A Virtual Reality Video to Improve Information Provision and Reduce Anxiety Before Cesarean Delivery: Randomized Controlled Trial

Abstract

Background Anxiety levels before cesarean delivery (CD) can lead to a negative birth experience, which may influence several aspects of the woman’s life in the long term. Improving preoperative information may lower preoperative anxiety and lead to a more positive birth experience. Objective This study aimed to determine whether a virtual reality (VR) video in addition to standard preoperative information decreases anxiety levels before a planned CD. Methods Women scheduled to undergo term elective CD were recruited from the outpatient clinic. They were randomized and stratified based on history of emergency CD (yes or no). All participants received standard preoperative information (folder leaflets and counseling by the obstetrician); the VR group additionally watched the VR video showing all aspects of CD such as the ward admission, operating theater, spinal analgesia, and moment of birth. The primary outcome measure was a change in score on the Visual Analogue Scale for Anxiety (ΔVAS-A) measured at admission for CD, compared with the baseline VAS-A score. Results A total of 97 women were included for analysis. The baseline characteristics were similar in both groups, except for a significantly higher level of education in the control group. There was no significant decrease in the VAS-A score of the women in the VR group (n=49) compared with those in the control group (n=48; ΔVAS-A=1.0; P=.08; 95% CI −0.1 to 2.0). Subgroup analysis for the group of women with a history of emergency CD showed a trend toward decreased preoperative anxiety, despite the small sample size of this subgroup (n=17; P=.06). Of the 26 participants who provided completed questionnaires, 22 (85%) in the VR group reported feeling more prepared after seeing the VR video; of the 24 participants’ partners who completed the questionnaires, 19 (79%) agreed with the participants. No discomfort or motion sickness was reported. Conclusions A VR video may help patients and their partners feel better prepared when planning a CD. This study showed that VR does not lead to a decrease in preoperative anxiety. However, subgroups such as women with a history of emergency CD may benefit from VR videos. Trial Registration International Standard Randomised Controlled Trial Number (ISRCTN) 74794447; http://www.isrctn.com/ISRCTN74794447 (retrospectively registered)

The Effect of Virtual Reality on Preoperative Anxiety: A Meta-Analysis of Randomized Controlled Trials

“…In the remaining 18 articles, the full texts were examined and among them, eight articles were excluded from the analysis due to the following reasons: no full-length articles ( n = 4), patients experienced VR during surgery ( n = 1), healthy subjects ( n = 1), non-randomized trial ( n = 1), and patients in both groups experienced VR ( n = 1). Finally, a total of 10 RCTs were included in this meta-analysis ( Figure 1 ) [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. Among them, seven studies included two groups (VR group and control group) [ 21 , 22 , 23 , 27 , 28 , 29 , 30 ], while three studies included multiple groups [ 24 , 25 , 26 ].…”

“…Among them, seven studies included two groups (VR group and control group) [ 21 , 22 , 23 , 27 , 28 , 29 , 30 ], while three studies included multiple groups [ 24 , 25 , 26 ]. Of these three studies with multiple groups, two included four groups (two intervention groups and two control groups) [ 24 , 25 ]. According to the Cochrane guidelines [ 18 ], we combined two intervention groups into a single VR group and two control groups into a single control group.…”

“…The preoperative anxiety score was measured and reported in 10 RCTs, including 813 patients [ 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ]. It was measured with various tools, including modified Yale Preoperative Anxiety Scale [ 23 , 27 , 28 , 29 ], Yale Preoperative Anxiety Scale [ 22 ], Amsterdam Preoperative Anxiety and Information score [ 21 , 30 ], Hospital Anxiety and Depression Scale [ 26 ], Visual Analogue Scale [ 25 ], or Numeric Rating Scale [ 24 ]. A high score corresponded to a high level of anxiety in 9 RCTs [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], whereas it was associated with a low level of anxiety in 1 RCT [ 21 ].…”

“…It was measured with various tools, including modified Yale Preoperative Anxiety Scale [ 23 , 27 , 28 , 29 ], Yale Preoperative Anxiety Scale [ 22 ], Amsterdam Preoperative Anxiety and Information score [ 21 , 30 ], Hospital Anxiety and Depression Scale [ 26 ], Visual Analogue Scale [ 25 ], or Numeric Rating Scale [ 24 ]. A high score corresponded to a high level of anxiety in 9 RCTs [ 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 ], whereas it was associated with a low level of anxiety in 1 RCT [ 21 ]. Therefore, we multiplied the mean values from a given study by “−1” to ensure that all the scales were moving in the same direction, according to the Cochrane guidelines [ 18 ].…”

“…Therefore, we multiplied the mean values from a given study by “−1” to ensure that all the scales were moving in the same direction, according to the Cochrane guidelines [ 18 ]. The preoperative anxiety scores were presented as the means with SD in two RCTs [ 24 , 25 ], median with interquartile range in four RCTs [ 23 , 27 , 28 , 30 ], and mean difference with 95% CI between two groups in two RCTs [ 21 , 29 ]. Robertson et al [ 26 ] presented the change in scores, from baseline to post-intervention, without baseline values.…”