Immersive Therapy for Anxiety Reduction During In-Office Urogynecologic Procedures

INTRODUCTION: Sadly, the majority of female veterans with pelvic floor disorders have a history of military sexual trauma (MST), which can make urogynecologic procedures incredibly anxiety-provoking. This leads to an increased need to go to the operating room for sedation, which carries risks (especially when repetitive) and expense. Virtual reality (VR) has been used in periprocedural settings as distraction to decrease pain and anxiety. Prior feasibility testing proved VR feasible in the setting, but identified a subset who preferred immersion without the isolation of a headset. OBJECTIVE: We sought to compare the efficacy of flat screen immersion, VR headset, and standard care to reduce anxiety for women veterans undergoing in-office urogynecologic procedures. METHODS: This prospective cohort study of women veterans undergoing office cystoscopic procedures received either standard care (verbal anesthesia), flat screen immersion of a survey-informed tailored audiovisual experience on a tablet + noise-canceling headphones vs off-the-shelf VR headset during their procedure. They were able to choose their experience within each technology type. Primary outcome was anxiety scored by the validated state-trait anxiety inventory (STAI-6), secondary outcomes included pain (10-cm visual analogue scale) and patient experience survey. Qualitative feedback was collected from both veterans and surgeons. Descriptive statistics were used to compare groups. Paired analyses were used for pain and anxiety outcomes. RESULTS: 75 women veterans participated (26 usual care, 33 VR, and 16 with flat screen). Demographics and periprocedural data are presented in Table 1. Participants who used immersive therapies exhibited lower anxiety scores after the procedure compared with before the procedure, mean reduction 1.7 points (11.3 vs 9.5, SE 0.7, p.02) for VR headset vs mean reduction 3 points (10.7 vs 7.7, SE 1.0, p.008) in flat-screen immersion. This was similar to standard care, mean reduction 2.3 points (10.9 to 8.6, SE 0.8, p .007), taking them all from the moderate anxiety to low anxiety, there was no statistical difference between groups (p 0.6) (Table 2). Linear regression showed post-procedure anxiety not independently associated with MST, abnormal findings on procedure, type of procedure performed, or use of immersive therapy. All three groups had little pain. Veterans had high satisfaction with their immersive experiences described as “positive or very positive” in 97% of VR vs 67% in flat screens. Similarly, the likelihood to use the technology again or recommend to a friend was 97% VR vs 80% in flatscreen. While flat-screen immersion was comfortable or very comfortable for 87% of veterans vs VR headset 81%. None of these were statistically significantly different. Surgeons reported immersive therapies improved their ability to teach learners, troubleshoot equipment, and maintain focus since the patient was calm, comfortable, and not needing the verbal anesthesia. CONCLUSIONS: Immersive therapies (headsets or flatscreens) are feasible and safe tools for use during urogynecologic office procedures, even for female veterans with a history of sexual trauma. Anxiety improved for everyone. Immersive therapies provided a positive experience for both patients and surgeons.Table 1Table 2