Background Pre-operative anxiety is common and is associated with negative surgical outcomes. Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition and has been shown to be associated with lower levels of anxiety. In this study, we investigated changes in pre-operative anxiety levels before and after using VR in patients undergoing minor gynecological surgery. Methods Patients who underwent elective minor gynecological surgeries in KK Women’s and Children’s hospital, Singapore were recruited. The VR intervention consisted of 10-min exposure via a headset loaded with sceneries, background meditation music and breathing exercises. For the primary outcome of pre-operative anxiety, patients were assessed at pre- and post-intervention using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes of self-reported satisfaction scores and EuroQol 5-dimension 3-level (EQ-5D-3L) were also collected. Results Data analysis from 108 patients revealed that HADS anxiety scores were significantly reduced from 7.2 ± 3.3 pre-intervention to 4.6 ± 3.0 post-intervention (p < 0.0001). Furthermore, HADS depression scores were significantly reduced from 4.7 ± 3.3 pre-intervention to 2.9 ± 2.5 post-intervention (p < 0.0001). Eighty-two percent of the patients self-reported VR intervention as ‘Good’ or ‘Excellent’. EQ-5D-3L showed significant changes in dimensions of ‘usual activities’ (p = 0.025), ‘pain/discomfort’ (p = 0.008) and ‘anxiety/ depression’ (p < 0.0001). Conclusions For patients undergoing minor gynecological procedures, the VR intervention brought about a significant reduction in pre-operative anxiety. This finding may be clinically important to benefit patients with high pre-operative anxiety without the use of anxiolytics. Trial registration This study was registered on clinicaltrials.gov registry (NCT03685422) on 26 Sep 2018.
Background. The effect of perioperative music listening has been proven to relieve preoperative anxiety and depression, while improving patient satisfaction. However, music listening has not been extensively studied in Singapore. Therefore, the primary aim of our study is to investigate the patient satisfaction towards perioperative music listening in the local setting. The secondary aim is to investigate the effect of perioperative music listening in reducing patient surgery-related anxiety and depression. Methods. After obtaining ethics board approval, we conducted a quasiexperimental study on a cohort of female patients who were undergoing elective minor gynaecological surgeries. Apple iPod Touch™ devices containing playlists of selected music genres and noise-cancelling earphones were given to patients to listen during the preoperative and postoperative periods. Hospital Anxiety and Depression Scale (HADS), EQ-5D-3L questionnaire, music listening preferences, and patient satisfaction surveys were administered. Wilcoxon signed-rank and McNemar’s tests for paired data were used for analysis. Results. 83 patients were analysed with 97.6% of patients in the preoperative period and 98.8% of patients in the postoperative period were satisfied with music listening. The median (IQR [range]) score for preintervention HADS anxiety was 7.0 (6.0 [0–17]), significantly higher than that in postintervention at 2.0 (4.0 [0–12]) (P<0.001). Similarly, there was a significant reduction in preintervention HADS depression as compared to postintervention (P<0.001). These results were corroborated by similar findings from the EQ-5D-3L questionnaire. Conclusion. Perioperative music listening improved patient satisfaction and can reduce patient anxiety and depression. We hope to further investigate on how wider implementation of perioperative music listening could improve patient care.
Perioperative music decreases pain, anxiety, and analgesia requirements while increasing patient satisfaction. We investigated the acceptability of perioperative music at a women’s and children’s hospital in Singapore, seeking to uncover barriers and facilitators to implementation in routine practice over a 12-week period. We used an undergraduate-led Rapid Qualitative Inquiry approach that includes data collection from multiple sources, iterative analysis, and additional data collection when necessary. Participants consisted of anesthesiologists and nurses working in the preoperative area, operating room, and postoperative recovery areas. In Stage 1, nurses and anesthesiologists answered a survey assessing attitudes and knowledge about perioperative music and attended a presentation introducing the intervention. In Stage 2, the results of the Stage 1 survey were disclosed, and nurses and anesthesiologists completed a second survey (Stage 1 survey questions with an additional query about implementation). Twenty-nine nurses were interviewed with semi-structured questions on barriers and facilitators to implementation. In Stage 3, nurses retook the Stage 2 survey after one month of implementation. The implementation of perioperative music was both acceptable and feasible in Singapore. The nurses’ and anesthesiologists’ acceptability increased over time with mostly positive qualitative feedback. Implementation barriers, including patient interest, timing of patient turnover, and added staff workload, appeared minor and could potentially be overcome by utilizing the intervention in the preoperative instead of postoperative area, deploying music in operating rooms with slower turnover, and evenly distributing staff workload. Local implementation stakeholders may make additional recommendations for scaling-up perioperative music interventions to fit other workflows while improving the patient experience.
Background: Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition. There is limited work on VR effectiveness during the preoperative period in the local setting. We investigated the feasibility and practicability of employing VR in anxiety management for patients undergoing minor gynaecological surgery, with the primary outcome being the changes in preoperative anxiety levels before and after the VR experience. Methods: A prospective cohort study was conducted in the KK Women’s and Children’s hospital between March 2019 and January 2020. Female patients undergoing gynaecological surgeries were recruited after obtaining informed consent. Patients were given a VR headset accompanied with a handphone loaded with VR experiences comprising sceneries, background meditation music and breathing exercises. The VR experience was administered for 10 mins and pre- and post-VR psychological assessments surveys were conducted. Results: Data analysis from 108 patients showed that our patient population had moderate state anxiety (39.6 (SD 11.14) and trait anxiety 40.1 (9.07) on the State-Trait Anxiety Inventory (STAI). The use of VR before surgery could reduce both Hospital Anxiety and Depression Scale (HADS) anxiety (7.2 ± 3.3 down to 4.6 ± 3.0; p<0.0001) and depression (4.7 ± 3.3 down to 2.9 ± 2.5; p<0.0001) scores. EQ-5D-3Lshowed no significant change in dimensions of ‘mobility’ and ‘self-care’ but significant changes to reported ‘usual activities’, ‘pain/discomfort’ and anxiety/ depression’ dimensions. Level 1 for ‘usual activities’ (“no problems with performing usual activities”) increased from 102 (94.4%) to 107 (99.1%) (p= 0.0253), ‘pain/discomfort’ (“I have no pain/discomfort”) increased from 72 (66.7%) to 84 (77.8%) and ‘anxiety/ depression’ (“I am not anxious/ depressed”) increased from 62 (57.4%) to 90 (83.3%) between pre- and post-VR experience. About 82% of patients rated the VR experience as ‘Good’ or ‘Excellent’.Conclusions: Our study showed significant reduction in preoperative anxiety after VR experience and has positive patient satisfaction. The use of VR may be suitable for patients with high anxiety preoperatively without the use of anxiolytics. Future work could include implementation studies upon adoption in clinical practice and the use in other surgical populations. Trial registration: Clinicaltrials.gov NCT03685422. Registered 26Sep2018 https://clinicaltrials.gov/ct2/show/NCT03685422?term=NCT03685422&draw=2&rank=1
Background: Pre-operative anxiety is common and is associated with negative surgical outcomes. Virtual reality (VR) is a promising new technology that offers opportunities to modulate patient experience and cognition and has been shown to be associated with lower levels of anxiety. In this study, we investigated changes in pre-operative anxiety levels before and after using VR in patients undergoing minor gynecological surgery. Methods: Patients who underwent elective minor gynecological surgeries in KK Women’s and Children’s hospital, Singapore were recruited. The VR intervention consisted of 10-minute exposure via a headset loaded with sceneries, background meditation music and breathing exercises. For the primary outcome of pre-operative anxiety, patients were assessed at pre- and post-intervention using the Hospital Anxiety and Depression Scale (HADS). Secondary outcomes of self-reported satisfaction scores and EurQol 5-dimension 3-level (EQ-5D-3L) were also collected. Results: Data analysis from 108 patients revealed that HADS anxiety scores were significantly reduced from 7.2 ± 3.3 pre-intervention to 4.6 ± 3.0 post-intervention (p<0.0001). Furthermore, HADS depression scores were significantly reduced from 4.7 ± 3.3 pre-intervention to 2.9 ± 2.5 post-intervention (p<0.0001). Eighty-two percent of the patients self-reported VR intervention as ‘Good’ or ‘Excellent’. EQ-5D-3L showed significant changes in dimensions of ‘usual activities’ (p=0.025), ‘pain/discomfort’ (p=0.008) and ‘anxiety/ depression’ (p<0.0001). Conclusions: For patients undergoing minor gynecological procedures, the VR intervention brought about a significant reduction in pre-operative anxiety. This finding may be clinically important to benefit patients with high pre-operative anxiety without the use of anxiolytics. Trial registration: This study was registered on clinicaltrials.gov registry (NCT03685422) on 26 Sep 2018.
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