Virtual reality for pain management in patients with heart failure: Study rationale and design

Exergames in exercise-based cardiac rehabilitation for patients with heart failure: a systematic review

AIM

The aim of this study was to systematically review the current literature on the use of exergames as an exercise-based cardiac rehabilitation intervention for patients with heart failure.

METHODS

PubMed, SCOPUS and CINAHL Plus databases were searched from January 2007 to August 2023. Studies considered eligible for inclusion had to report one or more of the following outcomes: functional capacity (e.g. VO 2 max), quality of life, mortality, hospital admissions, physical activity level, and engagement/satisfaction of the intervention. Only studies reported in English were included. Two reviewers independently assessed studies for their eligibility.

RESULTS

Two studies (in four reports) were included. Included studies reported only data on functional capacity (6-min walking test) and on physical activity level (accelerometers). Due to the low number of included studies, no meta-analysis was performed, and results were discussed narratively.

CONCLUSION

Exergames may potentially be a promising tool for exercise-based cardiac rehabilitation in patients with heart failure; however, the low number of included studies was insufficient to drawn proper conclusions. Benefits of exergames compared with traditional interventions could be the possibility of it being delivered at home, reducing some of the barriers that patients with heart failure must face. Further studies are required to assess the efficacy of exergame interventions in patients with heart failure, and to define proper guidelines to deliver exergame interventions in this population.This systematic review was registered on PROSPERO (CRD42023446948).

Experiences and perceptions of palliative care patients receiving virtual reality therapy: a meta-synthesis of qualitative studies

BACKGROUND

The combination of virtual reality (VR) and palliative care potentially represents a new opportunity for palliative care. Many previous studies have evaluated the application of VR therapy to patients with advanced disease receiving palliative care. However, patient-perspective reviews to comprehensively understand the actual experiences and feelings of patients and provide practical guidance for designing future studies are currently lacking. This review of qualitative evidence aimed to explore the experiences and perceptions of patients receiving VR therapy in palliative care.

METHODS

This study was conducted in accordance with the Enhancing Transparency in Reporting the Synthesis of Qualitative Research (ENTREQ) statement guidelines. Ten databases, namely, PubMed, Web of Science, EBSCO, OVID MEDLINE, Scopus, John Wiley, ProQuest, CNKI, WANFANG DATA, and SinoMed, were searched, and qualitative and mixed studies from the establishment of each database to June 30, 2023 were included. The Joanna Briggs Institute Critical Appraisal Checklist for Qualitative Research was used to assess the quality of the included studies. The data included in the literature were analyzed and integrated by "thematic synthesis" to formalize the identification and development of themes.

RESULTS

The nine selected studies altogether included 156 participants from seven hospice care facilities of different types and two oncology centers. Three key themes were identified: experiences of palliative care patients in VR therapy, the perceived value that palliative care patients gain in VR therapy, and perspectives of palliative care patients toward using VR therapy.

CONCLUSIONS

The patients' feedback covered discomfort caused by VR devices, good sense of experiences, and situations that affected the interactive experience. Some patients were unable to tolerate VR therapy or reported newer forms of discomfort. The findings indicated that VR therapy may be an effective approach to relieve patients' physical and psychological pain and help them gain self-awareness. Moreover, patients showed a preference for personalized VR therapy.

Virtual Reality for Pain and Anxiety Management in Cardiac Surgery and Interventional Cardiology

Pain and anxiety are common in patients undergoing cardiac surgery and percutaneous cardiac interventions. Virtual reality (VR) is an emerging non-pharmacological tool for pain and anxiety management. However, its application around cardiac procedures remains relatively unexplored. In this review, we perform a targeted non-systematic literature review to assess the current state-of-the-art of VR for pain and anxiety management in patients undergoing cardiac procedures. Contexts of interest were preprocedural, periprocedural, and postprocedural applications. Existing trials show inconsistent results. The majority of studies in the preprocedural (7 studies, n = 302), periprocedural (1 study, n = 99), and postprocedural stage (4 studies, n = 214) demonstrate significant reduction of pain and anxiety through VR distraction therapy or VR patient education. However, larger-scale trials (2 preprocedural studies [n = 233], 1 periprocedural study [n = 32], 2 postprocedural studies [n = 300]) report no effect. Current literature on effectiveness of VR for pain and anxiety management in cardiac surgery and interventional cardiology remains inconclusive.

Effectiveness of virtual reality technology in symptom management of end-of-life patients: protocol of a systematic review and meta-analysis

INTRODUCTION

With the worsening of population ageing globally, the number of the elderly with chronic and incurable diseases such as malignant tumours is gradually increasing, and the need for palliative care is growing. As a primary task in the end-of-life phase, symptom management is an essential aspect of palliative care, which aims to alleviate distressing symptoms of terminally ill patients and improve their quality of life. Virtual reality (VR) technology, which allows the creation of simulated environments in which a three-dimensional experience is generated, has been increasingly used in palliative care for symptom management. Therefore, we aim to conduct a systematic review to investigate the effects of VR-based interventions on end-of-life patients.

METHODS AND ANALYSIS

This protocol for conducting a systematic review and meta-analysis will be prepared following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 statement. We will conduct a series of searches from inception to 31 July 2022 in the following databases: PubMed, Embase, Web of Science, the Cochrane Library, JBI, EBSCO, CNKI, Wanfang and SinoMed. The key concepts of 'virtual reality' and 'end-of-life' will be combined in each database using both free-text terms and controlled vocabulary terms (eg, MeSH/Emtree terms), if available. Two independent reviewers will use raw data to explore the effectiveness of VR for symptom management in end-of-life patients. The Cochrane Risk-of-Bias tool will be used to assess the risk of bias of included studies. Disagreements will be resolved by a third independent reviewer to reach a consensus. For the included articles, Review Manager software will be used for data synthesis and I² statistics will be used to measure the heterogeneity. Subgroup analyses and sensitivity analyses will be used to identify the source of heterogeneity.

ETHICS AND DISSEMINATION

As this is a protocol for a systematic review and meta-analysis, patients will not be included in this study. For this reason, ethical approval is not required. In order to disseminate the research findings, the results and conclusions of this review will be submitted to a worldwide journal.

PROSPERO REGISTRATION NUMBER

CRD42022344679.

Toward a model for assessing smart hospital readiness within the Industry 4.0 paradigm

Purpose

The fourth industrial revolution and digital transformation have caused paradigm changes in the procedures of goods production and services through disruptive technologies, and they have formed new methods for business models. Health and medicine fields have been under the effect of these technology advancements. The concept of smart hospital is formed according to these technological transformations. The aim of this research, other than explanation of smart hospital components, is to present a model for evaluating a hospital readiness for becoming a smart hospital.

Design/methodology/approach

This research is an applied one, and has been carried out in three phases and according to design science research. Based on the previous studies, in the first phase, the components and technologies effecting a smart hospital are recognized. In the second phase, the extracted components are prioritized using type-2 fuzzy analytic hierarchical process based on the opinion of experts; later, the readiness model is designed. In the third phase, the presented model would be tested in a hospital.

Findings

The research results showed that the technologies of internet of things, robotics, artificial intelligence, radio-frequency identification as well as augmented and virtual reality had the most prominence in a smart hospital.

Originality/value

The innovation and originality of the forthcoming research is to explain the concept of smart hospital, to rank its components and to provide a model for evaluating the readiness of smart hospital. Contribution of this research in terms of theory explains the concept of smart hospital and in terms of application presents a model for assessing the readiness of smart hospitals.

Virtual Reality Therapy in Palliative Care: A Case Series

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.

Using virtual reality in palliative care: a systematic integrative review

BACKGROUND

Recently, healthcare services have witnessed an exponential increase in the use of immersive and non-immersive virtual reality (VR) technology to improve health-related outcomes. However, the use of VR in palliative care remains relatively unexplored.

AIMS

To review and synthesise evidence regarding the experiences of patients, families and healthcare professionals in palliative care who have engaged with immersive/non-immersive VR technology.

METHODS

A systematic integrative review using pre-defined MeSH search terms to identify eligible studies from five electronic databases (Cochrane Library, CINAHL, OVID Medline, Pubmed and Scopus) between April 2020 and February 2021.

FINDINGS

In total, 1066 articles were reviewed, 55 articles were considered eligible and subject to further analysis and a total of 16 articles met the inclusion criteria and were subject to critical appraisal. Rigorous analysis of eligible articles resulted in the identification of five overarching and interconnected themes: connection, VR as an emergent technology, perceptual change, safety, and future research.

CONCLUSION

This review identified that VR could support patients, families and healthcare professionals in palliative care. As a result of the COVID-19 pandemic, the findings could prove particularly significant for facilitating connection. However, further research is necessary to explore the full scope of VR use in this speciality.

Virtual reality for pain management in advanced heart failure: A randomized controlled study

BACKGROUND

Hospitalized patients with advanced heart failure often experience acute and/or chronic pain. While virtual reality has been extensively studied across a wide range of clinical settings, no studies have yet evaluated potential impact on pain management on this patient population.

AIM

To investigate the impact of a virtual reality experience on self-reported pain, quality-of-life, general distress, and satisfaction compared to a two-dimensional guided imagery active control.

DESIGN

Single-center prospective randomized controlled study. The primary outcome was the difference in pre- versus post-intervention self-reported pain scores on a numerical rating scale from 0 to 10. Secondary outcomes included changes in quality-of-life scores, general distress, and satisfaction with the intervention.

SETTING/PARTICIPANTS

Between October 2018 and March 2020, 88 participants hospitalized with advanced heart failure were recruited from an urban tertiary academic medical center.

RESULTS

Participants experienced significant improvement in pain score after either 10 minutes of virtual reality (change from pre- to post -2.9 ± 2.6, p < 0.0001) or 10 minutes of guided imagery (change from pre- to post -1.3 ± 1.8, p = 0.0001); the virtual reality arm experienced a 1.5 unit comparatively greater reduction in pain score compared to guided imagery (p = 0.0011). Total quality-of-life and general distress scores did not significantly change for either arm. Seventy-eight participants (89%) responded that they would be willing to use the assigned intervention again.

CONCLUSION

Virtual reality may be an effective nonpharmacologic adjuvant pain management intervention in hospitalized patients with heart failure.

TRIAL REGISTRATION

ClinicalTrials.gov database (NCT04572425).

The impact of a 360° virtual tour on the reduction of psychological stress caused by COVID-19

The continuous spread of the COVID-19 pandemic is causing people to feel anxiety and stress. This study constructs a four-layer research model to examine how a 360° virtual tour can reduce people's psychological stress through two types of presence (the sense of presence and telepresence) and affective-motivational states (enjoyment and involvement) in this extraordinary period of the COVID-19 pandemic. In order to test the moderating effect of involvement, partial least squares (PLS) analysis is employed to analyse valid data collected from 235 individuals. The results of this study indicate that telepresence has a higher impact in generating affective-motivational states than the sense of presence. Among the factors, enjoyment shows the highest effect on satisfaction with the 360° virtual tour experience and stress reduction; involvement moderates the effect of telepresence on satisfaction with the 360° virtual tour experience. This study also contributes to virtual reality research by distinguishing the concepts of 'sense of presence' and 'telepresence' as well as demonstrating the mechanisms whereby virtual reality technology influences people's psychological well-being. Timely recommendations are provided for people in order to reduce psychological stress during and after COVID-19 pandemic.