The effect of virtual reality on anxiety, stress, and hemodynamic parameters during cesarean section: A randomized controlled clinical trial

Decreasing Preoperative Anxiety in Patients with Newly Available Multimodal Approaches-A Narrative Review

Preoperative anxiety affects approximately 80% of adult patients; thus, identifying patients with excessive anxiety and implementing appropriate interventions can significantly reduce the risk of deterioration during the perioperative period. This narrative review presents current knowledge about pharmacological and nonpharmacological methods for reducing preoperative anxiety. Commonly used pharmacological options include benzodiazepines, ketamine, or fentanyl. Antidepressants have also been shown to be effective in alleviating symptoms, but they typically require four weeks to take effect. Establishment of supportive relationships with medical staff to help patients express their feelings have been shown to have a positive impact on anxiety reduction. Other nonpharmacological methods include the provision of information through informed consent forms, video materials, virtual reality, or the use of psychotherapeutic interventions such as breathing techniques, music therapy, or cognitive-behavioural therapy. Some studies suggest that essential oils may have a role in reducing perioperative anxiety. Nonpharmacological interventions can be used in patients of different ages. An increasing number of researchers advocate for a holistic approach that integrates less invasive and cost-effective interventions with conventional medicine. While various interventions have been proposed to manage preoperative anxiety, more research is needed to establish the most effective and feasible interventions for different patient populations.

Exploring the Efficacy of Virtual Reality Training in Obstetric Procedures and Patient Care-A Systematic Review

BACKGROUND

As technology continues to shape society, younger generations are increasingly accustomed to its integration into daily life, making it mandatory for medical educators to adopt innovative tools like virtual reality (VR). This systematic review examines the efficacy of VR in obstetric training and patient care, focusing on its impact on educational engagement, procedural skill acquisition, and pain management in obstetric patients.

METHODS

A systematic review of the current literature was conducted using databases: PubMed, Web of Science, Science Direct, Scopus, Embase, The Cochrane Library, and Clinicaltrials.gov analyzing randomized controlled studies on VR's use in obstetric training and patient care. Inclusion criteria focused on studies evaluating VR's role in enhancing clinical skills, and pain and anxiety management during labor and procedures. Only randomized controlled trials published in English were considered. The risk of bias was assessed using RoB 2 for RCTs. Data extraction and quality appraisal were performed independently by two reviewers.

RESULTS

A total of 18 studies met the inclusion criteria. Among them, 13 studies focused on VR for pain relief and anxiety reduction, and 5 studies on medical training and skill acquisition. Most studies used immersive VR headsets, while some utilized interactive VR or serious gaming platforms. Adverse effects such as motion sickness and visual discomfort were reported in a few cases but did not significantly impact participant engagement.

CONCLUSIONS

VR holds the potential to improve obstetric training and patient care by aligning with the learning preferences of younger generations and enhancing both educational and patient care experiences. However, heterogeneity in sample sizes, participants, and intervention types limits generalizability. Further large-scale, high-quality RCTs are needed to validate findings and standardize VR applications in obstetrics. This review was registered in PROSPERO (Registration ID: CRD42024619197).

Effectiveness of virtual reality therapy in the treatment of anxiety disorders in adolescents and adults: a systematic review and meta-analysis of randomized controlled trials

Background

To evaluate the effect of virtual reality therapy on anxiety disorders in adolescents and adults by Meta-analysis.

Methods

A comprehensive literature search was conducted by PubMed, Web of Science, Embase, CINAHL, Scopus, Cochrane (from inception to November 2024). Two researchers independently performed literature screening, quality evaluation and data extraction, and Stata16.0 and Review Man 5.4 software were used for Meta-analysis.

Results

A total of 33 studies involving 3182 adolescents and adults with anxiety disorders were included. The results of Meta-analysis showed that compared with conventional interventions, virtual reality therapy significantly improved the symptoms and level of anxiety in patients with anxiety disorder [SMD = -0.95, 95%CI (-1.22,-0.69), Z = 7.05, P < 0.00001].

Conclusion

The current findings suggest that VR therapy interventions have a positive effect on improving the anxiety state of patients with anxiety disorders. The aforementioned research findings must be confirmed by more high-caliber studies due to the number and quality limitations of the contained literature.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display, identifier CRD42024574772.

The Effects of Virtual Reality Application on Pain Intensity, Anxiety Level and Patient Satisfaction in Patients Who Undergo Bronchoscopy: A Randomized Controlled Trial

BACKGROUND

Bronchoscopy is a medical procedure that allows imaging of the airways and lungs. With the help of a light and camera at its tip, the bronchoscope device can enter the airway and provide real-time visualization. Since most patients are conscious during the bronchoscopy procedure, they may experience pain and anxiety regarding possible complications and an uncertain outcome.

AIM

This study was conducted to determine the effects of virtual reality (VR) application on pain intensity, anxiety level, physiological symptoms of anxiety (vital signs) and patients' satisfaction level with the use of virtual reality while undergoing a bronchoscopy.

DESIGN

A parallel randomized controlled trial.

SETTING

Bronchoscopy unit of the chest diseases service of a 1053 bed university hospital in eastern Turkey.

SAMPLE AND METHODS

The study was conducted with a total of 70 patients, 35 in the intervention group and 35 in the control group. The researcher interviewed patients and approved those who met the research criteria and agreed to participate in the study. The researcher applied relaxation exercises to the patients in the intervention group using virtual reality glasses for 5 minutes before the procedure and 4-5 minutes during the procedure. No interventions were made for the patients in the control group. Data were collected using the Descriptive Information Form, Visual Analog Scale (VAS), Anxiety Assessment Scale (AAS), Physiological Symptoms of Anxiety Follow-up Form, and Virtual Reality Glasses Application Satisfaction Form.

RESULTS

When compared with the control group, the mean scores of VAS, AAS, heart rate, diastolic and systolic blood pressure, and respiratory rate of the intervention group were found to decrease significantly, while the O2 saturation value increased significantly (p < .05). It was found that 82.5% of the patients in the intervention group want to use virtual reality glasses if they have another intervention, and 70% recommend relaxation exercises with virtual reality glasses to patients who will undergo bronchoscopy.

CONCLUSION

Study results for this sample revealed that the use of VR decreased pain intensity scores, state anxiety levels, anxiety severity, diastolic blood pressure, systolic blood pressure, heart rate and respiratory rate, and increased O2 saturation in patients who underwent bronchoscopy. In line with these results, VR should be considered during bronchoscopy procedures.

Efficacy of Virtual Reality as a Treatment Modality on Preoperative vs Postoperative Patient Anxiety: A Systematic Review

Background

This systematic review aimed to investigate the efficacy of VR as a treatment modality on preoperative vs postoperative patient anxiety.

Methods

A thorough search was performed over seven databases using Boolean operators and MeSH terms. Studies that used VR interventions and measured anxiety outcomes were included in the review.

Results

The included studies seem to indicate that VR interventions could help to decrease anxiety in surgical patients. Most of the studies reported significant decreases in anxiety scores or improved anxiety outcomes for their VR groups as compared to control groups or standard care groups. Specifically, preoperative and postoperative anxiety scores were found to be significantly lower in VR groups compared to control groups.

Conclusion

The combined results of the studies do imply that VR interventions have a positive effect on decreasing anxiety in surgical patients. Although some studies demonstrated a consistent pattern of results, others exhibit differences in their findings, which may be attributed to differences in study design, population, or intervention protocols.

Virtual reality for postsurgical pain management: An explorative randomized controlled study

BACKGROUND

Virtual reality (VR) is a promising tool in a multimodal analgesic approach; however, evidence regarding virtual reality for postsurgical pain is limited. This study investigates the initial effectiveness and feasibility of self-administered virtual reality in postsurgical pain management.

METHODS

Patients reporting a postsurgical pain score ≥4 were randomized for control or VR, stratified for 3 interventions with varying levels of immersion and interaction. Subjects were instructed to use virtual reality as add-on treatment at least 3 times a day for 10 minutes on days 2 till 4 postoperatively. Primary outcome was the mean daily pain intensity. Results of pain scores were related to patient and intervention characteristics, to explore which characteristics interact with virtual reality effects. Secondary outcomes were analgesic use, anxiety, stress, and feasibility.

RESULTS

One hundred patients were included in the analyses: 37 in the control group and 63 for VR. VR did not demonstrate a significant effect on self-reported pain scores (P = .43), nor were specific patient or intervention characteristics associated with greater VR effects. Analgesic usage did not differ between groups. However, there was a trend toward greater cumulative percentages of patients achieving a 30% pain reduction, and significantly lower daily experienced stress (P = .01) and anxiety (P = .03) levels in VR intervention groups. VR was used less than prescribed, mainly because of illness and pain. Adverse events included disorientation, nausea, and fatigue.

CONCLUSIONS

This explorative study did not demonstrate initial effectiveness of VR as add-on pain treatment regarding pain and analgesic use; however, VR positively affected stress and anxiety. VR is safe and suitable for a wide target audience, and feasibility differed between interventions. Personalizing and improving VR technology may enhance its effectiveness.

Virtual reality treatment could reduce anxiety for women undergoing cesarean section with spinal anesthesia: a randomized controlled trial

PURPOSE

Cesarean section may result in adverse psychosocial and behavioral outcomes because women put considerable emphasis on the process of birth. Virtual reality treatment has been shown by many studies to reduce anxiety and improve patient satisfaction. Therefore, we designed a randomized controlled trial to investigate whether the application of virtual reality technology during cesarean section can reduce maternal anxiety and improve satisfaction.

METHODS

We recruited 128 women undergoing elective cesarean delivery with proposed spinal anesthesia and randomly assigned them to either virtual reality or routine care. The virtual reality intervention was a virtual reality program tailored specifically for women undergoing cesarean section. Primary outcome was the change in anxiety score (change = preoperative-intraoperative score). Secondary outcomes included patient satisfaction score, requirement of intraoperative sedative and analgesic drugs, and respiratory rate.

RESULTS

The change in anxiety score in the virtual reality group was significantly higher than that in the routine care group (30 [20, 47.5] vs 10 [- 10, 23.8], respectively; P < 0.001, with Hodges-Lehmann median difference estimate of 20 (95% confidence interval CI, 15-30)). There were no significant differences between the two groups in patient satisfaction scores, the requirement of intraoperative sedative and analgesic drugs, and respiratory rate and side effects.

CONCLUSION

Virtual reality treatment could reduce the anxiety of women undergoing elective cesarean section, which is beneficial to the mother and baby. Trial registration This study was registered at the Chinese Clinical Trial Registry (ChiCTR2200061936) on July 11, 2022, and can be reached at https://www.chictr.org.cn/showprojEN.html?proj=173329.

Effect of Music Therapy on Anxiety in Pregnancy: A Systematic Review of Randomized Controlled Trials

Pregnancy can heighten anxiety levels, impacting both maternal and fetal well-being. This systematic review synthesizes evidence from 33 randomized controlled trials exploring the effects of music therapy on anxiety in pregnant women. The studies included diverse populations, ranging from women undergoing in vitro fertilization (IVF) to those facing high-risk pregnancies. Music therapy interventions varied widely, including virtual reality experiences, classical music, lullabies, and patient-selected music, administered at different pregnancy stages such as IVF treatments, elective cesarean sections, and high-risk hospitalizations. The findings consistently demonstrated that music therapy significantly reduces anxiety levels in pregnant women. Positive outcomes included reductions in both state and trait anxiety, improved pregnancy rates, and enhanced maternal-fetal parameters. Additionally, music therapy showed promise in reducing anxiety during labor, cesarean deliveries, and high-risk hospital stays. These varied interventions and their positive outcomes highlight the potential of music therapy as an effective, non-pharmacological approach to managing pregnancy-related anxiety. This review provides a comprehensive overview of the existing evidence on music therapy's efficacy in alleviating anxiety during pregnancy. It underscores the need for further research to standardize interventions and incorporate music therapy into routine prenatal care. By enhancing the overall well-being of expectant mothers, music therapy could become a valuable adjunct to conventional prenatal care practices.

Effects of virtual reality and nature sounds on pain and anxiety during hysterosalpingography: a randomized controlled trial

OBJECTIVE

The objective of this study was to determine the effects of listening to nature sounds alone and virtual reality plus listening to nature sounds on pain and anxiety in hysterosalpingography.

METHODS

This three-arm parallel randomized controlled trial included 135 (45 in each group) women who underwent hysterosalpingography in Turkey. The virtual reality+nature sounds group viewed a nature video with virtual reality glasses and listened to nature sounds during hysterosalpingography, whereas the nature sounds group only listened to nature sounds. The control group received only routine care.

RESULTS

During hysterosalpingography, women in virtual reality+nature sounds group experienced less pain than those in control group (p=0.009). After hysterosalpingography, pain levels were lower in both virtual reality+nature sounds group and nature sounds group than in control group (p=0.000 and p=0.000, respectively), anxiety levels were lower in virtual reality+nature sounds group than in nature sounds group and control group (p=0.018 and p=0.000, respectively), and anxiety levels were lower in nature sounds group than in control group (p=0.013).

CONCLUSION

Virtual reality with nature content plus listening to nature sounds and only listening to nature sounds are effective in reducing pain and anxiety related to hysterosalpingography procedures in women. Compared with only listening to nature sounds, virtual reality plus listening to nature sounds further reduced hysterosalpingography-related pain and anxiety.

Virtual Reality and Stress Management: A Systematic Review

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

Effects of Virtual Reality on Pain, Anxiety, Patient Satisfaction in Coronary Angiography: A Randomized Trial

BACKGROUND

Since patients are conscious during the coronary angiography procedure, they may experience pain and anxiety regarding possible complications and an uncertain outcome.

AIM

This study was conducted to determine the effects of virtual reality application on pain severity, anxiety level, and patient satisfaction in patients who undergo coronary angiography.

METHOD

This randomized controlled study was conducted with a total of 70 patients, including 35 patients in the intervention and 35 patients in the control group. Apart from their routine treatment, virtual reality glasses application was used in the intervention group patients during the procedure. The patients in the control group were given only routine treatment. Data were collected by using "Descriptive Information Form", "Visual Analogue Scale (VAS)", Anxiety Assessment Scale (AAS), "Physiological Symptoms of Anxiety Follow-up Form", and "Virtual Reality Glass Application Satisfaction Form".

RESULTS

Mean post-intervention scores of VAS, AAS, heart rate, diastolic and systolic blood pressure, respiratory rate of the intervention group decreased significantly compared with the control group, while O2 saturation value was found to increase significantly.

CONCLUSIONS

In this study, it was found that virtual reality application was effective in reducing pain and anxiety, increasing patient satisfaction, and normative regulation of vital signs in patients who undergo coronary angiography.

Effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean: a systematic review and meta-analysis

This systematic review and meta-analysis aimed to explore the effectiveness of preoperative multimedia educational sessions on the levels of anxiety and satisfaction among women undergoing cesarean section (CS). The Scopus, PubMed, and Cochrane databases were searched without language limitations for eligible randomized controlled trials (RCTs) published from their inception up to October 15, 2023. A random-effect meta-analysis was conducted, and the quality of this meta-analysis was evaluated using the GRADE (Grading of Recommendations Assessment, Development, and Evaluation) approach. Seven RCTs (n = 1006 women) met the inclusion criteria. Preoperative multimedia sessions were found to significantly reduce anxiety levels (n = 6 RCTs, weighted mean difference: -3.10; 95 percent confidence intervals (CI): -4.48, -1.73; I2 = 44.24 percent, moderate certainty of evidence) compared to the control group. However, there was no significant difference between the two groups regarding women's satisfaction after surgery (n = 5 RCTs, risk ratio: 1.37; 95 percent CI: 0.76, 2.50; I2 = 98.26 percent, moderate certainty of evidence). Leave-one-out sensitivity analysis showed robustness of the outcomes. The findings of this meta-analysis suggest that providing multimedia educational programs before surgery could potentially have a beneficial effect on the levels of anxiety experienced by women undergoing CS. However, it is imperative to validate these results through larger samples and multi-centered RCTs.

Improving immersive experiences in virtual natural setting for public health and environmental design: A systematic review and meta-analysis of randomized controlled trials

In recent years, virtual reality (VR) technology has emerged as a powerful tool in the field of therapeutic landscapes. For hospitalized patients or individuals with limited mobility, VR provides highly personalized therapy by simulating authentic natural environments within a safe, convenient, and engaging setting. This study investigated the effectiveness of immersing patients in virtual natural environments for health recovery and compared the varying impacts of different types of landscapes on patients' recovery levels. The aim was to complement traditional medical approaches and enhance environmental design in the field of public health. Researchers systematically reviewed databases (January 2018 to August 2, 2023) to identify randomized controlled trials comparing the efficacy of virtual nature immersion with other treatments. The inclusion/exclusion criteria were established based on the population, intervention, comparison, outcomes, study design, and other aspects (expanded PICO) framework. The Cochrane tool was employed to assess the risk of bias. Meta-analysis was conducted by pooling the mean differences with a 95% confidence interval. Among 30 trials, a total of 2123 patients met the inclusion criteria, with 15 studies included in the meta-analysis. 30 trials met the criteria. Results show significant improvements in pain, anxiety, fear, and some physiological indicators with virtual nature-based treatments. On the other hand, natural scenes incorporating blue and green elements have been applied more extensively and have shown more significant effects. In comparison to conventional methods, this study strongly advocates that virtual reality environments are a crucial tool in bridging the gap between patients and nature, demonstrating their potential to reshape medical interventions and improve environmental design in the field of public health.

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.

Effects of Virtual Reality Interventions on the Parameters of Normal Labor: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. A Meta-Analysis of Virtual Reality Interventions on the Parameters of Normal Labor

BACKGROUND

Clinical and experimental studies on virtual reality have shown that this easy-to-use and non-invasive method is a safe and effective strategy during normal labor.

AIM

This study aims to analyze the effects of virtual reality (VR) interventions on some of the parameters of normal labor.

DESIGN

Systematic review and meta-analysis.

METHOD

Higher Education Council National Thesis Center, Scopus, PubMed, Google Scholar, and Science Direct databases were systematically searched for randomized controlled trials that administered VR to the intervention group but not to the control group and were published through January 2022. RevMan software was used to analyze the meta-analysis data. Pain, anxiety, satisfaction, and the duration of the first and second stages of labor were assessed as outcomes of normal labor.

RESULTS

Seven randomized controlled trials, with a total of 756 women in total, met the inclusion criteria. Virtual reality interventions significantly reduced pain scores when cervical dilatation was ≤4 cm (MD = -0.43, 95% expansion here (CI [-0.65, -0.21], p < .001) and ≥9 cm (SMD = -1.91, 95% CI [-2.56, -1.26], p < .001). Anxiety scores significantly decreased (SMD = -1.08, 95% CI [-1.75, 0.41], p < .001), and childbirth satisfaction significantly increased (MD = 11.24, 95% CI [2.17, 20.30], p < .001) in the VR intervention groups. Finally, when compared to the control groups, the duration of the first stage of labor (SMD = -0.53, 95% CI [-0.83, -0.22], p < .01) and the second stage of labor (MD = -0.39, 95% CI [-0.76, -0.02], p = .001) were significantly decreased in the VR intervention groups.

CONCLUSIONS

Virtual reality interventions are effective methods to reduce pain, anxiety, and the duration of the first and second stages of labor and to increase satisfaction with normal labor.

Informational video on preoperative anxiety and postoperative satisfaction prior to elective cesarean delivery: a systematic review and meta-analysis

BACKGROUND

Preoperative anxiety affects 60 to 80% of patients who are candidates for surgery. Reducing preoperative anxiety can improve surgical outcomes, shorten hospital stays, and minimize disruptions in lifestyle. Having information affects people ability to identify important points and improve their understanding, and lack of information causes fear and anxiety, which negatively affects decision-making. Studies have shown that the intervention of education before cesarean section has a beneficial effect on women anxiety level. Providing information before surgery can reduce patients' anxiety. This study was conducted to determine the effect of information video before elective cesarean delivery on preoperative anxiety and post-operative satisfaction.

METHODS

The search for relevant studies was systematically conducted in PubMed, Scopus, Web of Science, Cochrane Library, SID (Persian database), and Google Scholar (search engine) until July 4, 2023, in both English and Persian languages. The revised tool for assessing the risk of bias in randomized trials (RoB 2.0) and ROBIN-I were used to evaluate the risk of bias, and heterogeneity was assessed using I². In cases of high heterogeneity, a random effects model was used instead of a fixed effects model. Subgroup analysis was performed based on the duration of the video, and the type of intervention for the primary outcome. Sensitivity analysis was conducted based on the type of study. A random-effects meta-regression analysis was conducted to identify potential sources of high heterogeneity for preoperative anxiety. The certainty of the evidence was assessed using GRADE.

RESULTS

A total number of 557 articles were found in databases. Three hundred sixty-eight studies were screened based on their titles, abstracts, and full texts. Of these, 16 studies were assessed for eligibility, and 7 were excluded. Ultimately, nine papers were included. Meta-analysis results showed that the information video before elective cesarean delivery compared to control group may have little or no effect on preoperative anxiety, but the evidence is uncertain (SMD - 0.22, 95% CI -0.51 to 0.06, 9 trials, 1020 participants, I2 = 80%; very low-certainty evidence). Also, it probably increases the post-operative satisfaction (SMD 0.26, 95% CI 0.10 to 0.42, 5 trials, 618 participants, I2 = 0%; Moderate-certainty evidence). The random effect meta-regression analyses indicated a significant correlation between the mean age of the intervention group (β = 0.137, P < 0.001) and the mean age of the control group (β = 0.150, P = 0.0246) with effect size.

CONCLUSION

This study found that watching an informational video prior to elective cesarean delivery resulted in a decrease in preoperative anxiety. However, it is important to note that the reduction was not statistically significant, and there was a high level of inconsistency among the results. Nonetheless, the intervention did lead to an improvement in women's post-operative satisfaction. To determine the optimal time duration and content type of informational videos, further studies with more appropriate methodology are necessary.

Effects of virtual reality on anxiety and pain in adult patients undergoing wound-closure procedures: A pilot randomized controlled trial

Background

In emergency departments, suturing is a typical procedure for closing lacerated wounds but is invasive and often causes anxiety and pain. Virtual reality (VR) intervention has been reported as a relaxing measure.

Objective

The study aims to examine the effects of VR intervention on anxiety, pain, physiological parameters, local anesthesia requirements and satisfaction in Chinese adult patients undergoing wound closure in emergency departments in Hong Kong.

Methods

Adult patients who had lacerated wounds and were undergoing wound closure by suturing can communicate in Chinese and were hemodynamically stable were invited for this trial. Eighty patients were randomly assigned to the VR group, which received VR intervention and standard care, or to the control group, which received standard care only. The primary outcome was anxiety, and the secondary outcomes included pain, blood pressure, pulse rate, satisfactory with pain management, service satisfactory, and extra local analgesia requirement. Outcomes were conducted at baseline, during the procedure and 5 min after the procedure.

Results

The VR group had a significantly greater reduction in anxiety (p < 0.001), pain (p < 0.001), systolic blood pressure (p < 0.001), diastolic blood pressure (p < 0.001), pulse rate (p = 0.003) and requested less amount of additional local anesthesia (p = 0.025). The satisfactory level with pain management (p = 0.019) and service (p = 0.002) were significantly higher in participants who received VR intervention. In addition, most participants preferred to have VR in the future, and no major adverse events associated with the use of VR were reported.

Conclusion

This pilot study provides insight into the use of VR and the direction of future studies. It may effectively improve psychological and physiological outcomes in adult patients during wound-closure procedures in emergency departments.

Virtual Reality Headset Simulating a Nature Environment to Improve Health Outcomes in Pregnant Women: A Randomized-Controlled Trial

The single-blind randomized-controlled experimental study aimed to determine the effects of watching nature images through virtual reality (VR) headset on stress, anxiety, and attachment levels of pregnant women with preterm birth threats (PBTs). The participants were 131 primiparous pregnant women admitted to the perinatology clinic due to PBT between April 5, 2022 and July 20, 2022. The intervention group watched videos containing nature images accompanied by nature sounds in six sessions through VR headset three times daily for 2 days. Each session lasted for 5 min. The data were accumulated with the Information Form, Stress Subscale of Depression Anxiety Stress Scale-21, State Anxiety Inventory, Prenatal Attachment Inventory, and Information Form of Satisfaction Level of VR Headset. State anxiety and stress levels of pregnant women in intervention group were statistically significantly lower than those in controls. There was no difference in prenatal attachment levels concerning intragroup comparisons of intervention group.