Effects of visual and audiovisual distraction on pain and anxiety among patients undergoing colonoscopy

Effects of non-pharmacological interventions on anxiety in patients undergoing colonoscopy: A network meta-analysis of randomized controlled trials

BACKGROUND

Anxiety is a common and significant problem in patients who need to undergo colonoscopy. However, the question of which non-pharmacological intervention is the best strategy to reduce anxiety in patients undergoing colonoscopy remains unanswered.

OBJECTIVES

To evaluate and rank the effectiveness of various non-pharmacological interventions for reducing anxiety in patients undergoing colonoscopy in order to identify the most effective strategies.

METHODS

We searched PubMed, Cochrane Library, Embase, Web of Science, and Medline for randomized controlled trials published from the database construction to March 2024. The primary outcome was the difference between pre- and post-intervention anxiety means. A network meta-analysis was conducted utilizing the "gemtc" package based on R4.3.0.

RESULTS

The analysis encompassed 24 randomized controlled trials, incorporating 2525 participants and evaluating 9 non-pharmacological interventions. All non-pharmacological interventions reduced anxiety in patients undergoing colonoscopy compared to standard care, with music intervention (SMD = -0.52, 95 %CI (-0.84,-0.20)), audiovisual distraction (SMD = -0.54, 95 %CI(-0.96,-0.12)), video information (SMD = -1.47, 95 %CI(-2.03,-0.90)), individual education (SMD = -1.72, 95 %CI(-2.76,-0.70)), and electroacupuncture (SMD = -1.12, 95 %CI(-2.10,-0.13)) having statistically significant effects. SUCRA ranking identified the priority of individual education (SUCRA: 92.5 %) and video information (SUCRA: 87.7 %). Meta-regression and sensitivity analysis further demonstrated the stability of the evidence. The certainty of the evidence was mostly rated as medium to low.

CONCLUSION

This review highlights the superior effects of individual education and video information in reducing anxiety in patients undergoing colonoscopy. The findings of our review could provide clinical decision-makers and healthcare practitioners, such as doctors and nurses, with evidence-based practices for selecting interventions to reduce anxiety in patients undergoing colonoscopy.

Impact of virtual reality distraction during colonoscopy vs intravenous deep sedation: Results of a single-center randomized controlled trial

Background and study aims

Colonoscopy is associated with discomfort that requires intravenous sedation (IVS). The aim of this randomized controlled trial (RCT) was to explore the feasibility of virtual reality distraction (VRD) for colonoscopy using two primary endpoints: cecal intubation rate and the rate of rescue with IVS.

Patients and methods

Patients scheduled for elective colonoscopy with IVS were randomized in a 2:1 ratio in favor of VRD, with rescue IVS by propofol if needed. VRD involved use of a device providing a visual and auditive experience similar to clinical hypnosis.

Results

Ninety patients were included (VRD:60, IVS: 30). Cecal intubation rate was similar in both groups (92.8% for VRD vs 100% for IVS, P =0.3). The rate of rescue IVS in the VRD group was 63.6%. There was a decrease in median total dose of propofol per patient in the VRD group (1.15 mg/kg for VRD and 4.41 mg/kg for IVS, P <0.001) and in the subgroup of VRD patients who received IVS rescue (3.17 mg/kg for VRD and 4.41 mg/kg for IVS, P =0.003). The median level of pain was higher and the median level of comfort was lower in the VRD group (respectively 3 vs 0, P <0.001 and 7 vs 10, P <0.001).

Conclusions

This RCT provides preliminary data to better understand the feasibility of VRD for colonoscopy. We have not identified differences in procedure outcomes compared with conventional IVS, but nevertheless, higher pain and lower comfort scores were reported.

Is the Transverse Colon Overlooked? Establishing a Comprehensive Colonoscopy Database from a Multicenter Cluster-Randomized Controlled Trial

Background and Study Aim: Colonoscopy holds the highest volume of all endoscopic procedures, allowing for large colonoscopy databases to serve as valuable datasets for quality assurance. We aimed to build a comprehensive colonoscopy database for quality assurance and the training of future AIs. Materials and Methods: As part of a cluster-randomized controlled trial, a designated, onsite medical student was used to acquire procedural and patient-specific data, ensuring a high level of data integrity. The following data were thereby collected for all colonoscopies: full colonoscopy vides, colonoscope position (XYZ-coordinates), intraprocedural timestamps, pathological report, endoscopist description, endoscopist planning, and patient-reported discomfort. Results: A total of 1447 patients were included from the 1st of February 2022 to the 21st of November 2023; 1191 colonoscopies were registered as completed, 88 were stopped due to inadequate bowel cleansing, and 41 were stopped due to patient discomfort. Of the 1191 completed colonoscopies, 601 contained polypectomies (50.4%), and 590 did not (49.6%). Comparing colonoscopies with polypectomies to those without the withdrawal time (caecum to extubating the scope) was significantly longer for all parts of the colon (p values < 0.001), except the transverse colon (p value = 0.92). The database was used to train an AI, automatically and objectively evaluating bowel preparation. Conclusions: We established the most thorough database in colonoscopy with previously inaccessible information, indicating that the transverse colon differs from the other parts of the colon in terms of withdrawal time for procedures with polypectomies. To further explore these findings and reach the full potential of the database, an AI evaluating bowel preparation was developed. Several research partners have been identified to collaborate in the development of future AIs.

Virtual Reality and Augmented Reality Use Cases in Gastroenterology

PURPOSE OF REVIEW

Virtual reality (VR) and augmented reality (AR) are emerging technologies with significant potential in medical education and therapeutic interventions, particularly within gastroenterology. This review aims to explore the current applications of VR and AR in enhancing endoscopy training, procedural skills, and patient comfort, while also identifying their role in non-pharmacological pain management and pre-procedure education.

RECENT FINDINGS

Extensive research has been conducted on the use of VR and AR in surgical and neurological fields, but their application in gastroenterology is still evolving. VR simulators provide realistic training environments, contributing to improved procedural skills and patient care. Additionally, VR has been shown to reduce patient discomfort and serve as an alternative to sedation during procedures like colonoscopies. AR, specifically in colonoscopies, has demonstrated potential in enhancing polyp detection by overlaying real-time digital information, leading to better diagnostic accuracy. Studies also suggest that VR can improve patient outcomes in functional gastrointestinal disorders and enhance pre-procedure education, increasing patient satisfaction. VR and AR hold significant promise in gastroenterology by advancing both educational and procedural practices. These technologies offer cost-effective, patient-friendly solutions that improve diagnostic accuracy and patient outcomes. Continued research is essential to fully realize the benefits of VR and AR in gastroenterology, as these tools become more prevalent in clinical practice.

Impact of Spinal Manipulative Therapy on Brain Function and Pain Alleviation in Lumbar Disc Herniation: A Resting-State fMRI Study

OBJECTIVE

To elucidate how spinal manipulative therapy (SMT) exerts its analgesic effects through regulating brain function in lumbar disc herniation (LDH) patients by utilizing resting-state functional magnetic resonance imaging (rs-fMRI).

METHODS

From September 2021 to September 2023, we enrolled LDH patients (LDH group, n=31) and age- and sex-matched healthy controls (HCs, n=28). LDH group underwent rs-fMRI at 2 distinct time points (TPs): prior to the initiation of SMT (TP1) and subsequent to the completion of the SMT sessions (TP2). SMT was administered once every other day for 30 min per session, totally 14 treatment sessions over a span of 4 weeks. HCs did not receive SMT treatment and underwent only one fMRI scan. Additionally, participants in LDH group completed clinical questionnaires on pain using the Visual Analog Scale (VAS) and the Japanese Orthopedic Association (JOA) score, whereas HCs did not undergo clinical scale assessments. The effects on the brain were jointly characterized using the amplitude of low-frequency fluctuations (ALFF) and regional homogeneity (ReHo). Correlation analyses were conducted between specific brain regions and clinical scales.

RESULTS

Following SMT treatment, pain symptoms in LDH patients were notably alleviated and accompanied by evident activation of effects in the brain. In comparison to TP1, TP2 exhibited the most significant increase in ALFF values for Temporal_Sup_R and the most notable decrease in ALFF values for Paracentral_Lobule_L (voxelwise P<0.005; clusters >30; FDR correction). Additionally, the most substantial enhancement in ReHo values was observed for the Cuneus_R, while the most prominent reduction was noted for the Olfactory_R (voxelwise P<0.005; clusters >30; FDR correction). Moreover, a comparative analysis revealed that, in contrast to HCs, LDH patients at TP1 exhibited the most significant increase in ALFF values for Temporal_Pole_Sup_L and the most notable decrease in ALFF values for Frontal_Mid_L (voxelwise P<0.005; clusters >30; FDR correction). Furthermore, the most significant enhancement in ReHo values was observed for Postcentral_L, while the most prominent reduction was identified for ParaHippocampal_L (voxelwise P<0.005; clusters >30; FDR correction). Notably, correlation analysis with clinical scales revealed a robust positive correlation between the Cuneus_R score and the rate of change in the VAS score (r=0.9333, P<0.0001).

CONCLUSIONS

Long-term chronic lower back pain in patients with LDH manifests significant activation of the "AUN-DMN-S1-SAN" neural circuitry. The visual network, represented by the Cuneus_R, is highly likely to be a key brain network in which the analgesic efficacy of SMT becomes effective in treating LDH patients. (Trial registration No. NCT06277739).

Effect of Virtual Reality on Pain, Anxiety, and Vital Signs in Endoscopy

AIM

This study was conducted to evaluate the effect of relaxation exercise with VR (Virtual Reality) glasses on pain severity, anxiety level, and vital signs in patients undergoing endoscopy.

METHODS

This is a quasi-experimental study including a control group with a pretest/post-test applied. This study was conducted with a total of 100 patients, including 50 patients in the intervention and 50 patients in the control group. The data were collected by using Personal Information Form, Visual Analogue Scale (VAS), Visual Anxiety Scale, Vital Signs Form and Virtual Reality Glass Application Satisfaction Form.

RESULTS

In the inter group evaluation, the mean systolic and diastolic blood pressure, heart rate and respiratory rate of the patients in the experimental group after endoscopy were found to be lower than the control group (p < .05). When the effect size value (Cohen d) of this finding was examined, it was found that the application of virtual reality glasses had a large effect on systolic and diastolic blood pressure and a moderate effect on respiration and heart rate. It was found that the mean VAS score of the patients in the control group after the endoscopy procedure was significantly higher than their mean values before the procedure (p = .001). There was no statistically significant difference in the mean VAS scores, anxiety scores and O2 saturation values of the patients in the experimental and control groups after the endoscopy. The mean virtual reality glasses satisfaction value of the patients was found to be 6.98.

CONCLUSION

Relaxation exercise performed with virtual reality glasses has positive effects on mean systolic and diastolic blood pressure values, heart rate and respiratory rate in patients undergoing endoscopy. In line with these results, it is recommended that the use of virtual reality glasses during endoscopy should be widespread by nurses.

The Effect of Virtual Reality, Music Therapy, and Stress Ball Application on Pain and Anxiety During Outpatient Gynecological Procedures: A Randomized Controlled Trial

PURPOSE

The aim of this study was to determine the effect of virtual reality, music therapy, and stress ball applications, which are methods of distraction, on pain, anxiety, and patient satisfaction during outpatient gynecological procedures.

DESIGN

This study was a randomized controlled trial with control and intervention groups, pre-test and post-test.

METHODS

The study was conducted with 200 women who underwent gynecological surgical procedures without sedation in a state hospital on the European side of Istanbul between October 2022 and March 2023. There were four groups in the study: Virtual Reality (n = 50), Music Therapy (n = 50), Stress Ball (n = 50), and Control group (n = 50). Data were collected using a Descriptive Information Form, Visual Analog Scale, State-Trait Anxiety Inventory, Life Information Follow-up Form, and Patient Satisfaction Evaluation Form. The scales were completed separately by the investigator before the procedure, 10 minutes after the procedure, and 1 hour after the procedure.

FINDINGS

A statistically significant difference between the intervention groups and control groups of women who underwent a gynecological procedure at the 10th minute after the procedure (P=.000) and at the 1st hour after the procedure (P=.000) was significant. State-Trait Anxiety Inventory of women by groups decreased after the procedure and showed a statistically significant difference (P =.000). Satisfaction scores of the women with the intervention according to the groups also showed a significant difference (P =.000). When the satisfaction scores of the women with the intervention were compared by groups, the satisfaction scores ranged from the highest to the lowest, as virtual reality, music therapy, and stress ball application, respectively.

CONCLUSIONS

Virtual reality, music therapy, and stress ball applications, which are methods of distraction during the outpatient gynecological procedure, were effective in reducing anxiety and pain and increasing patient satisfaction.

The Impact of Visual Distraction Interventions on Patients' Pain and Anxiety During Colonoscopy: A Systematic Review and Meta-Analysis of Randomized Controlled Trials

BACKGROUND AND OBJECTIVE

Patients undergoing colonoscopy may experience psychological distress related to the procedure, which may deter adherence and acceptance of future colonoscopies. Visual/audiovisual distraction interventions to alleviate colonoscopy-related pain and anxiety have been developed. This study aims to investigate the impact of these interventions on colonoscopy-related outcomes.

METHODS

We conducted a systematic review and meta-analysis of randomized controlled trials (RCTs) testing the efficacy of visual/audiovisual distraction. Eligible studies were systematically retrieved by searching PubMed, EMBASE, WOS, SCOPUS, and Cochrane through June 2024 and extracted by 2 investigators. Continuous and dichotomous outcome variables were pooled using Cohen's d and risk ratio (RR) with confidence interval (CI) using Stata MP version 17. We assessed heterogeneity using the χ2 test and I2 statistic (PROSPERO ID: CRD42024555902).

RESULTS

We included 13 RCTs with 1439 patients randomized to an active intervention (n=804) or usual care (n=635). Only 3 RCTs were endoscopists-blinded studies, whereas the rest were open-label. The interventions included playing nature scene videos, real-time videos of the colonoscopy, or movies preferred by the patients. The active intervention arm was associated with a significant reduction in the pain experienced during colonoscopy (Cohen's d: -0.57, 95% CI [-0.79, -0.35], P<0.0001), reduced anxiety related to colonoscopy (Cohen's d: -0.66, 95% CI [-1.15, -0.18], P=0.01), and increased patients' satisfaction (Cohen's d: 0.65, 95% CI [0.49, 0.80], P<0.0001) compared with patients who received the usual care during colonoscopy. There were no significant differences between both groups in the willingness to re-undergo the procedure (RR: 1.11, 95% CI [0.98, 1.25], P=0.09), analgesia use (Cohen's d: -0.21, 95% CI [-0.42, 0.0], P=0.05), or total procedure duration (Cohen's d: -0.12, 95% CI [-0.24, 0.0], P=0.06).

CONCLUSIONS

Visual/audiovisual distraction interventions decrease colonoscopy-associated pain and anxiety and increase patients' satisfaction. These are promising interventions to improve patient compliance and quality of care during colonoscopy.

The effect of virtual reality glasses applied during intrauterine device insertion on pain, anxiety and satisfaction: Randomized controlled study

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.

Causes of intraprocedural discomfort in colonoscopy: a review and practical tips

Colonoscopy is a commonly performed procedure in the United Kingdom and the gold standard for diagnosis and therapy in the gastrointestinal tract. Increased levels of pain during colonoscopy have been associated with reduced completion rates and difficulties in maintaining attendance for repeat procedures. Multiple factors play a role in causing discomfort intra-procedurally: patient factors, such as gender, anatomy and pre-procedure anxiety; operator factors, such as patient position and level of experience and other factors, such as bowel preparation and total procedure time. A literature search was performed to identify papers that explained how patient, operator and endoscopy factors influenced pain and discomfort in endoscopy. A further search then also identified papers describing solutions to pain and discomfort that have been explored. After review of the literature, key methods are selected and discussed in this paper. Solutions and aids that can resolve and improve pain and discomfort include endoscopic methods such as variable stiffness and ultrathin scopes. Operator improvements in techniques and ergonomics alongside the use of newer technologies such as propelled endoscopy, computer-assisted endoscopy and task distraction. To improve patient experience and outcomes, the investigation and research into improving techniques to reduce pain is crucial. This review aims to identify the modifiable and non-modifiable factors associated with intra-procedural discomfort during colonoscopy. We discuss established methods of improving pain during colonoscopy, in addition to newer technologies to mitigate associated discomfort.

Three Distraction Methods for Pain Reduction During Colonoscopy: A Randomized Controlled Trial Evaluating the Effects on Pain and Anxiety

PURPOSE

The aim of this study was to compare the effects of distraction methods on pain, anxiety, and satisfaction during a colonoscopy.

DESIGN

This experimental research was conducted as a single-center, randomized, parallel-group trial.

METHODS

A total of 120 patients were recruited and randomized into 4 groups (music, stress ball, audiovisual distraction, and control). The data were collected using individual an identification form, observation form, the Visual Analog Scale, and the State-Trait Anxiety Inventory.

FINDINGS

Pain severity during colonoscopy was found to be lower in the intervention (music and audiovisual distraction) groups compared to the stress ball and control groups (P < .001).There was no statistically significant difference between the pre- and postanxiety levels in the intervention groups compared to the control group. After the colonoscopy, satisfaction levels were significantly higher in the music group compared to the audiovisual, control, and stress ball groups (P < .001).

CONCLUSIONS

Distraction methods used during colonoscopy were found to reduce pain. Although sedation is widely used during a colonoscopy procedure and is accepted as a general standard, music and VR can be used as effective alternative strategies in reducing pain for colonoscopy patients.

A Randomized Controlled Trial on the Effect of Music Listening on Procedural Pain, Anxiety and Comfort Levels during Cystoscopy

This study aimed to determine the effect of music listening on procedural pain intensity, anxiety, and comfort levels in patients during cystoscopy. This study was a prospective, randomized controlled trial. Study participants were randomly assigned to either a control or music group. The outcome measures were assessed using the Visual Analogue Scale, State Anxiety Scale, and General Comfort Questionnaire. A total of 36 patients in each group completed the study. The mean scores of pain in the music and control groups immediately after cystoscopy were 3.22 (SD, 1.72) and 5.22 (SD, 1.92), respectively. A statistically significant difference (between-group effect) was found, indicating that pain scores in the music group were significantly lower than those of the control group (group: F = 15.756, p < .001). However, no statistically significant difference was noted between the two groups regarding anxiety and comfort scores 20 min after cystoscopy (t₁ = 1.156, p = .526; t₁ = -0.586, p = .560, respectively). Music listening is a safe, economical, and effective method in pain management in patients undergoing cystoscopy.

Satisfaction and tolerability using virtual reality (VR) as adjunctive treatment during flexible bronchoscopy: a randomized control trial

BACKGROUND

Patient comfort during invasive and therapeutic procedures is important. The use of virtual reality (VR) devices during flexible bronchoscopy (FB) as a method of distraction to increase patient tolerability and improve satisfaction has not been investigated. We aim to assess the satisfaction and tolerability of participants undergoing FB with or without VR.

METHODS

This was a single-center, open-label study on patients undergoing bronchoscopy, randomized into the control and interventional (VR) groups. The control group received standard care during FB. The interventional group was given a VR device during FB showing nature videos with soothing instrumental music. Pain, breathlessness, and cough were evaluated using a 10 cm visual analogue scale administered before and after FB. Anxiety was assessed using the State-Trait Anxiety Inventory. Satisfaction questionnaire (5-point Likert scale) was given to participants post FB.

RESULTS

Eighty participants enrolled, 40 in each arm. Median (IQR) satisfaction score in the VR group was 5.0 (3.0-5.0), and in the control group was 4.0 (3.0-5.0); (p < 0.001). Breathlessness, cough, and anxiety post FB were significantly less severe in the interventional group (p = 0.042, p = 0.001, p < 0.001), but the pain was not significantly different (p = 0.290).

CONCLUSION

VR used during FB led to better participants' satisfaction and tolerability (breathlessness and cough). There was a significantly lower anxiety score in the VR group.

Effect of visual distraction on pain in adults undergoing colonoscopy: a meta-analysis

BACKGROUND

Pain is a contributing factor to the low compliance rate for performing a colonoscopy on screening for colorectal cancer.

PURPOSE

This meta-analysis aimed to evaluate the effect of visual distraction on adults undergoing colonoscopy.

METHODS

We searched PubMed, EMBASE, Web of Science, and Cochrane Library Database from their inception to February 2022. Randomized controlled trials comparing visual distraction with non-visual distraction were considered for inclusion. The fixed-effects and random-effects models were used to pool the data from individual studies and the Cochrane risk of bias assessment tool was used to determine the methodology quality.

RESULTS

This meta-analysis included four studies (N = 301) for pain level and total procedure time, three studies (N = 181) for satisfaction score, three studies (N = 196) for anxiety level, and four studie (N = 402) for willingness to repeat the procedure. The pooled analysis shown that significantly lower pain levels (SMD, - 0.25; 95% CI - 0.47 to - 0.02; P = 0.03), higher satisfaction score with the procedure (SMD, 0.63; 95% CI, 0.33 to 0.93; P < 0.0001), and higher willingness to repeat the procedure (OR, 2.66; 95% CI 1.70 to 4.17; P < 0.0001) in the visual distraction group than those in the non-visual distraction group, with no significant differences in total procedure time (SMD,- 0.07; 95% CI - 0.30 to 0.15; P = 0.53) or anxiety level (SMD,- 0.27; 95% CI - 0.55 to 0.01; P = 0.06).

CONCLUSIONS

Visual distraction improved the patient's pain, satisfaction, and willingness to repeat the procedure. Thus, visual stimulation is an effective way to reduce pain during colonoscopy and should be recommended.

Comparing Auditory and Visual Distractions for Reducing Pain Severity and Pain Anxiety in Older Outpatients with Burn: A Randomized Controlled Trial

Pain and anxiety are major issues among older patients with burn injuries. Complementary medicine and non-pharmacological methods can relieve pain and anxiety in older people, but comparison of the effects of these methods needs further research. This study aimed to compare the effects of auditory and visual distractions on pain severity and pain anxiety in older outpatients referred to a burn clinic for dressing change. In this randomized controlled clinical trial, older men were randomly assigned to three groups as auditory distraction, visual distraction, and control (n = 45 in each group). The Visual Analogue Scale (VAS) and the Burn Specific Pain Anxiety Scale (BSPAS) were used to asses pain severity and pain anxiety before and immediately after the interventions, and after wound dressing. Reduction in pain severity and pain anxiety after visual distraction was reported. Auditory distraction only reduced pain anxiety. Therefore, visual distraction had a better effect on alleviating pain anxiety compared with auditory distraction. Visual distraction is suggested to be used during dressing changes for older outpatients with burn injuries in outpatient clinics in order to reduce their burn-related suffering and improve their collaboration with the therapeutic regimen.

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 Impact of a Music Video on Procedural Pain and State Anxiety

PURPOSE

Patients with chronic pain and/or spasticity who have an intrathecal targeted drug delivery (TDD) pump require frequent needle access procedures to refill the pump's medication reservoir. Some patients find the access procedure painful and/or anxiety provoking. The purpose of this study was to determine if a nursing intervention of providing a distraction with a music relaxation video during the pump access procedure would reduce patients' pain and state anxiety.

DESIGN/METHODS

In this longitudinal, pre-test post-test, quasi-experimental design, patients watched a 13-minute calming music video while the nurse performed the needle access procedure. Data collection instruments included a combination of researcher-developed questionnaires, the Defense & Veterans Pain Rating Scale (DVPRS), and the State Trait Anxiety Inventory (STAI). Pain and anxiety were measured pre- and post-pump refill procedures at baseline with no intervention (T1) and at two subsequent pump refills with the music video intervention (T2 and T3).

RESULTS

The sample consisted of 31 adults with chronic pain (n = 28) or spasticity (n = 3). All participants had an implanted pump for at least six months. Specialty trained nurses refilled the participants' pump in their home. The findings support the use of a music video as an effective intervention for reducing participants' perception of pain and anxiety during the pump refill procedure. Neither pre-test pain nor pre-test anxiety scores differed across time. Post-test mean pain scores decreased consistently across time (T1 = 5.55, T2 = 4.42, T3 = 4.23; P = .002). Post-test anxiety scores showed a significant decrease (P <.05) between T1 (M = 37.87) and T2 (M = 30.94) which was not sustained at T3 (M = 35.68, P = .284). Overall, the majority of participants indicated liking the music video intervention. They also expressed interest in using the intervention for future refill procedures or other stressful situations.

CONCLUSIONS

The music video was effective in producing a sustained reduction over time of participants' pain during the pump refill procedures; it was most effective in initially reducing participants' state anxiety at the initial intervention visit; however, it did not demonstrate a progressively sustained effect. Participants' opinions about the music video experience were positive.

Effect of media distraction (audio-visual and music) for pain and anxiety control in patients undergoing shock-wave lithotripsy: A systematic review and meta-analysis

Audio-visual (AV) or music distraction may be used to reduce pain during several healthcare procedures. The present manuscript is a systematic review and meta-analysis to assess the effectiveness of media distraction in reducing pain and anxiety in extracorporeal shock wave lithotripsy (ESWL) patients. The PubMed, Embase, Scopus, BioMed Central, Ovoid and CENTRAL (Cochrane Central Register of Controlled Trials) databases were screened for studies assessing the role of media distraction (music/AV media) in reducing pain and anxiety of ESWL patients. Data were summarized using the mean difference (MD) with 95% confidence intervals (CI). A total of 11 randomized controlled trials were included. Pooled analysis indicated a statistically significant difference in pain outcomes with media distraction [mean difference (MD): -1.18; 95% CI: -2.35, -0.01; I²=96.8%)]. Subgroup analysis indicated that both AV media (MD: -2.94; 95% CI: -4.70, -1.17; I²=79.2%) and music (MD: -0.86; 95% CI: -1.37, -0.35; I²=62.5%), led to significant reduction in pain outcomes. Pooled analysis indicated a statistically significant reduction of anxiety scores with the use of media distraction (MD: -3.91; 95% CI: -6.44, -1.38; I²=77.7%). To conclude, the present review suggests that media distraction in the form of AV media or music may be beneficial in reducing the pain and anxiety of patients undergoing ESWL. Evidence is, however, weak considering the small effect size, confidence intervals being close to zero, and instability of the results on sensitivity analysis. In clinical practice, media distraction may be used during ESWL as a nursing intervention, but a clinically important reduction of pain and anxiety may not be expected.

Improving the discomfort and satisfaction of colonoscopy by distraction with smartphones: A prospective randomized controlled study

BACKGROUND

Colonoscopy is an uncomfortable procedure. Distraction is thought to reduce pain by decreasing the amount of attention a person spends on a painful stimulus. We aimed to assess the usefulness of smartphones on discomfort associated with the colonoscopy.

METHODS

We designated 360 enrolled patients according to prospective randomized controlled study into two groups, including smartphone (SP) group (Relaxation by smartphones) and Control group (No relaxation). Measured outcomes included the discomfort, satisfaction, polyp detection rate and the willingness to repeat colonoscopy were analyzed between groups.

RESULTS

The pain and distension scores of SP group patients were significantly lower than those of the Control group (2.18 ± 2.80 vs 3.55 ± 3.07, P < .001; 4.15 ± 2.35 vs 4.79 ± 2.36, P = .011, respectively). Importantly, patient-reported satisfaction scores of the SP group were significantly higher than those of the Control group (96.45 ± 7.17 vs 91.12 ± 10.49, respectively; P < .001). Moreover, although there were no statistical differences, patients using smartphones were more likely to have shorter reach cecum times (09m:11 s vs 07m:37 s, P = .116) and more polyp detection rate (13.3% vs 9.4%, P = .246). In addition, more patients using smartphones were willing to repeat colonoscopy but no statistical difference (85.0% vs 81.7%, P = .396).

CONCLUSION

Patient using smartphone is a special manner to increase satisfaction during colonoscopy with a less discomfort and is more likely to be polyp detection rate.

Watching Videos of Colonoscopies and Receiving Interpretations Reduce Pain and Anxiety While Increasing the Satisfaction of Patients

BACKGROUND

Pain associated with colonoscopies is a major barrier to patients participating in colorectal cancer screenings. While sedation and analgesia are used to reduce pain during the procedure, they are associated with increased complications and costs. Thus, it is necessary to identity novel techniques to relieve pain in a safe and cost-effective way.

AIMS

To test whether watching real-time videos of colonoscopies while receiving detailed interpretations of the procedures reduces pain and anxiety and increases a patient's satisfaction.

METHODS

Patients were randomized into three groups including a group who watched real-time videos of their colonoscopies (Group A), a group who watched real-time videos of their colonoscopies while receiving detailed interpretations of the procedures from the endoscopists (Group B), and a group who did not receive either method (Group C).

RESULTS

Pain and anxiety scores were significantly (Group A vs. Group C, [Formula: see text]; Group B vs. Group C, [Formula: see text]) lower in Groups A and B compared to Group C. Additionally, significantly (Group A vs. Group C, [Formula: see text]; Group B vs. Group C, [Formula: see text]) increased satisfaction was observed in Groups A and B compared to Group C. There were no statistically significant differences observed in the pain and anxiety scores when comparing Groups A and B. However, the overall satisfaction score was significantly ([Formula: see text]) higher in Group B compared to Group A.

CONCLUSIONS

Real-time videos of colonoscopies as well as videos along with detailed interpretations of the procedures decrease pain and anxiety while improving satisfaction in patients undergoing colonoscopies without sedation. Videos combined with interpretations lead to a greater increase in patient satisfaction.

A systematic review of effectiveness of interventions applicable to radiotherapy that are administered to improve patient comfort, increase patient compliance, and reduce patient distress or anxiety

OBJECTIVES

The aim of this review was to search existing literature to identify comfort interventions that can be used to assist an adult patient to undergo complex radiotherapy requiring positional stability for periods greater than 10 min. The objectives of this review were to; 1) identify comfort interventions used for clinical procedures that involve sustained inactivity similar to radiotherapy; 2) define characteristics of comfort interventions for future practice; and 3) determine the effectiveness of identified comfort interventions. The Preferred Reporting Items for Systematic Reviews and meta-analyses statement and the Template-for-Intervention-Description-and Replication guide were used.

KEY FINDINGS

The literature search was performed using PICO criteria with five databases (AMED, CINAHL EMBASE, MEDLINE, PsycINFO) identifying 5269 titles. After screening, 46 randomised controlled trials met the inclusion criteria. Thirteen interventions were reported and were grouped into four categories: Audio-visual, Psychological, Physical, and Other interventions (education/information and aromatherapy). The majority of aromatherapy, one audio-visual and one educational intervention were judged to be clinically significant for improving patient comfort based on anxiety outcome measures (effect size ≥ 0.4, mean change is greater than the Minimal-Important-Difference and low-risk-of-bias). Medium to large effect sizes were reported in many interventions where differences did not exceed the Minimal-Important-Difference for the measure. These interventions were deemed worthy of further investigation.

CONCLUSION

Several interventions were identified that may improve comfort during radiotherapy assisting patients to sustain and endure the same position over time. This is crucial for the continual growth of complex radiotherapy requiring a need for comfort to ensure stability for targeted treatment.

IMPLICATIONS FOR PRACTICE

Further investigation of comfort interventions is warranted, including tailoring interventions to patient choice and determining if multiple interventions can be used concurrently to improve effectiveness.

Comparison of the Effects of Visual and Auditory Distractions on Fistula Cannulation Pain among Older Patients Undergoing Hemodialysis: A Randomized Controlled Clinical Trial

Pain associated with fistula cannulation is a challenge for nurses who provide care to older patients undergoing hemodialysis. Several non-pharmacological methods have been suggested for relieving fistula cannulation pain, but the benefits of visual and auditory distraction methods among older patients undergoing hemodialysis have not been investigated yet. Therefore, this study aimed to compare the effects of visual and auditory distractions on fistula cannulation pain among older patients undergoing hemodialysis. This randomized controlled clinical trial was conducted on 120 older patients undergoing hemodialysis. They were randomly assigned to three groups of visual distraction, auditory distraction, and the control (n = 40 in each group) using a simple random assignment method. The distraction interventions continued for three consecutive sessions and the numeric rating scale of pain severity was used for data collection. Descriptive and inferential statistics were used for data analysis using SPSS. It was found that pain severity significantly reduced after the distraction interventions in either the auditory or visual distraction groups and also after all three distraction sessions (p = 0.001). However, visual distraction had a better effect on the reduction of pain severity. Therefore, while both visual and auditory distractions reduced pain severity in older patients undergoing hemodialysis, visual distraction was more effective. Nurses are encouraged to incorporate visual distraction as a safe and non-pharmacologic technique into routine nursing care for reducing older patients’ suffering and improving their wellbeing when fistula cannulation is performed.

A systematic review of non-pharmacological interventions used for pain relief after orthopedic surgical procedures

The purpose of the present review was to evaluate the available evidence on the efficacy of various non-pharmacological interventions to relieve pain after orthopedic surgical procedures. An electronic search of the PubMed, Embase and Cochrane library databases was performed to retrieve studies of all types assessing the role of non-pharmacological interventions for pain relief after orthopedic surgical procedures. The included studies were required to assess pain outcomes using a validated measurement index, such as the Visual Analog Scale. The quality of randomized control trials (RCTs) was assessed using the Cochrane tool, while the ROBINS-I tool was used for non-RCTs. A total of five studies were included, namely three RCTs and two non-RCTs. The included studies used relaxation therapy, guided imagery, music and audio-visual distraction for pain management. There was considerable heterogeneity concerning study participants and types of intervention, which precluded a meta-analysis. Overall, all studies reported a significant beneficial effect of non-pharmacological interventions for pain relief. To conclude, current evidence from a limited number of studies indicates there may be a potential role of non-pharmacological interventions, including relaxation therapy, guided imagery, music and audio-visual distraction, in pain management of patients after orthopedic surgery. Owing to considerable heterogeneity and risk of bias in the included studies, strong conclusions cannot be drawn. Further high-quality RCTs assessing the role of such non-pharmacological techniques of pain management are required to strengthen the current evidence.

Comparative evaluation of virtual reality distraction and counter-stimulation on dental anxiety and pain perception in children

BACKGROUND

This study evaluated the efficacy of virtual reality (VR) distraction and counter-stimulation (CS) on dental anxiety and pain perception to local anesthesia in children.

METHODS

A prospective, randomized, single-blinded interventional clinical trial with a parallel design was used. Seventy children 7-11 years old who required local anesthesia (LA) for pulp therapy or tooth extraction were recruited and allocated to two groups with equal distribution based on the intervention. Group CS (n = 35) received CS and Group VR (n = 35) received VR distraction with ANTVR glasses. Anxiety levels (using pulse rate) were evaluated before, during, and after administration of local anesthesia, while pain perception was assessed immediately after the injection. Wong-Baker faces pain-rating scale (WBFPS), visual analog scale (VAS), and Venham's clinical anxiety rating scale (VCARS) were used for pain evaluation. Student's t-test was used to test the mean difference between groups, and repeated measures ANOVA was used to test the mean difference of pulse rates.

RESULTS

Significant differences in mean pulse rates were observed in both groups, while children in the VR group had a higher reduction (P < 0.05), and the mean VCARS scores were significant in the VR group (P < 0.05). Mean WBFPS scores showed less pain perception to LA needle prick in the CS group while the same change was observed in the VR group with VAS scores.

CONCLUSIONS

VR distraction is better than CS for reducing anxiety to injection in children undergoing extraction and pulpectomy.

Visual network alterations in brain functional connectivity in chronic low back pain: A resting state functional connectivity and machine learning study

Chronic low back pain (cLBP) is associated with widespread functional and structural changes in the brain. This study aims to investigate the resting state functional connectivity (rsFC) changes of visual networks in cLBP patients and the feasibility of distinguishing cLBP patients from healthy controls using machine learning methods. cLBP (n = 90) and control individuals (n = 74) were enrolled and underwent resting-state BOLD fMRI scans. Primary, dorsal, and ventral visual networks derived from independent component analysis were used as regions of interest to compare resting state functional connectivity changes between the cLBP patients and healthy controls. We then applied a support vector machine classifier to distinguish the cLBP patients and control individuals. These results were further verified in a new cohort of subjects. We found that the functional connectivity between the primary visual network and the somatosensory/motor areas were significantly enhanced in cLBP patients. The rsFC between the primary visual network and S1 was negatively associated with duration of cLBP. In addition, we found that the rsFC of the visual network could achieve a classification accuracy of 79.3% in distinguishing cLBP patients from HCs, and these results were further validated in an independent cohort of subjects (accuracy = 66.7%). Our results demonstrate significant changes in the rsFC of the visual networks in cLBP patients. We speculate these alterations may represent an adaptation/self-adjustment mechanism and cross-model interaction between the visual, somatosensory, motor, attention, and salient networks in response to cLBP. Elucidating the role of the visual networks in cLBP may shed light on the pathophysiology and development of the disorder.

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We investigated rsFC changes of visual networks in cLBP patients.

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rsFC of the primary visual network with S1 and M1 increased in cLBP patients.

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rsFC of the visual networks can differentiate cLBP patients from controls (with 79.3% accuracy).

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Classification results can be validated in an independent cohort (with 66.7% accuracy).

Short article: Willingness to undergo colonoscopy with virtual reality instead of procedural sedation and analgesia

OBJECTIVE

This study explored the willingness of patients to start colonoscopy with virtual reality (VR) instead of procedural sedation and analgesia (PSA), as well as their motives and characteristics. There is a growing interest in colonoscopy without PSA. Offering VR as a distraction technique instead of PSA may increase the percentage of colonoscopies without PSA.

PATIENTS AND METHODS

A survey with demographic, colonoscopy-related and psychology-related questions was completed by 326 adults referred for colonoscopy with PSA.

RESULTS

Overall, 25.7% reported to be willing to start with VR instead of PSA. Main reasons for this choice were receiving as little medication as possible, resuming daily life activities faster and participating in traffic independently afterwards. Logistic regression analysis showed that significant predictors of the willingness to use VR were male sex, higher educational level and absence of worries about the outcome of the colonoscopy.

CONCLUSION

If VR turns out to be effective in the future, present results may be useful to customize patient information to help patients choosing VR.

Effect of audiovisual distraction on the management of dental anxiety in children: A systematic review

BACKGROUND

Audiovisual distraction, a non-pharmacological intervention, has been used to manage dental anxiety in prior clinical trials.

AIM

Synthesize the available evidences to evaluate the efficacy of audiovisual distraction techniques on the management of dental anxiety in children.

DESIGN

Electronic databases (PubMed, Cochrane Central Register of Controlled Trials, and Embase) were searched. We included randomized controlled trials (RCTs), and methodological quality of included trials was assessed using the Cochrane Collaboration's criteria. Information on reported anxiety, pain, behaviors, vital signs (including blood pressure, oxygen saturation, and pulse rate), and children satisfaction was analyzed.

RESULTS

Nine studies were included for a systematic review, and none of them had low risk of bias. Significant differences in anxiety were found. According to the study, a majority of results indicated a significant difference in pain and behavior between the audiovisual and control group. Three studies reported children in the audiovisual group preferred usage of an audiovisual device for future dental visits. No significant differences could be found regarding blood pressure.

CONCLUSIONS

There is some low-quality evidence suggesting that the usage of audiovisual distraction during dental treatment may relieve children's dental anxiety.

Factors Associated with Anxiety About Colonoscopy: The Preparation, the Procedure, and the Anticipated Findings

BACKGROUND

Previous research has assessed anxiety around colonoscopy procedures, but has not considered anxiety related to different aspects related to the colonoscopy process.

AIMS

Before colonoscopy, we assessed anxiety about: bowel preparation, the procedure, and the anticipated results. We evaluated associations between patient characteristics and anxiety in each area.

METHODS

An anonymous survey was distributed to patients immediately prior to their outpatient colonoscopy in six hospitals and two ambulatory care centers in Winnipeg, Canada. Anxiety was assessed using a visual analog scale. For each aspect, logistic regression models were used to explore associations between patient characteristics and high anxiety.

RESULTS

A total of 1316 respondents completed the questions about anxiety (52% female, median age 56 years). Anxiety scores > 70 (high anxiety) were reported by 18% about bowel preparation, 29% about the procedure, and 28% about the procedure results. High anxiety about bowel preparation was associated with female sex, perceived unclear instructions, unfinished laxative, and no previous colonoscopies. High anxiety about the procedure was associated with female sex, no previous colonoscopies, and confusing instructions. High anxiety about the results was associated with symptoms as an indication for colonoscopy and instructions perceived as confusing.

CONCLUSIONS

Fewer people had high anxiety about preparation than about the procedure and findings of the procedure. There are unique predictors of anxiety about each colonoscopy aspect. Understanding the nuanced differences in aspects of anxiety may help to design strategies to reduce anxiety, leading to improved acceptance of the procedure, compliance with preparation instructions, and less discomfort with the procedure.

Sound as a supportive design intervention for improving health care experience in the clinical ecosystem: A qualitative study

PURPOSE

Most prior hospital noise research usually deals with sound in its noise facet and is based merely on sound level abatement, rather than as an informative or orientational element. This paper stimulates scientific research into the effect of sound interventions on physical and mental health care in the clinical environment.

METHODS

Data sources comprised relevant World Health Organization guidelines and the results of a literature search of ISI Web of Science, ProQuest Central, MEDLINE, PubMed, Scopus, JSTOR and Google Scholar.

RESULTS

Noise induces stress and impedes the recovery process. Pleasant natural sound intervention which includes singing birds, gentle wind and ocean waves, revealed benefits that contribute to perceived restoration of attention and stress recovery in patients and staff.

CONCLUSIONS

Clinicians should consider pleasant natural sounds perception as a low-risk non-pharmacological and unobtrusive intervention that should be implemented in their routine care for speedier recovery of patients undergoing medical procedures.

The effect of audiovisual distraction on the tolerability of flexible bronchoscopy: a randomized trial

OBJECTIVE

It is important to minimize patient discomfort during invasive diagnostic and therapeutic procedures such as bronchoscopy. The aim of this study was to investigate the effect of audiovisual distraction on the tolerability of flexible bronchoscopy (FB).

MATERIALS AND METHODS

We conducted a prospective, randomized, controlled trial on patients undergoing FB at a hospital in Zahedan, Iran, in 2015. The patients were equally and randomly divided into a control group and an experimental group. Patients in the control group received standard care during FB While patients in the experimental group selected familiar folk music that was played during the procedure along with the screening of images of nature. The duration of the FB was recorded and cough, dyspnea, choking, nausea and pain were evaluated using a visual analogue scale before and after the procedure. Statistical analysis was carried out using paired and independent t-tests, χ² -tests and analysis of covariance.

RESULTS

Sixty patients met the inclusion criteria and were randomized. The duration of the FB procedure was significantly shorter in the experimental group compared with the control group (mean ± standard deviation 7.87 ± 2.12 min and 10.27 ± 1.72 min, respectively; P < 0.05). Dyspnea, cough and pain were significantly less severe in the experimental group compared with the control group (P < 0.05), but choking and nausea were not significantly different between the two groups (P > 0.1).

CONCLUSIONS

Our findings showed that audiovisual distraction had a positive effect on the tolerability of FB. This method has important potential as a simple and practical approach in reducing discomfort during invasive diagnostic and treatment procedures.