The Feasibility, Usability, Acceptability, and Clinical Utility of a Virtual Reality Intervention in the Inpatient Setting

Recent advances in Virtual Reality (VR) technology have made it possible for researchers to develop interventions for a wide variety of disease states, including obesity, pain, impaired motor functioning, and anxiety. Over the last decade, improvements in software and hardware design, as well as associated cost reductions, have made VR a practical tool for widespread use, rather than an expensive novelty. Interventions that would not be possible or practical in the real world have been developed in the virtual world, resulting in immersive multi-sensory (primarily audio-visual) experiences that can distract patients from painful experiences and motivate them to achieve personal goals.

VR environments allow patients to visualize non-disease states, and practice living more healthily, whether the focus is stroke rehabilitation, exposure therapy for social anxiety, or simply interacting with the world with reduced pain levels. A number of studies have demonstrated the efficacy of VR interventions, and all of them are built around this basic premise. For example, a meta-analysis of diagnosis-specific exposure therapies for anxiety disorders - PTSD, agoraphobia/panic disorder, social anxiety, and animal phobias) reports large effects (Cohen's Q-statistic >0.80) for VR interventions on symptom reports at therapy termination.1 Similarly, a meta-analysis of post-stroke motor rehabilitation VR interventions reports that, in observational studies, patients experience significantly reduced impairment (14.7%) and improved motor functioning (20.1%).

Hospital inpatients will most likely benefit from VR as a distraction from acute pain during procedures, painful drug infusions, adverse side effects of treatments, or from boredom and inactivity, which could lead to increased reports of distress and reduced satisfaction with care. Several areas of research may provide a useful model for bringing VR distraction interventions to all types of hospital inpatients. A recent review by Li and colleagues (2012) highlighted advances in these treatment areas.

To date, the most widely studied form of VR interventions is the reduction of pain and anxiety associated with burn care. Compared to use of analgesic medication alone, patients who use VR distraction interventions in combination with analgesic drugs have reported reduced pain and distress during burn wound care across most studies, and both lower pain ratings and increased range of motion during physical therapy in some studies. Use of a VR distraction environment called SnowWorld - developed by H.G. Hoffman and colleagues, and employed across many of these studies - allows burn patients to move through ice canyon and play with snow. Additions of VR hypnosis and relaxation modules to SnowWorld have also been tested in burn patients, with mixed results; patients undergoing hypnosis reported lower pain and anxiety levels, but those undergoing relaxation while receiving morphine reported higher pain levels.

Studies of cancer patients have demonstrated some efficacy for use of VR in patients receiving chemotherapy and lumbar punctures. Although pain scores are often reduced in a direction favoring the use of VR, studies to date have not demonstrated conclusive, long term benefits for symptom reduction. However, patients do report short perceived time in treatment, reduced physiological arousal during treatment, and lower perceived pain during treatment.