Overview
Virtual reality (VR) has recently emerged as a non-medication-based method to manage anxiety. The patient wears a VR headset and is offered an immersive environment with hypnotic components with sound and imagery in a 3D environment. VR creates an immersive 3D environment and diverts attention away from worrying thoughts (anxiety) and pain and has been found useful to manage minor procedural pain and related anxiety.
This is a pilot feasibility trial to evaluate the effectiveness of VR in improving patient related outcomes (PROM) after joint replacement surgery.
Description
Psychological factors, (anxiety in particular) link into the biological human stress response systems and can thus have an important bearing on perioperative outcomes. Current pharmacological and non- pharmacological interventions to manage anxiety are not as effective as desired due to a multitude of reasons (side effects, staffing requirements such as psychologists, expense or lack efficacy).
Addressing psychological factors like perioperative anxiety with a relatively easy to use, non-invasive technique such as Virtual Reality (VR) is likely to improve PROM (Patient Reported Outcome Measures). Recently, Virtual Reality (VR) has emerged as a non-pharmacological method to manage preoperative anxiety. VR is theorised to decrease perioperative pain and anxiety by diverting attention away from nociception stimulus, extinction of negative expectancy and fear towards pain and modulating pain related neuroendocrine stress responses. VR thus is able to improve PROM (Patient Reported Outcome Measures) and also improve post-operative pain /opioid use, length of stay in hospital and joint arthroplasty complication rates.
The researchers aim to perform a pilot feasibility study in preparation for the multi-centre randomised control trial that will follow. The primary objective of the pilot feasibility trial will be to test the acceptability, level of adherence to the trial protocol by patients, the ease with which the intervention can be implemented and estimates of the effect size/variability that should be used in the statistical design of the main study.
Eligibility
Inclusion Criteria:
- NHS Highland patients
- Able to provide written informed consent (remotely)
- ASA Grade 1 and 2
- Listed for elective surgery at NHSH NTC
- Adults\>18 years undergoing joint arthroplasty surgery (hip and knee) will be included
- Fluent in English
- Able to receive and write emails
- Willing to comply with study protocols/training
- Access to Wi-Fi to undertake VRIT and complete questionnaires online
Exclusion Criteria:
- Not able to provide written informed consent
- Considered unsuitable by Clinician (with reason)
- Vision /hearing difficulties which preclude interaction with immersive environment
- Unable or unwilling to comply with study procedures and activities
- Participation in another interventional trial which undermines the scientific basis of the study
- Have a history of alcohol or substance abuse or Parkinson's disease or Multiple Sclerosis or Labyrinthitis (Ménière's disease), history of seizures, motion sickness or dementia
- Non NHS Highland patients
- Photosensitive epilepsy
- Patients with surgery scheduled for a Friday
