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

Influence of visual objects and music on anxiety levels and imaging process in patients undergoing coronary CT angiography

OBJECTIVE

High anxiety during coronary computed tomography angiography (CCTA) can compromise imaging quality, increase radiation exposure, and elevate medication use. Therefore, optimizing waiting room environments to reduce patient anxiety is important for clinical outcomes. This study examines the effects of music and visual stimuli in the waiting rooms on patients' anxiety levels, heart rate, radiation dose, and beta-blocker use prior to CCTA.

METHODS

This study, designed as a prospective and randomized trial, was conducted between April 15 and August 15, 2024, with 216 patients randomized into two groups: a standard waiting room (SWR) and a designed waiting room (DWR) featuring music and visual objects. Anxiety and depression levels were measured using the Hospital Anxiety and Depression Scale (HADS) and the State-Trait Anxiety Inventory (STAI). Additional parameters, such as heart rate, radiation dose, and beta-blocker requirement, were also recorded.

RESULTS

In the DWR group, anxiety scores and heart rates were significantly lower compared to the SWR group (p < 0.001). Additionally, a notable reduction in radiation dose and beta-blocker use was observed in the DWR group (p < 0.05). In the general patient population, higher anxiety scores were associated with poorer imaging quality. Imaging quality was significantly better in the DWR group (p < 0.001).

CONCLUSION

It has been demonstrated that waiting room designs enriched with music and visual stimuli reduce anxiety during CCTA scanning, enhancing patient comfort, improving imaging quality, and enabling imaging with lower radiation doses. The design of such waiting rooms can improve patient experience while optimizing outcomes.

KEY POINTS

Question Can a waiting room with music and visual stimuli reduce anxiety and heart rate in CCTA patients, improving imaging quality and reducing beta-blocker use? Findings Music and visual stimuli reduced anxiety and heart rate, lowering beta-blocker use and radiation doses while improving imaging quality in CCTA. Clinical relevance Integrating music and visual stimuli in waiting rooms helps reduce anxiety and heart rate, leading to less medication use and radiation exposure while enhancing imaging quality. This simple, cost-effective approach improves patient comfort and optimizes outcomes in CCTA procedures.

The effect of music on patient anxiety undergoing bronchoscopy: a randomized controlled trial

BACKGROUND

Bronchoscopy is a fundamental diagnostic and therapeutic examination with rare complications which is often associated to anxiety and discomfort. The aim of our study is to evaluate the effect of music on anxiety levels among patients undergoing bronchoscopy in the pneumology department.

METHODS

We conducted a prospective, randomized, investigator-blinded, controlled trial performed in two university hospitals. The patients were randomized into two groups: experimental group who had preselected classic Tunisian music during bronchoscopy and control group who had bronchoscopy without music. we assessed anxiety level using Spilberger's State Anxiety inventory (S-STAI) and comfort level using visual analogic scale (VAS). Vital signs and side effects during bronchoscopy were also assessed.

RESULTS

One hundred thirty-six patients were equally assigned into the two groups. the anxiety levels before and after bronchoscopy were similar into the two groups. The music had no effect on anxiety level using the S-STAI . There was no significant difference between the two groups regarding side effects and vital signs during bronchoscopy. There was a significant effect of music on mean change of VAS score (p = 0.018).

CONCLUSION

The music improved comfort level of patients undergoing bronchoscopy.

TRIAL REGISTRATION

This study was retrospectively registered in the pan African Clinical Trial Registry with the trial number PACTR202309620440045 on 3 September 2023.

Technology-Based Music Interventions to Reduce Anxiety and Pain Among Patients Undergoing Surgery or Procedures: Systematic Review of the Literature

BACKGROUND

Hospitalized patients undergoing surgery or procedures may experience negative symptoms. Music is a nonpharmacological complementary approach and is used as an intervention to reduce anxiety, stress, and pain in these patients. Recently, music has been used conveniently in clinical situations with technology devices, and the mode of providing music is an important factor in technology-based music interventions. However, many reviews have focused only on the effectiveness of music interventions.

OBJECTIVE

We aimed to review randomized controlled trials (RCTs) of technology-based music interventions for reducing anxiety and pain among patients undergoing surgery or procedures. We examined the clinical situation, devices used, delivery methods, and effectiveness of technology-based music interventions in primary articles.

METHODS

The search was performed in the following 5 electronic databases: PubMed, MEDLINE (OvidSP), CINAHL complete, PSYCINFO, and Embase. This systematic review focused on technology-based music interventions. The following articles were included: (1) RCTs, (2) studies using interactive technology (eg, smartphones, mHealth, tablets, applications, and virtual reality), (3) empirical studies reporting pain and anxiety outcomes, and (4) English articles published from 2018 to 2023 (as of January 18, 2023). The risk of bias was assessed using the Cochrane Risk of Bias tool version 2.

RESULTS

Among 292 studies identified, 21 met the inclusion criteria and were included. Of these studies, 9 reported that anxiety scores decreased after music interventions and 7 reported that pain could be decreased before, during, and after procedures. The methodology of the music intervention was important to the results on anxiety and pain in the clinical trials. More than 50% (13/21, 62%) of the studies included in this review allowed participants to select themes themselves. However, it was difficult to distinguish differences in effects depending on the device or software used for the music interventions.

CONCLUSIONS

Technology-based music interventions could help reduce anxiety and pain among patients undergoing surgery or procedures. The findings of this review could help medical teams to choose a practical methodology for music interventions. Future studies should examine the effects of advanced technology-based music interventions using smart devices and software that promote interactions between medical staff and patients.

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.

Prospective cohort study of topical versus general anaesthesia for flexible bronchoscopy

BACKGROUND

Topical anaesthesia (TA) and general anaesthesia (GA) are performed for flexible bronchoscopy (FB) worldwide. However, few studies have compared the two anaesthesia methods in terms of perioperative discomforts.

METHODS

648 patients undergoing FB were recruited in Shanghai Pulmonary Hospital, a specialised medical centre in China, from January 2019 to December 2019. The patients underwent FB under TA or GA. The TA group received 1% lidocaine by nasal route, and the GA group received total intravenous anaesthesia. The level of perioperative discomfort and patient satisfaction were assessed. The investigators were blind to the group allocation.

RESULTS

Finally, 239 patients received TA and 182 patients received GA. The basic demographic properties were comparable between two groups. There were no significant differences in terms of sore throat, 61.5% in TA group vs 57.1% in GA group. However, there was a significant difference in terms of postoperative nausea and vomiting (34.3% in TA group vs 56.6% in GA group), and dizziness (37.7% in TA group vs 78% in GA group). There was a significant difference in terms of total complication scores (17.2±5.1 in TA group vs 7.7±4.3 in GA group) and satisfaction degree of patients (2.6±1.1 in TA group vs 4.3±0.8 in GA group).

CONCLUSIONS

Compared with TA, GA significantly reduced the total complication scores of perioperative discomforts and improved the satisfaction score of patients for FB.

TRIAL REGISTRATION NUMBER

This clinical trial was registered with www.chictr.org.cn (ChiCTR1800019971).

Evaluation effect of color in dental office and dentist's uniform while using two different distraction techniques on injection anxiety of 6-9 years' old children referring to Hamedan Dental School: Randomized clinical trial

Background:

The management of children's anxiety in dental offices is still a challenge for the treatment team. The most important factors which affect children's dental anxiety are the clinician-related factors and the physical factors of the dental operatory. Color is an environmental factor whose relationship with the perceptive and emotional factors of children has been reported. On the other hand, distraction is essential factors in a treatment environment that can be used to manage children's anxiety.

Materials and Methods:

In this randomized clinical trial study, from 132 6 to 9 years of age children, 52.3% were male, and 47.7% were female, with a mean age of 7.45 ± 1.1 years. The children's anxiety levels were determined using the Venham Picture Test and pulse oximetry before and after the administration of local anesthesia. The children were randomly assigned to two groups (n = 66): Group 1, music, and Group 2, animated cartoons. The data were analyzed with SPSS 25, using descriptive statistics and the statistical tests consisting of one-way analysis of variance (ANOVA), t-test, and repeated-measures ANOVA, followed by Tukey honestly significant difference tests. Statistical significance was set at P < 0.05.

Results:

The anxiety levels were the lowest in the blue and pink environments and the highest in the black and red. Anxiety levels between different colors in terms of physiologic markers and the questionnaire in each distraction technique at different intervals was significantly different.

Conclusion:

The use of blue, pink, green, and yellow for dentists' attire, and the interior design of the dental operatory decreased the child patients' anxiety.

Audiovisual distraction as an anxiety-minimising adjuvant to regional anaesthesia in adult limb surgery: a service evaluation using patient reported experience measures

Audiovisual distraction (AVD) is an expanding anxiety-minimising technique for patients undergoing surgery under regional anaesthesia (RA). We evaluated patient satisfaction with AVD in the setting of conscious RA for limb surgery using patient reported experience measures (PREMs). Service evaluation using PREMs, via standardised post-operative patient questionnaire, in a single tertiary referral centre for orthopaedic and plastic surgery over an 18-month period. Outcome measures included impact of AVD on peri-operative anxiety, comfort, satisfaction and comparison with previous general anaesthesia (GA) experiences. 50 adult patients undergoing elective limb surgery under RA ± sedation were provided with a wifi-enabled tablet device peri-operatively and completed a post-operative questionnaire regarding their AVD experience. 100% were satisfied with AVD and would recommend to others. 78% were anxious before or during the procedure, of which 97% felt that AVD improved their anxiety levels. Of the 94% with previous experience of GA, 89% reported a 'better' experience with RA + AVD. PREMs regarding AVD were encouraging and lay a foundation for further clinical service development and research into incorporation of this technique for appropriate RA patient groups. Our findings are particularly relevant in the COVID-affected era of anaesthesia as RA benefits and strategies to minimise anxiety are reappraised.

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.

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.