Department of Surgery, Amsterdam UMC Location University of Amsterdam, Meibergdreef 9, Amsterdam, The Netherlands.
Amsterdam Gastroenterology and Metabolism, Amsterdam, The Netherlands.
Knee Surg Sports Traumatol Arthrosc. 2023 Dec;31(12):6069-6079. doi: 10.1007/s00167-023-07629-z. Epub 2023 Oct 28.
Despite the use of perioperative anxiolytics and pain medication, surgery can be a stressful and painful experience. Providing patients with distractions using video and/or audio tools in addition to medication may be helpful. To date, no studies have compared different distraction modalities in a same-day surgical setting in adults. This study aims to determine whether audio-visual distraction with video glasses (AVD) is more effective in reducing anxiety and pain compared to audio distraction (AD) in conscious patients undergoing orthopaedic surgery. It was hypothesised that AVD, being the more immersive modality, would be more effective than AD on the outcome parameters.
Fifty patients undergoing orthopaedic surgery with local and/or regional anaesthesia in a clinical day-care setting were randomly assigned to receive either fixed-scenery AVD or patient-choice AD with music. Primary outcome was anxiety, as measured by the Dutch version of the Spielberger State-Trait Anxiety Inventory-6 (STAI-6) prior to and 15 min after the intervention. Secondary outcomes were pain (Numeric Rating Scale Pain [NRS-P]), systolic and diastolic blood pressure, heart rate and patient satisfaction.
Within each group, there was a significant reduction in anxiety (p = 0.028 for AVD, p < 0.001 for AD). In contrast to our hypothesis, listening to music without watching a video (AD group) reduced anxiety significantly more than experiencing full AVD (p = 0.018). The mean pain score did not change significantly within either user group, nor did pain scores differ between user groups.
In conscious patients undergoing surgery, watching a movie (using video glasses and a headphone set) and listening to music (using only a headphone set) are able to significantly reduce anxiety. AVD, although believed to provide higher levels of distraction, did not prove to be superior to AD. The clinical relevance of this study highlights the potential benefits of AVD or AD modalities in improving the surgical experience for conscious patients. Further research is required to examine the influence of freedom of choice in content on the aforementioned outcomes. To estimate the true value of higher immersion levels, different distraction modalities (e.g. AVD versus virtual reality) featuring the exact same scenery or content need to be compared.
Level I.
尽管在围手术期使用了镇静剂和止痛药，但手术仍然是一种有压力和痛苦的体验。除了药物之外，为患者提供视频和/或音频工具等分散注意力的方法可能会有所帮助。迄今为止，尚无研究比较过在成人一日手术环境中使用不同的分散注意力方式。本研究旨在确定与使用音频设备相比，在接受骨科手术的清醒患者中使用视频眼镜的视听分散（AVD）是否能更有效地减轻焦虑和疼痛。研究假设，作为更具沉浸式的模式，AVD 在疗效参数上会优于音频分散（AD）。
50 名在临床日间病房接受局部和/或区域麻醉的骨科手术患者被随机分配接受固定场景的 AVD 或患者选择的音乐 AD。主要结局是使用荷兰斯皮尔伯格状态特质焦虑量表-6（STAI-6）评估的焦虑程度，在干预前和干预后 15 分钟进行测量。次要结局包括疼痛（数字评分量表疼痛[NRS-P]）、收缩压和舒张压、心率和患者满意度。
在每个组内，焦虑程度均显著降低（AVD 组 p=0.028，AD 组 p<0.001）。与我们的假设相反，与观看视频（AD 组）相比，不观看视频仅听音乐（AD 组）显著降低焦虑程度（p=0.018）。在任何一个用户组内，平均疼痛评分均无显著变化，且用户组之间的疼痛评分也无差异。
在接受手术的清醒患者中，观看电影（使用视频眼镜和耳机）和听音乐（仅使用耳机）均能显著降低焦虑程度。虽然认为 AVD 提供了更高水平的分散注意力，但它并不优于 AD。这项研究的临床意义突显了视听分散或听觉分散等方式在改善清醒患者手术体验方面的潜在益处。需要进一步研究以考察内容选择自由度对上述结果的影响。为了评估更高沉浸度的实际价值，需要比较具有相同场景或内容的不同分散注意力方式（例如 AVD 与虚拟现实）。
I 级。
