The Nethersole School of Nursing, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, N.T., Hong Kong.
Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Int J Nurs Stud. 2024 Dec;160:104886. doi: 10.1016/j.ijnurstu.2024.104886. Epub 2024 Aug 30.
Virtual reality exposure and distraction are recent novel technologies for reducing preoperative anxiety symptoms. However, the effectiveness of virtual reality-enhanced interventions in adults is still controversial and has yet to be evaluated in a systematic review.
The study aimed to (1) evaluate the effectiveness of virtual reality-enhanced interventions on preoperative anxiety symptoms in adults compared to comparators; and (2) identify the factors affecting the effectiveness of interventions.
Systematic review, meta-analysis, and meta-regression analysis of randomised controlled trials.
We conducted a three-step systematic search from inception until May 1, 2024, using (1) eleven databases, (2) two clinical registries, and (3) citation and grey literature searches in either English or Chinese. The package meta of R software version 4.3.1 was used to perform the meta-analysis, subgroup analysis, and meta-regression analyses. We adopted the restricted maximum likelihood estimator for random-effects meta-analysis and univariate random-effects meta-regression analyses. The Cochrane risk-of-bias tool version 2 and the Grading of Recommendations, Assessment, Development, and Evaluation criteria were used to examine quality assessment and the certainty of evidence.
We selected 26 randomised controlled trials with 2357 participants from 12 different countries. Random-effects meta-analyses showed that virtual reality-enhanced interventions had a statistically significant reduction in preoperative anxiety symptoms (t = -5.58, p < 0.001) with a moderate to large effect size (Hedges' g = -0.76, 95 % confidence interval: -1.03 to -0.48) compared to usual care. Statistically significant subgroup differences were found for the nature of the intervention, geographical region, country, and type of surgery. The improvement in preoperative anxiety symptom outcomes was greater when the virtual reality-enhanced interventions were chosen by patients (g = -2.55, 95 % CI: -3.08 to -2.02) when compared to virtual reality exposure interventions with educational content (g = -0.72, 95%CI: -1.07 to -0.38) or virtual reality distraction interventions (g = -0.64, 95 % CI: -1.04 to -0.23). Trials conducted in Asia had a greater effect on preoperative anxiety symptom outcomes (g = -0.98, 95 % CI: -1.33 to -0. 62) in comparison with those conducted in non-Asia (g = -0.23, 95 % CI: -0.54 to 0.07). The random-effects meta-regression identified sample size (β = -0.008, p = 0.031) as a statistically significant covariate of preoperative anxiety symptoms. The overall certainty of the evidence was very low.
Virtual reality-enhanced interventions can be considered supplementary interventions for adults undergoing elective surgery. Future trials on a large scale with follow-up assessments are needed.
PROSPERO registration ID: CRD42024486343.
虚拟现实暴露和分散注意力是减少术前焦虑症状的新的新颖技术。然而，虚拟现实增强干预措施在成年人中的有效性仍存在争议，尚未在系统评价中进行评估。
本研究旨在（1）评估虚拟现实增强干预措施与对照相比在成年人术前焦虑症状方面的有效性；（2）确定影响干预效果的因素。
随机对照试验的系统评价、荟萃分析和荟萃回归分析。
我们进行了三步系统搜索，从开始到 2024 年 5 月 1 日，使用（1）11 个数据库，（2）两个临床注册处，以及（3）英语或中文的引文和灰色文献搜索。R 软件版本 4.3.1 的 meta 包用于进行荟萃分析、亚组分析和荟萃回归分析。我们采用受限最大似然估计进行随机效应荟萃分析和单变量随机效应荟萃回归分析。采用 Cochrane 偏倚风险工具第 2 版和 Grading of Recommendations, Assessment, Development, and Evaluation 标准来评估质量评估和证据的确定性。
我们从 12 个不同国家中选择了 26 项随机对照试验，共 2357 名参与者。随机效应荟萃分析表明，与常规护理相比，虚拟现实增强干预措施在术前焦虑症状方面具有统计学显著降低（t=-5.58，p<0.001），具有中等至较大的效应量（Hedges'g=-0.76，95%置信区间：-1.03 至-0.48）。对于干预的性质、地理位置、国家和手术类型，存在统计学显著的亚组差异。与具有教育内容的虚拟现实暴露干预（g=0.72，95%CI：-1.07 至-0.38）或虚拟现实分散干预（g=0.64，95%CI：-1.04 至-0.23）相比，当虚拟现实增强干预由患者选择时，术前焦虑症状结果的改善更大（g=-2.55，95%CI：-3.08 至-2.02）。与非亚洲地区（g=0.23，95%CI：-0.54 至 0.07）相比，亚洲地区进行的试验对术前焦虑症状结果的影响更大（g=-0.98，95%CI：-1.33 至-0.62）。随机效应荟萃回归确定样本量（β=-0.008，p=0.031）是术前焦虑症状的统计学显著协变量。证据的总体确定性非常低。
虚拟现实增强干预措施可被视为接受择期手术的成年人的辅助干预措施。未来需要进行更大规模的试验，并进行随访评估。
PROSPERO 注册号：CRD42024486343。
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