Effectiveness of Virtual Reality to Reduce Pre-Operative Anxiety
Overview
- Phase
- Not Applicable
- Intervention
- Not specified
- Conditions
- Virtual Reality
- Sponsor
- Children's Hospital Los Angeles
- Enrollment
- 450
- Locations
- 1
- Primary Endpoint
- STAI
- Status
- Suspended
- Last Updated
- 2 years ago
Overview
Brief Summary
This study aims to test the effectiveness of virtual reality (VR) as a non-pharmaceutical intervention to reduce pain and anxiety in children undergoing various procedures in the Ambulatory Surgery Center (ASC) at CHLA, as measured by self- and proxy-report.
Detailed Description
4 million children undergo surgery in the US each year and up to 65% of these children experience significant anxiety and distress before surgery. High anxiety can be traumatic, but it can also lead to postoperative adverse outcomes, such as increased pain and analgesics requirements, delayed hospital discharge, and maladaptive behavioral changes, in children after the surgery. Non-pharmacological intervention, complementary and alternative medicine (CAM) interventions, such as virtual reality, has been shown to decrease anxiety and distress in other medical procedures (e.g., burn care, phlebotomy). Yet to date, no clinical trial has been conducted to examine the effectiveness of virtual reality (VR) to reduce anxiety and distress prior to outpatient surgeries in the operating room setting. The current study aims to: 1) Determine if VR is more effective than standard care for preventing anxiety, distress, and pain before surgery among children undergoing anesthesia induction, 2) To evaluate healthcare provider's and caregiver's assessment of patient cooperation and caregiver's distress and satisfaction with VR compared to standard of care, and 3) to explore the influence of patient and caregiver characteristics on the effectiveness of VR in preventing pre-operative anxiety and distress and subsequent post-operative outcomes. Study Population: Children (age 10 - 21 years) and their parents who are scheduled to undergo outpatient surgery, whose health status is American Society of Anesthesiologists (ASA) physical status I-III, and are in the normal range of development are eligible to be in the study. Study Methodology: The study is a randomized, controlled trial designed to examine the effects of VR on the level of preoperative pain, anxiety and distress of children undergoing surgery. Statistical Analyses: Univariate Analysis of Variance (ANOVA) will be used to compare differences in primary and secondary outcome variables in VR + standard of care to standard of care only conditions when pre and post-operative measures are available. Univariate ANOVA will be used to compare conditions on post-operative variables. Multiple regression analyses will be used to examine the influence of patient and caregiver variables on patient outcomes in the VR group only.
Investigators
Jeffrey I Gold, PhD
Professor of Anesthesiology, Pediatrics, and Psychiatry & Behavioral Sciences
Children's Hospital Los Angeles
Eligibility Criteria
Inclusion Criteria
- •Children who are 10-21 years old
- •Children who are English speaking (parents may be Spanish English speaking or Spanish speaking)
- •Children who are scheduled to undergo outpatient surgery are eligible to participate in this project.
- •Children whose health status is American Society of Anesthesiologists (ASA) physical status I-III will be recruited for this study. ASA status I refers to patients who are normal and healthy with no known systemic disease. ASA status II refers to patients who have mild or well-controlled systemic diseases, such as non-insulin dependent diabetes, upper respiratory conditions, well-controlled asthma or allergies.
- •Only children who are in the normal range of development will be recruited for this study. This will be assessed by report from the parents. The rationale for excluding patients with developmental delay is that due to their cognitive impairments, such children react to the stressors of surgery differently than do children without such developmental delay. It is unclear how such children would use the preparation programs and interventions included in this study, and it is likely that their responses on baseline and outcome measures will differ from children of normal developmental parameters.
Exclusion Criteria
- •Children with health status defined by ASA status IV-V will be excluded from this study. ASA status IV refers to patients with an incapacitating systemic disease that is a constant threat to life. ASA status V patients are considered moribund.
- •Children who are taking psychotropic medications that affect emotion modulation will be excluded from this study.
- •Children with organic brain syndrome, mental retardation, or other known cognitive/neurological disorders
- •Children with visual, auditory, or tactile deficits that would interfere with the ability to complete the experimental tasks or use the technological devices
- •Children with a history of seizure disorder.
- •Children currently sick with flu-like symptoms or experiencing a headache or earache
Outcomes
Primary Outcomes
STAI
Time Frame: Approximately 5-15 minutes after procedure
The STAI is a self-administered measure of anxiety in adults. It is comprised of separate, self-report scales for measuring two distinct anxiety concepts: state anxiety (A-State) and trait anxiety (A-Trait). The STAI-Y distinguishes between a general proneness to anxious behavior rooted in the personality and anxiety as a fleeting emotional state. The instrument consists of two 20-item scales. In the current study, the measure will be used to measure trait and state anxiety. The STAI is the validated instrument for measuring anxiety in working adults, and in young adults in high school and college.
Parent Anxiety Scale
Time Frame: Approximately 5-15 minutes after procedure
The parent is asked to indicate "how nervous, afraid, or worried" they believe their child was about the task on a scale of 1 to 10, from least to most anxious. (See description of Child Anticipatory/Procedural Anxiety)
STAI-C (if elementary or junior high aged), STAI-Y (if in high school or college)
Time Frame: Approximately 5-15 minutes after procedure
The STAIC is a self-administered measure of anxiety in children. It is comprised of separate, self-report scales for measuring two distinct anxiety concepts: state anxiety (A-State) and trait anxiety (A-Trait). The STAI-C distinguishes between a general proneness to anxious behavior rooted in the personality and anxiety as a fleeting emotional state. The instrument consists of two 20-item scales. In the current study, the measure will be used to measure both state and trait anxiety. The STAI is the validated instrument for measuring anxiety in in elementary and junior high aged children.
The Faces Pain Scale (FPS-R)
Time Frame: Approximately 5-15 minutes after procedure
Revised is an updated version of the Wong-Baker Faces Pain Rating Scale depicting no pain as a neutral expression as compared with the smiling face of the original measure. The child is asked to point to the face cartoon that depicts how they are currently feeling because of their pain. Face measures are thought to measure pain intensity, and the Wong-Baker Faces measure has demonstrated good reliability and validity.
Child Satisfaction Questionnaire
Time Frame: Approximately 5-15 minutes after procedure
The child survey is 13-item, Likert-like survey to assess child estimates of pain reduction, fear reduction, decreased behavioral distress, and overall satisfaction; it mirrors the parent survey. There are two versions, one for each treatment condition. Two versions of the survey exist, to account for condition (VR vs. standard of care).
CAMPIS-R
Time Frame: Peri-procedure
The CAMPIS-R is a standardized rating scale that codes videotaped verbal interactions in the pediatric treatment room. The CAMPIS-R codes the subject, speaker, phase of medical procedure, verbal content, affective tone, and to whom vocalizations are directed. Adult vocalizations are coded as coping-promoting (nonprocedural talk or humor directed to the child, commands to engage in coping strategies), distress-promoting (reassuring comments, apologies, giving control to the child, criticism, and empathetic statements), or neutral (humor to adults, nonprocedural talk to adults, child's condition talk, commands for procedural activity, praise, notification of procedure to come, behavioral commands to child, checking child's status).
Yale Preoperative Anxiety Scale (m-YPAS; Kain et al., 1995; Kain et al., 1997)
Time Frame: Peri-procedure
The YPAS consists of 27 items in five domains of behavior indicating anxiety in young children (Activity, Emotional expressivity, State of arousal, Vocalization and Use of parents). This measure takes approximately 5-10 minutes to complete. The 'adjusted YPAS total score' ranges from 0 to 100 with higher scores indicating greater anxiety. The YPAS was developed originally to measure the anxiety of children while undergoing induction of anesthesia. Recently, we validated the YPAS against a self-report measure, the State Trait Anxiety Inventory for Children (Kain et al., 1997; STAIC). Data Obtained: Standard scores for the anxiety level of children during the perioperative period.
7-item self-report measure of healthcare provider's perceptions about the child's cooperation, pain, distress, and anxiety
Time Frame: Peri-procedure
The healthcare provider survey is a 7-item Likert-like investigator-developed survey to assess their estimates of pain and anxiety management, cooperation, and satisfaction with the procedure. Healthcare providers are also invited to write comments about the use of VR (if applicable) during the IV placement procedure.
6-item self-report measure of healthcare provider's perceptions about the child's cooperation, distress, and anxiety
Time Frame: Peri-procedure
The healthcare provider survey is a 6-item Likert-like investigator-developed survey to assess their estimates of fear reduction, decreased behavioral distress, and overall satisfaction related to the procedure they just performed with the child/adolescent. Healthcare providers are also asked about sedative use and are invited to write comments about the use of VR (if applicable) during the mask induction procedure.
VAS anticipatory anxiety measure
Time Frame: Approximately 5-15 minutes after procedure
The VAS anticipatory anxiety measure is a vertical VAS, anchored with 0 at the bottom indicating the least amount and 10 at the top indicating the greatest amount, in response to the instruction to rate "how nervous, afraid, or worried" they were about the upcoming task. The scale also has color cues, graded from yellow at the bottom to dark red at the top, as well as a neutral face at the bottom and a face showing a negative expression at the top. Prior research used the VAS to rate anticipatory anxiety and pain in children.
Child State Anxiety Index (CASI) or Anxiety Sensitivity Index (ASI) if 18 and older
Time Frame: Approximately 5 minutes to one hour before procedure
The Childhood Anxiety Sensitivity Index (CASI): CASI is an 18-item scale that measures the tendency to view anxiety-related bodily sensations as dangerous (e.g., ''It scares me when my heart beats fast''). Items are scored on a 3-point scale (none, some, a lot), and total scores are calculated by summing all items. The CASI has demonstrated high internal consistency and adequate test-retest reliability. The CASI correlates well with measures of trait anxiety but also accounts for variance in fear not attributable to trait anxiety measures.
Parent Pain Scale
Time Frame: Approximately 5-15 minutes after procedure
Parents/Caregivers will be asked to report on their child's pain on a faces pain scale of 1 to 6, from least to most pain, during 1) the IV start procedure and 2) the mask induction. (See description of Child Pain - POST)
Secondary Outcomes
- Malaise Scale (MS)(Approximately 5-15 minutes after procedure)
- Parent Satisfaction Questionnaire(Approximately 5-15 minutes after procedure)
- Blood pressure and heart rate (BP/ HR)(Approximately 5 minutes to one hour before procedure)
- Watcha Scale (Watcha et al., 1992)(Approximately 5-15 minutes after procedure)
- Analgesic Requirements(Peri-procedure)
- Pediatric Anesthesia Emergence Delirium (Sikich, 2004; PAED)(Approximately 5-15 minutes after procedure)
- Child Presence Questionnaire(Approximately 5-15 minutes after procedure)
- Behavior Assessment System for Children (BASC-2)(Approximately 5 minutes to one hour before procedure)