Virtual reality for perioperative anxiety treatment in a resource-variable setting: an observational trial

Abstract

Background: Most children experience preoperative anxiety. Virtual reality (VR) safely reduces this anxiety in high-resource settings. However, identifying patients with high anxiety requires an efficient affect scale. In settings with variable resources, clinical affect scales have not been validated, and financial constraints have limited VR’s anxiolytic use. The primary aim was to determine if an affordable VR headset reduced preoperative anxiety at a resource-limited hospital in Kenya. The secondary aim measured the correlation between a novel clinical anxiety scale and standard scales for identifying anxiety in this setting.

Methods: Patients aged 6–18 years presenting for elective surgery requiring general anaesthesia (GA) were enrolled in this observational trial. Anxiety scores were collected from standard-of-care (SOC) patients without VR. After implementing preoperative VR, anxiety scores were measured again. The primary outcome compared preoperative anxiety between SOC and VR groups, measured with the modified Yale Preoperative Anxiety Scale (mYPAS). The secondary outcome measured the correlation of the clinically efficient Happy, Relaxed, Anxious, Distressed, with a yes/no answer to cooperation (HRAD±) scale to the mYPAS and Induction Compliance Checklist (ICC).

Results: The study included 97 patients, 59 in the SOC group and 38 in the VR group. Analyses demonstrated a reduction in mYPAS scores in the VR group by a median of 5.8 (p = 0.02) while in the waiting room and 6.3 (p = 0.002) upon arrival at the operating room (OR). There was a positive association between mYPAS and HRAD± in the waiting room and upon OR arrival (p = 0.0003, p < 0.0001, respectively). Induction HRAD± and the ICC were positively correlated (p = <0.0001).

Conclusion: Patients who used VR reported less anxiety than patients in the SOC group. The HRAD± scale had a moderate correlation to the mYPAS and ICC. Integrating the HRAD± scale with VR may increase the detection and treatment of preoperative anxiety in resource-variable settings.