Virtual Reality Improves Patient Experience and Anxiety During In-office Carpal Tunnel Release

Abstract

Background: This study examined how wide- awake local anesthesia no tourniquet (WALANT) surgery in the office versus the standard operating room (OR) impacts patient experience, and the effect wide awake virtual reality (WAVR) has in conjunction with WALANT on patient experience. Methods: This is a patient-reported outcome study of patients undergoing carpal tunnel release by a single surgeon between August 2017 and March 2021. Patients were classified by location; traditional OR versus WALANT in-office. In-office patients were further classified by whether they chose to use WAVR or not. Patients rated overall experience, enjoyability, and anxiety using a Likert scale (1–7). Results: The online survey had a 44.8% response rate. OR patients were twice as likely to report a neutral or negative experience (23% versus 11%, P = 0.03), significantly lower enjoyment scores (44% versus 20%, P = 0.0007)‚ and higher anxiety (42% versus 26%, P = 0.04) compared with office-based WALANT patients. With the addition of WAVR, office patients reported higher enjoyment than those who did not use WAVR (85% versus 73%, P = 0.05). Patients reporting an anxiety disorder were more likely to choose WAVR when compared with patients without anxiety disorder (73.8% versus 56.4%). When they chose WAVR, they had greater anxiolysis (79% versus 47%, P = 0.01)‚ and increased enjoyment (90% versus 59%, P = 0.005). Conclusions: This study demonstrates improved patient experience in the office setting, further amplified by WAVR. Preexisting anxiety disorder is a positive predictive variable toward the patients’ choice to use WAVR.

Protocol of a Multicenter Prospective Trial of Office-Based Carpal Tunnel Release With Ultrasound Guidance (ROBUST)

“…Potential concerns regarding transferring procedures from the operating room to the office include the risk of higher complication rates and poorer outcomes. However, current evidence suggests that these concerns may be unfounded [4][5][6][7]. Given the efforts to improve value in health care, further investigation is warranted to understand the association between operative settings and patient outcomes with CTR.…”

“…While CTR procedures have been historically performed in a hospital-based operating room or ambulatory surgery center, advances in surgical techniques and anesthesia have allowed surgeons to perform the procedures in different operative settings. Because the operative setting is the primary cost driver of CTR [3], there has been recent interest in performing CTR in an office-based setting using local anesthesia, which may contribute to lower cost, faster patient recovery, greater patient satisfaction, and similar low complication rates [4][5][6][7].…”

The use of mixed reality technology within the donor collection experience

“…[6][7][8][9][10][11][12][13][14] In healthcare, virtual reality (VR) platforms have been an effective strategy to reduce anxiety and pain via distraction during a variety of procedures including blood draws and intravenous (IV) catheter placement. [15][16][17][18][19][20][21][22][23] Pediatric patients who used immersive VR during peripheral IV catheter (PIVC) placement had significantly lower post-PIVC pain scores and post-PIVC anxiety scores compared to patients in the standard care group. 21 Distraction strategies in blood donors have helped to reduce anxiety and reaction symptoms.…”

“…Multiple studies have demonstrated that donation‐related fear and anxiety are a major deterrent for blood donation, cause attrition, and increase the likelihood of needle pain and vasovagal reactions 6–14 . In healthcare, virtual reality (VR) platforms have been an effective strategy to reduce anxiety and pain via distraction during a variety of procedures including blood draws and intravenous (IV) catheter placement 15–23 . Pediatric patients who used immersive VR during peripheral IV catheter (PIVC) placement had significantly lower post‐PIVC pain scores and post‐PIVC anxiety scores compared to patients in the standard care group 21 …”

The Impact of Virtual Reality on the Patients and Providers Experience in Wide-Awake, Local-Only Hand Surgery

“…Recent literature has suggested a benefit of the use of VR during wide-awake hand surgery in reducing patient anxiety and improving patients’ experience. 14 , 15 , 16 However, further work is indicated to better understand this technology in different patient populations and settings as well as understand its impact on providers and clinical workflow. This study sought to assess whether immersive VR could decrease patient anxiety in veterans and what impact it had on both patients’ and providers’ experience during wide-awake, local-only hand surgery in a minor procedure room at a VAHCS hospital.…”