Virtual Reality Analgesia In Trauma Rehab

Anxiety Clinical Trial

Official title:

Utilizing Virtual Reality Analgesia (VRA) as a First Line Nonpharmacologic Analgesic Intervention on the Acute Rehabilitation Unit: A Pilot Study

Clinical Trial Details — Status: Recruiting

Administrative data

• NCT number: NCT03894592
• Other study ID #: 2018-9196
• Status: Recruiting
• Phase: N/A
• Start date: August 1, 2019
• Est. completion date: October 2020

Study information

• Verified date: July 2019
• Source: New York City Health and Hospitals Corporation
• Contact: Michelle Stern, MD
• Phone: 9175779543
• Email: Michelle.Stern[@]nychhc.org
• Is FDA regulated: No
• Study type: Interventional

Clinical Trial Summary

This will be a pilot study utilizing Virtual Reality Analgesia (VRA) as a first line nonpharmacologic analgesic intervention on the Acute Rehabilitation Unit. In order to assess the efficacy of the intervention with a set of outcome measures will be defined:

• Pain will be measured using the VAS for all subjects pre-, during and post-intervention via self-report.

• Number of opioids/oral pain medication consumed will be analyzed

• Patient anxiety will be measured on the Short ( State-Trait Anxiety Index) STAI anxiety scale pre- and post-intervention.

• Heart rate and blood pressure will also be measured pre and post intervention.

Description:

The purpose of this project is to evaluate the efficacy of virtual reality analgesia (VRA) for Adult patients in acute pain in the Acute Rehabilitation unit. Given the severity of the opioid epidemic, physicians are looking for alternative non-opioid/non-pharmacologic interventions to decrease both pain, and the need for opioids.

The recognition of pain by an individual requires both a noxious stimulus as well as attention on the part of the subject. Studies have shown that pain sensation is less on the visual analogue scale (VAS) when subjects are distracted, and that distraction can assist in pain control, since humans have limited attention capacity. When treating Adult patients with acute pain, it could thus be useful to have an effective method of pain distraction to improve tolerance and comfort, and to decrease the amount of narcotic medications prescribed.

Virtual reality (VR) is a digital simulation of a three-dimensional environment in which the user is capable of interacting with the generated world via computerized equipment such as gloves or a virtual reality head-mounted display (VRHMD). 360-degree VR video is a subset of virtual reality which creates an immersive experience of real world environments, allowing the user to have a sense of presence and exploration while wearing a (VRHMD). VR exposure is shown to be a potent distractor and has been repeatedly shown to provide analgesia during painful procedures. Since adults are often very attracted to technology, computer games, and virtual reality, we propose a study to allow adults to interact with a custom virtual reality environment in order to consume a substantial proportion of their attentional resources during acute pain episodes. We hypothesize that immersing the patients in VR will allow these patients to spend less attention on pain and allow for less need for other analgesia i.e. opioids.

VR has been demonstrated as a valid method of analgesia for both adults and pediatrics during painful procedures. To the investigator's knowledge, no one has evaluated the use of VRA to reduce opioid consumption in the Acute Rehab unit. In addition to relieving pain, anxiety, stress, and possibly decreasing general sedation, VRA may also decrease medical costs by decreasing length of stay.

Virtual Reality Analgesia (VRA) has been shown by research to be more effective when more immersive. To accomplish this, various head-sets and technologies have been developed to provide a more enveloping experience. Until recently, virtual reality head-mounted displays (VRHMD) had not been widely accepted due to their poor performance and high cost. But recent developments with the Oculus Rift DK1(DK 1 is a model number) in 2012 changed this paradigm. The now commercially available Oculus Rift is an inexpensive state of the art VRHMD. Using the Oculus Rift can create a high definition and smooth environment that will allow for maximal distraction at a modest price point. Therefore, equipment like the Oculus Rift could be an ideal VRA tool in the clinical setting.

Many corporations such as Samsung, Google, and others have invested both capital and development resources that have advanced virtual reality technologies and made them very inexpensive. With these changes, the investigators are finally at a point where both the hardware and the software needed to produce high quality VRHMD is now available at very low and moderate price points. An example of the lowest cost VRHMD is the Google Cardboard, a simple device that allows anyone with a cellphone to experience VR, for as little as $15.

The investigators propose a study utilizing the highest quality VRHMD to provide VRA during acute pain related to trauma. It is the investigators' hypothesis that by using VRA, significant decrease in the overall pain and discomfort can be observed resulting in a decrease in consumption of oral opioids.

Recruitment information / eligibility

• Status: Recruiting
• Enrollment: 54
• Est. completion date: October 2020
• Est. primary completion date: July 2, 2020
• Accepts healthy volunteers: Accepts Healthy Volunteers
• Gender: All
• Age group: 18 Years to 100 Years

Eligibility

Inclusion Criteria:

• Adult with Traumatic injury on the Acute Rehab Unit

• Adult ages 18-100

• Adult with intact vision who can attend VR intervention

• Adult receiving PO Medications

• Adult with motor control of at least one arm

Exclusion Criteria:

• Adult who has uncontrolled seizures more than 4 times per year

• Adult who is not attentive to VR secondary to poor concentration/poor cognition to external stimuli.

• Adult with no volitional control of the neck and or upper extremities.

Related Conditions & MeSH terms

• Anxiety
• Musculoskeletal Pain
• Opioid Use
• Trauma Injury
• Virtual Reality
• Virtual Reality Analgesia

Intervention

Other:
• Virtual reality
Trauma patients enrolled in the study will be offered Virtual Reality experieince per the protocol

Locations

Country	Name	City	State
United States	Jacobi Medical Center	Bronx	New York

Sponsors (1)

Lead Sponsor	Collaborator
New York City Health and Hospitals Corporation

Country where clinical trial is conducted

United States, 

Outcome

Type	Measure	Description	Time frame	Safety issue
Primary	Change in pain perception	will be measured using the Visual Analogue Scale (VAS) for all subjects pre-, during and post-intervention via self-report. The scale values range from 0 to 10. ) being no pain and 10 being the worst pain	1 year
Secondary	Increase or decrease in opioid/oral pain medication use	Number of opioids/oral pain medication consumed will be analyzed from the patients electronic medical record	1 year
Secondary	Heart Rate	Pre and post intervention heart rate will be monitored using regular hospital equipment to note any changes pre and post intervention.	1 year
Secondary	Patient reported anxiety	Anxiety will be measured on the Short STAI (State-Trait Anxiety Index) anxiety scale pre- and post-intervention.; The scale has 2 parts with 20 questions in each part. Each question is rated on a 4 point scale,1 to 4.; Total scores range from 20 to 80 for each part, with higher score indicating higher anxiety	1 year
Secondary	Blood Pressure	Pre and post intervention blood pressure will be monitored using regular hospital equipment to note any changes pre and post intervention.	1 year