Virtual Reality During Office Procedures for Anxiety Reduction in Women Veterans

Objectives: Sadly, the majority of female veterans with Pelvic Floor Disorders have a history of Military Sexual Trauma which can make office procedures incredibly anxiety-provoking. This leads to increased need for sedation in the Operating Room which carries risk and expense. Virtual Reality (VR) has been used in periprocedural settings as distraction to decrease pain and anxiety. We sought to test the feasibility of immersive VR as a nonpharmacologic intervention to reduce anxiety and pain and improve the experience of women veterans undergoing office urogynecologic procedures.

Methods: Prospective cohort study of women veterans undergoing office urogynecologic procedures. Those prior to implementation of VR intervention (using verbal anesthesia alone) were compared to those who used VR during their procedure. Primary outcome was state of anxiety scored by the validated state-trait anxiety inventory (STAI-6), secondary outcomes included pain (visual analogue scale) and patient experience. Qualitative feedback was collected from both veterans and surgeons. Descriptive statistics were used for comparison, pain and anxiety outcomes were assessed with paired analyses.

Results: 42 women veterans participated in the study (19 pre-VR and 23 used VR). Demographic and periprocedural data are seen in Table 1. Participants who used VR exhibited lower anxiety scores after the procedure vs. pre-procedure, with mean reduction 1.6 points (mean 11.0 vs 9.4 SE 0.7 p.04) taking them from the moderate anxiety to low anxiety range. This was similar in pre-VR group with mean reduction 2.6 points (mean 11.1 vs 8.4 SE 0.96 p .01). Comparing paired mean reduction between groups, there was no difference p 0.3. Linear regression showed that post-procedure anxiety was independently associated with MST history and abnormal findings noted at the time of procedure but not type of procedure or use of VR. Both groups had little pain pre and post procedure. Veterans had high satisfaction with VR. 95% (20/21) rated their overall VR experience as positive or very positive. 81% (17/21) rated the procedure using VR as “comfortable” or “very comfortable”, and 95% (20/21) were likely or very likely (with 67% 14/21 being very likely) to recommend the technology to a friend having this procedure. Surgeons reported that VR improved their ability to teach learners, troubleshoot equipment and maintain focus since the patient was calm, comfortable and distracted, needing the verbal anesthesia from the surgeon/ team.

Conclusions: Immersive Virtual Reality is a novel non-pharmacologic tool that can be used safely and feasibly during urogynecologic office procedures, even for female veterans with a history of sexual trauma. Anxiety improved both with VR and standard verbal anesthesia. VR provided a positive experience for both patients and surgeons. Qualitative feedback, will be used to further develop the technology to keep women veterans comfortable in the office setting, further testing is planned.