Effectiveness of virtual reality on pain and anxiety in patients undergoing cardiac procedures: A systematic review and meta-analysis of randomized controlled trials

BACKGROUND

Cardiac procedures often induce pain and anxiety in patients, adversely impacting recovery. Pharmachological approaches have limitations, prompting exploration of innovative digital solutions like virtual reality (VR). Although early evidence suggests a potential favourable benefit with VR, it remains unclear whether the implementation of this technology can improve pain and anxiety. We aimed to assess by a systematic review and meta-analysis the effectiveness of VR in alleviating anxiety and pain on patients undergoing cardiac procedures.

METHODS

Our study adhered to the PRISMA method and was registered in PROSPERO under the code CRD42024504563. The search was carried out in the PubMed, Web of Science, Scopus, and the Cochrane Library databases in January 2024. Four randomized controlled trials were included (a total of 382 patients). Risk of bias was employed to assess the quality of individual studies, and a random-effects model was utilized to examine the overall effect.

RESULTS

The results showed that VR, when compared to the standard of care, had a statistically significant impact on anxiety (SMD = -0.51, 95 % CI: -0.86 to -0.16, p = 0.004), with a heterogeneity I2 = 57 %. VR did not show a significant difference in terms of pain when compared to standard care (SMD= -0.34, 95 % CI: -0.75 to -0.07, p = 0.10). The included trials exhibited small sample sizes, substantial heterogeneity, and variations in VR technology types, lengths, and frequencies.

CONCLUSIONS

VR effectively lowers anxiety levels in patients undergoing cardiac procedures, however, did not show a statistically significant difference on pain.

Clinical application of virtual reality in patients with cardiovascular disease: state of the art

Virtual reality offers a multisensory experience to patients, allowing them to hear, watch, and interact in a virtual environment. Immersive virtual reality is particularly suitable for the purpose of completely isolating patients from the external environment to transport them away from the suffering related to the disease. On this state of the art, we summarize the available literature on the effectiveness of virtual reality on various physical and psychological outcomes in patients with atherosclerotic cardiovascular disease. Virtual reality has been employed in the cardiovascular field in various settings such as cardiac rehabilitation, interventional cardiology, and cardiac surgery. This technology offers promising opportunities to improve several outcomes related to cardiovascular disease, but further research is needed to entirely capture its benefits and to standardize the intervention.

Effectiveness of Rhythmic Auditory Stimulation on Gait in Parkinson Disease: A Systematic Review and Meta-analysis

Parkinson disease is a neurodegenerative disease present in approximately 2% of the population older than 65 years. Rhythmic auditory stimulation in the early 1990s aimed to improve individual mobility in terms of gait speed, stride length, and cadence. Our systematic review and meta-analysis aimed to summarize and evaluate the evidence of the effects of rhythmic auditory stimulation on gait speed, stride length, and cadence in patients with Parkinson disease. A systematic review and meta-analysis of randomized controlled trials was conducted to determine the efficacy of rhythmic auditory stimulation in patients with Parkinson disease. Five studies were included in the review (209 patients). Rhythmic auditory stimulation resulted, on average, a gait speed improvement of 0.53 standard deviation (SD) units (95% CI, 0.23 to 0.83; P = .0005), a stride length improvement of 0.51 SD units (95% CI, 0.18 to 0.84; P = .003) greater than that in the control group. All trials contained a risk of bias due to a lack of blinding. The quality of evidence was low. No adverse events were identified. Rhythmic auditory stimulation may have a beneficial effect on gait speed and stride length in patients with Parkinson disease. Future studies should consider a power analysis to recruit an adequate number of subjects and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of rhythmic auditory stimulation on gait in patients with Parkinson disease.

Virtual Reality During Chemotherapy Infusion: An Innovative Intervention in Holistic Nursing Practice

Patients with cancer receiving infusional chemotherapy show negative symptoms such as worry about their survival, anxiety, anguish, depression, fear, magnified perception of the passage of time, and difficulty managing boredom. Patients also suffer various side effects produced by chemotherapy such as nausea, vomiting, pain, and fatigue, which, together with psychological distress, drastically reduce their quality of life and adherence to therapy with a corresponding reduction in the probability of the individual's survival. Virtual Reality is one of the most innovative and promising digital health interventions, capable of quickly and effectively producing a positive influence on the psychosomatic axis, improving patients' quality of life during chemotherapy. Virtual Reality, through its 3-dimensional multisensory technology, isolates sensory channels from the negative external environment and enables an experience of being physically and psychologically present within virtual scenarios, in which patients can perceive sensations, emotions, cognitions, and interactions as if they really were in different surroundings. This article systematically expounds the scientific conditions necessary for effective, appropriate, and safe implementation of Virtual Reality interventions in holistic nursing practice, describing the underpinning conceptual framework, the types, technological characteristics, methods of use, duration, type of virtual content, and implementation procedure of Virtual Reality.

Effectiveness of Immersive Virtual Reality in People with Cancer Undergoing Antiblastic Therapy: A Randomized Controlled Trial

OBJECTIVES

This study aims to assess the effects of immersive Virtual Reality in people with cancer undergoing antiblastic therapy, on anxiety, fatigue and pain.

DATA SOURCES

This is a randomized controlled three-arm trial. Seventy-four cancer patients were recruited from a regional hospital in Italy, and randomly allocated into three groups: a Virtual Reality group (n=25), a narrative medicine group (n=25) and a standard care group (n=24). The primary outcome was anxiety. Secondary outcomes included fatigue and pain. The outcomes were evaluated immediately before and after the interventions. The findings showed that anxiety decreased more in the Virtual Reality group (Δpre-post = 6.24, 95% CI 2.578 to 9.902, p=.001, d = 0.63) than in the narrative medicine group, whereas it did not change for those in the standard care group. Fatigue decreased in the Virtual Reality group (Δpre-post = 0.576, 95% CI 0.246 to 0.907, p=.001, d = 0.23), while remaining stable in the narrative medicine group, and increasing in the standard care group. Average levels of pain did not change before and after the intervention [F(1,71) = 1.06, p=.307, ηp2 = .015].

CONCLUSION

Findings show that virtual reality is effective to reduce anxiety and fatigue in people with cancer undergoing antiblastic therapy.

IMPLICATIONS FOR NURSING PRACTICE

Virtual Reality can be recommended as an complementary intervention to manage anxiety and fatigue in people with cancer during antiblastic therapy.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05629507.

Effectiveness of immersive virtual reality on anxiety, fatigue and pain in patients with cancer undergoing chemotherapy: A systematic review and meta-analysis

PURPOSE

This Systematic review and meta-analysis aimed to assess the effectiveness of Virtual Reality on anxiety, fatigue and pain in patients with cancer during chemotherapy and provide evidence for decision-making in clinical practice.

METHODS

A systematic literature search was performed in the databases PubMed, Web of Science, Scopus, Cumulative Index of Nursing and Allied Health Literature and the Cochrane Library. Risk of Bias was used to assess the quality of individual studies, and Grading of Recommendations Assessment, Development and Evaluation was used to assess confidence for each individual outcome. A random-effects model was used to examine the overall effect.

RESULTS

Four randomized controlled trials and four crossover studies were included, with an overall sample of 459 patients. Results showed that Virtual Reality compared with standard care had a significant reduction of anxiety only (MD = -6.57, 95% CI: -11.59 to -1.54, p = 0.01) but with considerable heterogeneity (I² = 92%), while Virtual Reality was not significantly different from integrative interventions. The trials included showed small sample sizes, lack of statistical power, low methodological quality, high heterogeneity, and different Virtual Reality technology types, lengths and frequencies.

CONCLUSION

The quality of evidence is very low and the strength of recommendation is weak. Further research has large potential for reducing uncertainty about the effects of Virtual Reality in patients with cancer receiving chemotherapy. This study was registered with PROSPERO as CRD42020223375.

[Effectiveness of physical exercise on cardiovascular endurance and functional capacity in hemodialysis patients: a systematic review and meta-analysis]

Background. Physical exercise is a health intervention in the treatment of numerous chronic diseases. In patients on hemodialysis, physical exercise has been introduced during hemodialysis for different outcomes. Several meta-analyses show uncertainty about the effects. Objective. Our systematic review and meta-analysis aim at summarizing and evaluating the evidence of the effects of physical exercise on cardiovascular endurance and functional capacity of hemodialysis patients. Results. Five studies were included in the review (462 patients). Physical exercise brought an improvement in cardiovascular endurance and functional capacity (MD, 95%CI:62.24 [18.71, 105.77], p=0.005), compared to the control group. Most trials were at high risk of bias due to lack of blinding between the patients and the personnel, and between the patients and the outcome assessor. Conclusions. Physical exercise may have beneficial effect on cardiovascular endurance and functional capacity in hemodialysis patients. The quality of evidence is low and the strength of recommendations is weak for cardiovascular endurance. Future studies should consider a power analysis for an adequate sample size and minimize the risk of sample bias. Further research should provide the additional results required for an acceptable estimate of the effects of physical exercises in hemodialysis patients.

[Self-efficacy and self-management in patients in hemodialysis: a narrative review of multidisciplinary theories]

Hemodialysis is the most common treatment in patients with end-stage chronic kidney disease and the wide accessibility of this therapy has prolonged the patients' lifespan. However, it involves alterations in their emotional sphere and, often, a reduction in therapeutic compliance as the chronicity of kidney disease requires lifestyle changes difficult to maintain in the long term. The management of a chronic medical condition is in fact a complex process that necessarily requires multidisciplinary action. The concepts of "Self-efficacy" and "Self-management" fall within the Self-Determination Theory and are relevant in this context because they refer to the beliefs that everyone has about their abilities to control behavior and determine the success in adhering to prescribed therapies. Furthermore, the promotion of self-efficacy and self-management through an educational approach that makes use of so-called "eHealth" tools can help develop greater self-awareness in dialysis patient, a better control over their care choices and an increased adherence to therapeutic-dietary indications. This article aims at highlighting the importance of implementing an approach based on eHealth in the management of hemodialysis patients. It also wants to raise awareness of the related multidisciplinary theories to be applied in this clinical context to promote greater therapeutic adherence, and therefore a better quality of life and care.

Beneficial Effects of Listening to Classical Music in Patients With Heart Failure: A Randomized Controlled Trial

BACKGROUND

Practical recommendations on nonpharmacologic non-device/surgical interventions in patients with heart failure (HF) are well known. Although complementary treatments may have beneficial effects, there is no evidence that these on their own improve mortality, morbidity, or quality of life. We examined the effects of listening to recorded classical music on HF-specific quality of life (QOL), generic QOL, sleep quality, anxiety, depression, and cognitive state in patients with HF in the home-care setting.

METHODS AND RESULTS

Multicenter randomized controlled trial. One hundred fifty-nine patients with HF were randomized on a 1:1 basis in 2 groups: experimental (music) and control. Patients were evaluated after 30, 60, 90 days (experimental period) and at 6 months. Patients randomized to the music group listened to music from a large preselected playlist, at least 30 minutes per day, for 3 months on an MP3 player. Patients in the control group received standard care. HF-specific QOL, generic QOL, self-care, somatic perception of HF symptoms, sleep quality, anxiety and depression, and cognitive abilities were assessed throughout the use of specific scales. On average, patients in the music group showed greater improvements in terms of HF-specific QOL (P < .001), generic-QOL (P = .005), quality of sleep (P = .007), anxiety and depression levels (P < .001 for both), and cognitive performances (P = .003).

CONCLUSIONS

Listening to recorded classical music is a feasible, noninvasive, safe, and inexpensive intervention, able to improve QOL in patients with HF in the home-care setting.

Effects of Listening to Live Singing in Patients Undergoing Hemodialysis: A Randomized Controlled Crossover Study

Background:

Participation in music therapy is associated with improved psychological and physical indices among chronically ill patients. Listening to music during hemodialysis treatments positively affects patients’ hemodynamics, laboratory values, quality of life, and physical symptoms. The effect of live singing during hemodialysis treatments, however, has not previously been studied.

Methods:

A total of 24 participants with a diagnosis of end-stage kidney disease participated in the study. The vocalist was a musically trained dialysis nurse. Twelve of the patients listened to 15 min of live singing during 6 consecutive hemodialysis sessions, while the other 12 underwent standard hemodialysis. After a washout period of 2 days, the two groups were reversed.

Results:

Listening to live music was associated with improvements in systolic and diastolic blood pressure, better quality of sleep, fewer cramps, and reduced anxiety/depression, pain, and itching ( p < .05, all values).

Conclusions:

Listening to live music during hemodialysis is an effective and potentially low-cost therapy for the dialysis care team to employ during hemodialysis treatments.

[Multicenter validation of an evaluation tool for clinical training activities (SVAT) of the nursing students]

OBJECTIVE

To evaluate the psychometric characteristics of the Scheda di Valutazione delle Attività di Tirocinio (SVAT).

METHOD

The degree courses in Nursing of the University of Modena and Reggio Emilia, site of Reggio Emilia, the University of Bologna Formative Section BO1, Imola and training center of Cesena, the University of Ferrara training centers of Ferrara and Codigoro were all enrolled in the research. For the content validation the reactive Delphi method was chosen. The panel of experts expressed a qualitative-intuitive judgment on the adequacy of language and on the stimulus material (SVAT). For internal consistency Cronbach's alpha was calculated the. The test-retest method was used for the reliability of stability.

RESULTS

all indicators of the SVAT have achieved a degree of consensus not less than 80% demonstrating its content validity. The face validity is demonstrated by an average score equal to or greater than 7 obtained by all indicators. The reliability of internal consistency of the SVAT was appraised by Cronbach's alpha that was 0.987 for the entire instrument. The reliability of the stability has been calculated through the correlation's coefficient expressed by Pearson's r that was 0.983 (p = 1.3E-198).

DISCUSSION

in Italy there is no a "gold standard" tool to evaluate the clinical performance of nursing students during and at the end of their clinical training. The SVAT proves to be a valuable and reliable tool it furthermore could stimulate the discussion and the debate among educators and nurses, so that also in our country, it may be possible develop and refine tools that support the evaluation of clinical skills of nursing students.

Effects of live saxophone music on physiological parameters, pain, mood and itching levels in patients undergoing haemodialysis

BACKGROUND

Few studies have focused on the effect of music in patients undergoing haemodialysis.

OBJECTIVES

To determine the effects of live saxophone music on various physiological parameters and pain, mood and itching levels.

DESIGN

A randomised controlled study with 114 patients undergoing haemodialysis with a control group (n = 57) and an experimental group (n = 57) who received 30 minutes of live saxophone music therapy.

MEASUREMENTS

Systolic and diastolic blood pressure, pulse rate, glycaemia, oxygen saturation, pain, mood and itching levels were measured before and after the live music performance, resulting in baseline and post-test values for the patients in the experimental group.

RESULTS

The experimental group showed a statistically significant reduction in pain level, and an improvement in mood and itching levels and in the oxygen saturation.

CONCLUSION

Live saxophone music could be introduced to improve clinical and quality-of-life measures in patients undergoing haemodialysis.

[Mental and physical equilibrium for better quality of care: experience of the Ravenna CNAI group]

The current orientation of health services is a progressive reduction of resources and a constant increase of efficiency and efficacy: this implies a greater demand on health personnel with the risk of stress and demotivation. In this context , well-balanced mental and physical conditions are essential and health workers should be given all the support they need to obtain and maintain such conditions, also to avoid repercussions on patients. For this purpose a satellite group of the CNAI nursing association organized two formative events based on guided imagery and mindfulness , to increase self-awareness, aimed not only at nurses but also rehabilitation and other health care workers. Results were evaluated using a questionnaire and demonstrated better awareness , less psychosomatic stress-related problems , improved quality of life and well-being.

[AHNA Standards of Holistic Nursing Practice]

Gli AHNA Standards of Holistic Nursing Practice produced by the American Holistic Nurses Association are acknowledged as the most advanced holistic document governing nursing care. The result is a document that isn ot only scientifically and culturally important for world nursing, but also represents a scientific attempt to return to the true, historically holistic, nature of nursing. The AHNA standards reject the mechanical-reductive model in favor of a holistic, multidisciplinary model and an anthropological view of man as an entire being and not separate anatomical parts, with a body-mind-spirit axis connected to the surrounding environment in a circular exchange. The results of holistic nursing and multidisciplinary research coupled with a new vision of man, are extremely important.

[Tutorial functions in 1st level nursing masters: cognitive study]

Tutorial functions are becoming increasingly more respondent to the requirements of student-based training. On the basis of national and international experiences, some active learning methods seem to be suitable for tutoring. Both basic and post-basic training can be directed towards satisfying the requirements of a society that is continually changing , forming professionals who are able to guarantee and maintain suitable levels of skill.In this study the results of a cognitive study, performed in various Italian universities where Masters in Nursing have already been implemented, are described. In particular, these results have shown the need for tutorial teaching methods that actively involve students in the training process.

[Clinical practice quality in BNC (Bachelor of Nursing Course). Evaluation of students' satisfaction in the Italian Red Cross School of Nursing, University of Bologna]

This study is linked to the previous our "UNI EN ISO 9001:2000 quality system. Project and application at BNC (Bachelor of nursing Course), University of Bologna: degree of satisfaction of third year's students". The aim of this study, carried on in 2006, were to find out how satisfied second (n=61) and third years (n=95) nursing bachelor course students, University of Bologna, were with their clinical practice, about each essential element in this kind of learning. The data were collected using a questionnaire purposely made, with 48 items in 9 fields. 279 questionnaires returned ,79 by second year students and 190 by third year students. Results suggest a general satisfaction of students about their clinical practice experiences. Also in this study, the intermediate evaluation, very important in nursing clinical learning, is a critical variable.

[Planning and application of a valutation methodology in UNI EN ISO 9001:2000 quality system, for the analysis satisfaction level of third-year student University of Bologna, Bachelor of Nursing Course, CRI School of Nursing formative section]

The quality of nursing assistance is closely related to the quality of training. In the certification UNI EN ISO 9001:2000 in 2004 of the Bologna nursing school regarding Planning and performance of theoretical-practical nursing training a continual improvement of the product/service is implicit. A method was therefore devised to evaluate the degree of satisfaction in third-year nursing students in Bologna which demonstrated a medium/high level of satisfaction regarding all teaching-related procedures. By monitoring satisfaction levels , it is possible to identify any critical areas and to implement improvement where needed.