safe and fun. The results of this study highlight the need to more thoroughly understand the perceptions of hospitalised children and may serve as a reference for designing child-friendly care interventions for nursing practice.

The Effects of Virtual Reality on Preoperative Anxiety in Patients Undergoing Colorectal and Abdominal Wall Surgery: A Randomized Controlled Trial

PURPOSE

The purpose of this study was to investigate the effects of a virtual reality (VR) application on preoperative anxiety (PA) in patients undergoing colorectal and abdominal wall surgery.

DESIGN

A prospective, parallel two-armed, randomized controlled trial.

METHODS

Eighty six patients were divided into the control group (n = 43) and in the experimental group (n = 43). The experimental group received a preoperative VR application for 10 minutes. The routine preoperative procedure used at the clinic was used for the patients in the control group. The anxiety level was assessed using the Anxiety Specific to Surgery Questionnaire (ASSQ) and measured with physiological responses to anxiety, such as changes in systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), respiratory rate (RR), and peripheral oxygen saturation (SpO₂), before and after the VR application.

FINDINGS

The VR application reduced PA levels in the experimental group (P < .001) and changes in the SBP (P < .001), DBP (P < .001), HR (P < .001), RR (P = .041) and SpO₂(P = .019) values) compared to the levels in the control group.

CONCLUSIONS

VR applications can reduce psychological and physiological responses to PA in patients undergoing colorectal and abdominal wall surgery.

Virtual Reality as a Hypnotic Tool in the Management of Anxiety During the Performance of the Axillary Block

Regional anaesthesia is a gold standard in upper limb orthopaedic surgery. Carried out on an awake patient, it can be a source of anxiety. In recent years, hypnotic techniques have been proposed in the management of perioperative anxiety. Among them, virtual reality is increasingly used as a distraction tool during anxious or painful actions despite the scarcity of proof of its benefit in the literature. Before implementing the systematic use of virtual reality when performing regional anaesthesia in our institution, we designed a study hypothesizing that the use of a virtual reality headset when performing an axillary block would reduce patient's anxiety. The study is an investigator-initiated, prospective monocentric and observational trial comparing anxiety scores of patients who underwent upper limb surgery under an axillary block with or without virtual reality headset. The perioperative anxiety was assessed by a numerical range scale before and after the peripheral nerve block performance. Between June 2021 and June 2022, 99 patients were included: 53 wearing the virtual reality headset and 46 not. The difference in numerical range scale for anxiety before and after the axillary block performance did not differ in the virtual reality group compared to the group without headset (mean = -1.9 ± 2.5 vs -1.5 ± 2.0, (p = 0.2520)). Technical difficulties reported by the operators were similar in both groups. Despite the large number of patients included, the virtual reality headset did not reduce patient's anxiety during a peripheral nerve block. Perioperative anxiety was low in all patients.

Effect of virtual reality on preoperative anxiety in patients undergoing septorhinoplasty

BACKGROUND

The aim of this study was to evaluate the effect of a virtual reality video on preoperative anxiety, hemodynamic parameters, and patient satisfaction in patients undergoing septorhinoplasty.

METHODS

This was a prospective, observational cohort trial. Forty patients between the ages of 18...65 who were scheduled for elective septorhinoplasty, with an American Society of Anesthesiologists (ASA) physical status I...II were included in the study. Patients experienced a 15-minute virtual reality (VR) video via a phone using a VR device. A three-dimensional, 360.. video depicted the beauty of nature and was accompanied by meditation music.

PATIENTS

.. oxygen saturation values, heart rate, and blood pressure were monitored and recorded. Using the State-Trait Anxiety Inventory scale, anxiety scores and hemodynamic parameters were compared before and after VR application.

RESULTS

Median anxiety scores decreased significantly from 40.5 to 34 (p.ß<.ß0.001). VR also had positive effects on hemodynamic parameters.

CONCLUSIONS

VR reduces preoperative anxiety and has positive effects on hemodynamic parameters in patients undergoing septorhinoplasty. We anticipate that VR will be increasingly used as a non-pharmacological preoperative approach in the future.

Effects of virtual tour on perioperative pediatric anxiety

BACKGROUND

There is a high incidence of perioperative anxiety in the pediatric population, with adverse side effects, such as emergency delirium and maladaptive postoperative behaviors.

AIMS

The study's objective was to compare the level of preoperative anxiety in children after standard preparation plus a virtual tour of the operating room vs. standard preparation alone.

PATIENTS/METHODS

This was a prospective single-center, randomized, controlled, blinded trial with parallel assignment, registered as NCT04043663. Eligible subjects were healthy children (ASA I-II) aged 4-12, scheduled for outpatient surgery. Five visits were conducted during the study, two at the hospital and three over the phone. Variables assessed were child's anxiety through the modified Yale Perioperative Anxiety Scale, demographic data, cooperation with induction through the Induction Compliance Checklist, preoperative parental anxiety through the State-Trait Anxiety Inventory and Anxiety Visual Analog Scale, the postoperative delirium degree through the Pediatric Anesthesia Emergence Delirium Scale, the presence of behavioral changes through the Post Hospitalization Behavior Questionnaire for Ambulatory Surgery, and the overall parental satisfaction.

RESULTS

A total of 125 participants were included; 61 (48.8%) of them were randomized to the Virtual Tour Group (VT+) and 64 (51.2%) to the Non-virtual Tour Group (VT-). Yale Preoperative Anxiety Scale results in VT+ vs. VT- were mean 27.26 vs. 32.57, and median 23.4 (CI 95% 23.4-23.4) vs. 23.4 (CI 95% 23.4-33.4), (p = .0086). In the VT+ group, satisfaction was higher for questions one (p = .0213), three (p = <.0001), and four (p = .0130). Throughout the study, we observed a significant reduction in perioperative anxiety in the VT+ group, facilitating anesthetic induction in perfect (p = .018) and moderate compliance (p = .0428). The other variables did not show statistically significant differences.

CONCLUSION

Our study confirms previous studies that found virtual tours for perioperative patients may reduce perioperative anxiety and improve satisfaction. We found no impact on longer-term outcomes.

Effects of Patient Education and Distraction Approaches Using Virtual Reality on Pre-operative Anxiety and Post-operative Pain in Patients Undergoing Laparoscopic Cholecystectomy

BACKGROUND

Fear of post-operative pain often contributes to pre-operative anxiety; accordingly, pain and anxiety are among the most common complications in patients undergoing laparoscopic cholecystectomy (LC).

AIM

The present study aimed to determine the effects of patient education and distraction using virtual reality (VR) on pre-operative anxiety and post-operative pain in patients undergoing LC.

METHOD

This randomized clinical trial included 150 patients in the surgery wards of educational hospitals in Mashhad, Iran, in 2020. The participants were randomly assigned to three groups of education, distraction, and control. The education and distraction groups watched two five-minute animations and three 360-degree images of nature using VR glasses 2 hours before and 4 hours after the surgery, respectively. On the other hand, the control group received routine care. Anxiety was measured using Spielberger's State Anxiety Inventory before and half an hour after the intervention. Moreover, the pain was measured using the visual analog scale and McGill Pain Questionnaire.

RESULTS

The results demonstrated a significant reduction in the two VR groups regarding the pre-operative anxiety mean scores, compared with the control group (p < .001). Furthermore, a significant reduction was observed in post-operative pain scores of patients in the two intervention groups compared with the control group (p = .001).

CONCLUSIONS

As evidenced by the results, both VR approaches of patient education and distraction equally decreased pre-operative anxiety and post-operative pain in patients undergoing LC.

Can virtual reality technology be considered as a part of the surgical care pathway?

INTRODUCTION

Virtual reality (VR) is emerging as a new technology in the healthcare sector. It has been shown to enhance the patient's experience and satisfaction in various settings. This review aims to give a brief description of the use of VR and establish validity of its applications to improve the patient's pathway through surgery.

METHODS

A literature search was conducted using the PubMed and Embase™ databases to identify fields in which VR technology has been trialled in relation to surgery. The search terms 'virtual reality' and 'surgery' were employed.

RESULTS

Although benefits relating to VR use have been identified in mental health, obesity management, and physical and cognitive rehabilitation, those in surgery have been less well documented. There are, however, some important but limited benefits reported in managing surgery related stress and improving preoperative patient education as well as VR being an adjunct to some level of postoperative analgesia.

CONCLUSIONS

The current applications of VR in relation to surgical care fall into four main categories: preoperative education, supporting mental health, postoperative pain management, and pre and postoperative patient optimisation. Future studies and validation of VR applications should be carried out so the technology can be utilised throughout the entire patient pathway as VR surgical care bundles.

Effect of a game-based intervention on preoperative pain and anxiety in children: A systematic review and meta-analysis

BACKGROUND

Games are increasingly being used as a means of alleviating pain and anxiety in paediatric patients, in the view that this form of distraction is effective, non-invasive and non-pharmacological.

AIMS

To determine whether a game-based intervention (via gamification or virtual reality) during the induction of anaesthesia reduces preoperative pain and anxiety in paediatric patients.

METHODS

A systematic review with meta-analysis of randomised controlled trials was performed in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and using RevMan software. The review was based on a search of the EMBASE, CINAHL, Medline, SciELO and Scopus databases, conducted in July 2021. No restriction was placed on the year of publication.

RESULTS

26 studies were found, with a total study population of 2525 children. Regarding pain reduction, no significant differences were reported. For anxiety during anaesthesia induction, however, a mean difference of -10.62 (95% CI -13.85, -7.39) on the Modified Yale Preoperative Anxiety Scale, in favour of game-based intervention, was recorded.

CONCLUSIONS

Game-based interventions alleviate preoperative anxiety during the induction of anaesthesia in children. This innovative and pleasurable approach can be helpful in the care of paediatric surgical patients.

RELEVANCE TO CLINICAL PRACTICE

In children, preoperative management is a challenging task for healthcare professionals, and game-based strategies could enhance results, improving patients' emotional health and boosting post-surgery recovery. Distractive games-based procedures should be considered for incorporation in the pre-surgery clinical workflow in order to optimise healthcare.

The effect of a video-assisted operating room promotion program on the anxiety levels of parents and their children: A randomized controlled trial protocol

PURPOSE

Anxiety experienced by parents is an important predictor of anxiety experienced by children. Different interventions are used to reduce the anxiety levels of children and their parents during the preoperative period. Apart from conventional training methods, watching videos about real-life operating rooms can reduce parents' and their children's anxiety levels. Children scheduled for surgery are likely to experience less anxiety if their parents experience less anxiety. A video-assisted operating room promotion program will develop for parents. This study will be aimed to evaluate the effect of the program on the anxiety levels of parents and children.

DESIGN AND METHODS

This study protocol is a single-center, single-blind, pre-test, post-test, follow-up parallel group randomized controlled trial. This study protocol was prepared with the Standard Protocol Items: Recommendations for Interventional Trials guidelines and will adhere to the Consolidated Standards of Reporting Trials Non-Pharmacologic Treatment Interventions checklist. A total of 100 eligible participants will be randomized into intervention and control groups. The intervention group will attend the program and receive standard care.

CONCLUSION

If we obtain the expected results, we think that they will help healthcare professionals develop methods and strategies to reduce the anxiety levels of parents and children through content covering the pre-, peri-, and post-surgical processes.

PRACTICE IMPLICATIONS

The results will assist healthcare professionals in the management of pain and guide them in developing technology-based nursing interventions. Trial registration It was registered at ClinicalTrials.gov in January 2022 (NCT05186766).

Virtual Reality as a Surgical Care Package for Patients Undergoing Weight Loss Surgery: A Narrative Review of the Impact of an Emerging Technology

While bariatric surgery is regarded as the most effective treatment for people with severe and morbid obesity, its pathway is regarded as a complex one due to the multidisciplinary approaches required from pre-surgery education until long-term management. This is essential to maintain weight loss and improve the quality of life after bariatric surgery. Although these approaches are broadened, patient education, pre-operative preparation, behavioural therapy, rehabilitation, and dietary changes are regarded as the main domains in such complex care. With the increase in technological adaptation in medical services, virtual reality (VR) has shown many benefits that can be utilized in the care of bariatric patients undergoing surgery. However, VR has not been innovated to be a multidomain care package in which bariatric patients could benefit throughout their journey from the pre-operative optimization, recovery, and long-term follow-up. This review aims to give a brief description of some of the applications of VR technology and question whether it has the potential to be considered as a virtual ecosystem to improve the bariatric patients’ experience and pathway throughout surgery and follow-up.

Technology-Based Approaches for Supporting Perinatal Mental Health

PURPOSE OF REVIEW

This review explores advances in the utilization of technology to address perinatal mood and anxiety disorders (PMADs). Specifically, we sought to assess the range of technologies available, their application to PMADs, and evidence supporting use.

RECENT FINDINGS

We identified a variety of technologies with promising capacity for direct intervention, prevention, and augmentation of clinical care for PMADs. These included wearable technology, electronic consultation, virtual and augmented reality, internet-based cognitive behavioral therapy, and predictive analytics using machine learning. Available evidence for these technologies in PMADs was almost uniformly positive. However, evidence for use in PMADs was limited compared to that in general mental health populations. Proper attention to PMADs has been severely limited by issues of accessibility, affordability, and patient acceptance. Increased use of technology has the potential to address all three of these barriers by facilitating modes of communication, data collection, and patient experience.

Virtual reality in preoperative preparation of children undergoing general anesthesia: a randomized controlled study

BACKGROUND

Preoperative anxiety can cause hyperalgesia, postoperative delirium and other adverse events, and even long-term psychological disorders. The aim of this trial was to determine whether preoperative virtual reality (VR) preparation reduces anxiety prior to induction of anesthesia.

METHODS

Data were analyzed for 99 children undergoing elective surgery. Participants were randomly assigned to a VR exposure intervention group or a control group. In the VR group, children watched a VR video showing a realistic interactive immersive virtual version of the perioperative process. The control group received conventional preoperative preparation. Preoperative anxiety using the modified Yale Preoperative Anxiety Scale-Short Form (mYPAS-SF) during anesthesia induction was the main outcome. Secondary outcomes included induction compliance, emergence delirium, pain, and parental satisfaction.

RESULTS

The VR group had lower mYPAS-SF scores when leaving the waiting area (27.1, interquartile range, IQR 22.9-33.3 vs. 33.3, IQR 27.1-39.6; P = 0.006), and during anesthesia induction (29.2, IQR 22.9-33.3 vs. 39.6, IQR 33.3-55.2; P = 9×10^-6). The Induction Compliance Checklist (ICC) scores during anesthesia induction were lower in the VR group (0.0, IQR 0.0-0.0 vs. 1.0, IQR 0.0-1.0; P = 0.003) than the control group, while parental satisfaction in the VR group was higher.

CONCLUSION

Virtual reality exposure as a preparation tool has a beneficial effect on anxiety, induction compliance and parental satisfaction in children undergoing elective surgery.

CLINICAL TRIAL REGISTRATION

ChiCTR2000035417.

The use of virtual reality in patient education related to medical somatic treatment: A scoping review

OBJECTIVE

To map the available evidence on the context, content and outcome of VR in patient education in situations related to preparation for medical somatic treatment.

METHODS

A Scoping review. In October 2020, the Embase, CINAHL, MEDLINE and PsycINFO databases were searched with the terms 'Virtual Reality' and 'Patient Education'. The literature was synthesised and mapped with a narrative approach.

RESULTS

17 studies published between 2015 and 2020 were included in the qualitative synthesis. VR was applied in (paediatric) surgery and radiation therapy treatment. VR interventions were heterogeneous regarding technical applications, context of implementation, guidance by healthcare professionals and integration in education sessions. Anxiety reduction was demonstrated significantly in some studies. Patients experienced VR education useful; it enhanced understanding, improved communication with healthcare professionals and encouraged treatment compliance.

CONCLUSIONS

The application of VR in patient education is a promising technology. Patients are highly satisfied and experience enhanced understanding. VR education was not effective in reducing all anxiety, pain and stress and improving preparedness for treatment. Practice implications It is important to develop VR interventions profoundly. The application of a methodological framework for VR development is recommended. Involve patients, educationalists and technology professionals in the development of technology interventions.

Impact of an Operating Room Nurse Preoperative Dialogue on Anxiety, Satisfaction and Early Postoperative Outcomes in Patients Undergoing Major Visceral Surgery-A Single Center, Open-Label, Randomized Controlled Trial

Background: Anxiety is common before surgery and known to negatively impact recovery from surgery. The aim of this study was to evaluate the impact of a preoperative nurse dialogue on a patient’s anxiety, satisfaction and early postoperative outcomes. Method: This 1:1 randomized controlled trial compared patients undergoing major visceral surgery after a semistructured preoperative nurse dialogue (interventional group: IG) to a control group (CG) without nursing intervention prior to surgery. Anxiety was measured with the autoevaluation scale State-Trait Anxiety Inventory (STAI, Y-form) pre and postoperatively. The European Organization for Research and Treatment of Cancer (EORTC) In-Patsat32 questionnaire was used to assess patient satisfaction at discharge. Further outcomes included postoperative pain (visual analogue scale: VAS 0−10), postoperative nausea and vomiting (PONV), opiate consumption and length of stay (LOS). Results: Over a period of 6 months, 35 participants were randomized to either group with no drop-out or loss to follow-up (total n = 70). The median score of preoperative anxiety was 40 (IQR 33−55) in the IG vs. 61 (IQR 52−68) in the CG (p < 0.001). Postoperative anxiety levels were comparable 34 (IQR 25−46) vs. 32 (IQR 25−44) for IG and CG, respectively (p = 0.579). The IG did not present higher overall satisfaction (90 ± 15 vs. 82.9 ± 16, p = 0.057), and pain at Day 2 was similar (1.3 ± 1.7 vs. 2 ± 1.9, p = 0.077), while opiate consumption, PONV levels and LOS were comparable. Conclusion: A preoperative dialogue with a patient-centered approach helped to reduce preoperative anxiety in patients undergoing major visceral surgery.

State-of-the-Art Review on Immersive Virtual Reality Interventions for Colonoscopy-Induced Anxiety and Pain

BACKGROUND

Colonoscopy related fear impairs the current gold standard screening of colorectal cancer. Compared to other minimally invasive procedures for cancer screening, colonoscopy-induced anxiety exceeds the procedure through bowel preparation. Immersive virtual reality's (iVR) role in alleviating the complex stress-pain relationship encountered during medical procedures is directly proportional to the rising affordability of state-of-the-art Head-Mounted-Displays (HMDs).

OBJECTIVE

to assess the effect of iVR on patients' colonoscopy-induced anxiety and pain.

MATERIALS AND METHODS

A systematic search was conducted in PubMed, Cochrane Central Register of Controlled Trials, Web of Science, Embase and Scopus databases up to January 2022. Clinical trials evaluating anxiety as an outcome were included without language restriction.

RESULTS

Four clinical trials were included: three on the patients' intraprocedural anxiety and one on patient education. Intraprocedural iVR interventions for colonoscopy-induced anxiety and pain revealed a similar effect as conventional sedation, while a statistically significant reduction was reported for non-sedated patients. iVR patient education improved the quality of bowel preparation and reduced patient anxiety before colonoscopy.

CONCLUSIONS

The current research highlights the need to use high-end HMDs and appropriate interactive iVR software content for colonoscopy-induced anxiety. Methodological frameworks regarding the eligibility of participants, double-blinding and randomization of iVR studies can facilitate the development of iVR implementation for anxiety and pain management.

The proper timing of virtual reality experience for reducing preoperative anxiety of pediatric patients: A randomized clinical trial

BACKGROUND

The virtual reality (VR) experience of an operation room (OR) prior to anesthesia and surgery has been known to reduce the anxiety and distress of pediatric patients. However, the proper timing needed for this is unknown. This randomized clinical study aimed to evaluate the proper timing of a VR tour of an OR (a few days before vs. immediately before anesthesia) to reduce the anxiety in a pediatric patient undergoing elective surgery.

METHODS

The children from the ages of 4-10 years old were randomly divided into three groups. The control group received standard verbal information about the process of anesthesia and surgery 10 min before anesthesia. The VR A group experienced a VR tour at the outpatient clinic a few days before anesthesia, whereas the VR B group experienced the tour 10 min before anesthesia at the reception area of the OR. The 4-min VR video used in this study showed the experience of Pororo, an animation character, entering the OR and undergoing anesthesia. We evaluated the anxiety of children using the modified Yale preoperative anxiety scale (m-YPAS), the anxiety of caregivers using Beck anxiety inventory (BAI), and caregivers' satisfaction.

RESULTS

The m-YPAS of the VR B group was significantly lower than that of the control and VR A groups (p = 0.001), whereas there was no statistically significant difference in BAI (p = 0.605) among the 3 groups. The score of caregivers' satisfaction with the overall process of anesthesia and surgery was higher in VR A group than in the control and VR B groups (p = 0.054).

CONCLUSION

The VR experience of an OR immediately before anesthesia was more effective than standard verbal information or a VR tour at the outpatient clinic a few days before anesthesia in reducing the anxiety and distress of children prior to surgery.

CLINICAL TRIAL REGISTRATION

[https://cris.nih.go.kr/cris/search/detailSearch.do/20773], identifier [KCT0006845].

Small surgeries, big smiles: using virtual reality to reduce the need for sedation or general anesthesia during minor surgical procedures

PURPOSE

Children often require anesthesia for simple diagnostic and therapeutic procedures. The aim of this study was to evaluate the feasibility of using virtual reality (VR) to reduce sedation in children undergoing minor surgical procedures.

METHOD

In this prospective, non-randomized clinical trial, pediatric patients at a free-standing children's hospital undergoing hormone implant placement, removal, or exchange were recruited to use VR and local anesthesia instead of procedural sedation or general anesthesia (GA). Patients were enrolled between November 2017 and March 2020, and were compared to historic controls who underwent similar procedures without VR between April 2016 and February 2020. Primary outcome measure was successful procedure completion without sedation or GA. Secondary measures included assessments of pain, fear and anxiety, patient compliance, procedural and recovery times.

RESULTS

Twenty-eight patients underwent 29 procedures with VR. Hormone implants (72%), removals (7%), or exchanges (21%) were completed without GA, sedation or IV placement. Procedure lengths and pain scores were similar between VR patients and historic controls, but recovery times were significantly shorter in VR patients (18 vs 65 min, p < 0.001). Participant satisfaction scores were high, with 95% recommending VR to others.

CONCLUSIONS

VR is a feasible alternative to sedation or GA for select pediatric patients undergoing minor surgical procedures.

Virtual reality for relatives of ICU patients to improve psychological sequelae: study protocol for a multicentre, randomised controlled trial

INTRODUCTION

Intensive care unit (ICU) admission of a relative might lead to psychological distress and complicated grief (post-intensive care syndrome-family; PICS-F). Evidence suggests that increased distress during ICU stay increases risk of PICS-F, resulting in difficulty returning to their normal lives after the ICU experience. Effective interventions to improve PICS-F are currently lacking. In the present trial, we hypothesised that information provision using ICU-specific Virtual Reality for Family members/relatives (ICU-VR-F) may improve understanding of the ICU and subsequently improve psychological well-being and quality of life in relatives of patients admitted to the ICU.

METHODS AND ANALYSIS

This multicentre, clustered randomised controlled trial will be conducted from January to December 2021 in the mixed medical-surgical ICUs of four hospitals in Rotterdam, the Netherlands. We aim to include adult relatives of 160 ICU patients with an expected ICU length of stay over 72 hours. Participants will be randomised clustered per patient in a 1:1 ratio to either the intervention or control group. Participants allocated to the intervention group will receive ICU-VR-F, an information video that can be watched in VR, while the control group will receive usual care. Initiation of ICU-VR-F will be during their hospital visit unless participants cannot visit the hospital due to COVID-19 regulations, then VR can be watched digitally at home. The primary objective is to study the effect of ICU-VR-F on psychological well-being and quality of life up to 6 months after the patients' ICU discharge. The secondary outcome is the degree of understanding of ICU treatment and ICU modalities.

ETHICS AND DISSEMINATION

The Medical Ethics Committee of the Erasmus Medical Centre, Rotterdam, the Netherlands, approved the study and local approval was obtained from each participating centre (NL73670.078.20). Our findings will be disseminated by presentation of the results at (inter)national conferences and publication in scientific, peer-reviewed journals.

TRIAL REGISTRATION NUMBER

Netherlands Trial Register (TrialRegister.nl, NL9220).

State of the Art: Immersive Technologies for Perioperative Anxiety, Acute, and Chronic Pain Management in Pediatric Patients

Purpose of Review

This review summarizes and provides a comprehensive narrative synthesis of the current evidence on immersive technology’s (i.e., virtual and augmented Reality) use for perioperative anxiety, acute, and chronic pain in pediatrics.

Recent Findings

Researchers have increasingly studied immersive technology as a non-pharmacological alternative for perioperative anxiety, acute, and chronic pain management. We found several research studies published over the last 3 years: almost all studies examined the use of virtual reality for perioperative anxiety and pain; only one case report was about the use of augmented reality for preoperative anxiety. Most studies showed that virtual reality intervention is effective and safe for perioperative anxiety, acute, and chronic pain. However, the studies are heterogeneous with relatively small sample sizes.

Summary

This review shows that more high-quality studies (i.e., randomized controlled trials with larger sample sizes and standardized methods for measuring and reporting outcomes) are needed to examine the effectiveness and adverse effects of virtual reality intervention on perioperative anxiety, acute, and chronic pain in pediatrics.

Virtual Reality Tailored to the Needs of Post-ICU Patients: A Safety and Immersiveness Study in Healthy Volunteers

Supplemental Digital Content is available in the text.

Objectives:

ICU treatments frequently result in long-term psychologic impairments, negatively affecting quality of life. An effective treatment strategy is still lacking. The aim of this study was to describe and evaluate the safety and immersiveness of a newly designed ICU-specific virtual reality module.

Design:

A randomized controlled healthy volunteer trial.

Setting:

ICU of the Franciscus Gasthuis & Vlietland Hospital (Rotterdam, the Netherlands), a large teaching hospital.

Participants:

Forty-five virtual reality–naive healthy volunteers.

Interventions:

Volunteers were randomized to three arms: the head-mounted display virtual reality group (n = 15), the 2D group (n = 15), and the crossover group (n = 15). Safety was assessed by changes in vital signs and the occurrence of simulator sickness (Simulator Sickness Questionnaire). Immersiveness was assessed using the Igroup Presence Questionnaire.

Measurements and Main Results:

Volunteers in the head-mounted display virtual reality group experienced more mild symptoms of simulator sickness, expressed as symptoms of dizziness (p = 0.04) and stomach awareness (p = 0.04), than the 2D group. Nevertheless, none of the individual Simulator Sickness Questionnaire items were scored as being severe, no changes in vital signs were observed, and no sessions were prematurely stopped. Volunteers in the crossover group experienced a higher total presence (p < 0.001) when using head-mounted display virtual reality, expressed as a higher sense of presence (p < 0.001), more involvement (p < 0.01), and more experienced realism (p < 0.001).

Conclusions:

ICU-specific virtual reality appears safe and more immersive than 2D, implicating that ICU-specific virtual reality is feasible for clinical use. One should however be aware of simulator sickness-related symptoms. Future research is needed to confirm these findings in survivors of critical illness.

Perioperative Pain Management and Opioid Stewardship: A Practical Guide

Surgical procedures are key drivers of pain development and opioid utilization globally. Various organizations have generated guidance on postoperative pain management, enhanced recovery strategies, multimodal analgesic and anesthetic techniques, and postoperative opioid prescribing. Still, comprehensive integration of these recommendations into standard practice at the institutional level remains elusive, and persistent postoperative pain and opioid use pose significant societal burdens. The multitude of guidance publications, many different healthcare providers involved in executing them, evolution of surgical technique, and complexities of perioperative care transitions all represent challenges to process improvement. This review seeks to summarize and integrate key recommendations into a "roadmap" for institutional adoption of perioperative analgesic and opioid optimization strategies. We present a brief review of applicable statistics and definitions as impetus for prioritizing both analgesia and opioid exposure in surgical quality improvement. We then review recommended modalities at each phase of perioperative care. We showcase the value of interprofessional collaboration in implementing and sustaining perioperative performance measures related to pain management and analgesic exposure, including those from the patient perspective. Surgery centers across the globe should adopt an integrated, collaborative approach to the twin goals of optimal pain management and opioid stewardship across the care continuum.