Research ArticleOriginal Article
Open Access

The effect of virtual reality on anxiety, stress, and hemodynamic parameters during cesarean section

A randomized controlled clinical trial

Sultan A. Almedhesh, Wafaa T. Elgzar, Heba A. Ibrahim and Hiba A. Osman
Saudi Medical Journal April 2022, 43 (4) 360-369; DOI: https://doi.org/10.15537/smj.2022.43.4.20210921

Article Figures & Data

Figures

  • Figure 1
    Figure 1

    - Participant’s flowchart. CS: cesarean section, OT: operating theater

  • Figure 2
    Figure 2

    - Filed workflow chart.

  • Figure 3
    Figure 3

    - The subjective parameters (B-MEPS [emotional preoperative stress], novel visual facial anxiety scale [NVFAS], and Birth Satisfaction Scale-Revised [BSS-R] among the 2 groups). A) For B-MEPS score the virtual reality (VR) group showed significantly lower stress levels immediately after skin suture and 2hours (h) postoprative compared to the control group. B) Regarding the NVFAS, the score decreased significantly in the VR group compared to the control group immediately after skin suture and 2h postoprative. C) The BSS-R 2h after CS showed that 58% of the VR group were completely satisfied compared to 11.3% of the control group with statistically significant difference (FET= 135. 359 p-value= 0.000)*p<0.05.

  • Figure 4
    Figure 4

    - The objective variables (maternal hemodynamic parameters among the 2 groups. A) The systolic blood pressure at the delivery time was significantly higher in the virtual reality [VR] group than the control group. B) The VR group showed significant increase in diastolic blood pressure at delivery and after skin suture. C) HR was decreased significantly in the VR group than the control group after skin suture and 2 hours postoperative. D) SpO2 did not differ significantly among VR and control groups at any time point. *p<0.05

Tables

  • Table 1

    - Mixed factorial ANOVAs for subjective parameters (B-MEPS and NVFAS).

    GroupAdmission to OT (Mean±SD)After skin suturing (Mean±SD)2 hours postoperative (Mean±SD)F for time (P-value)F for group (P-value)F for time* group interaction (P-value)
    B-MEPS   1284.153 (0.000)109.511 (0.000)61.307 (0.000)
    VR group30.74±3.1314.21±2.1612.76±1.27   
    Control group31.17±2.8417.32±2.2515.41±1.69   
    F(P-value)1.784(0.183)173.579 (0.000)273.635 (0.000)   
    NVFAS   1454.845 (0.000)292.192 (0.000)396.826 (0.000)
    VR group9.07±0.882.09±1.191.00±0.95   
    Control group9.20±0.874.21±0.973.41±0.91   
    F(P-value)1.791(0.182)330.417(0.000)580.417(0.000)   

    Bold values indicate a significant difference between groups (p<0.05). OT: operating theatre, VR: virtual reality, B-MEPS: brief measure of emotional preoperative stress, NVFAS: novel visual facial anxiety scale

    • Table 2

      - Mixed factorial ANOVAs for objective parameters (maternal hemodynamic variables).

      GroupAt admission to OT (Mean±SD)Immediately after anesthesia (Mean±SD)At skin incision (Mean±SD)At delivery (Mean±SD)After skin suturing (Mean±SD)2 hours postoperative (Mean±SD)F for time (P-value)F for group (P-value)F for time* group interaction (P-value)
      SBP      86.957 (0.000)2.217 (0.137)0.672 (0.597)
      VR group (n=176)129.89±19.44114.98±15.47112.00±21.22115.08±13.84113.64±13.34117.54±10.27   
      Control group (n=175)128.57±16.04113.46±22.57111.50±17.60111.18±17.52112.26±12.69115.51±11.27   
      F(P-value)0.485(0.486)0.538(0.464)0.057(0.811)5.331(0.022)0.984(0.322)3.094(0.079)   
      DBP      145.611 (0.000)8.678 (0.003)1.809 (0.124)
      VR group (n=176)76.21±10.1973.77±13.9562.71±13.3562.51±9.3165.25±10.9071.01±7.97   
      Control group(n=175)74.58±12.3171.85±18.2360.37±9.2157.26±15.9363.02±8.8369.68±7.80   
      F(P-value)1.819(0.178)1.229(0.268)3.644(0.057)14.211(0.000)4.413(0.036)2.496(0.115)   
      HR      65.847 (0.000)1.854 (0.174)3.254 (0.024)
      VR group (n=176)101.15±20.5497.95±18.6991.46±22.0590.46±17.2787.15±12.4487.08±10.22   
      Control group (n=175)100.46±17.6596.88±16.2893.89±11.8892.68±12.3091.59±10.3889.85±6.52   
      F(P-value)0.114(0.736)0.326(0.568)1.642(0.201)1.910(0.168)13.166(0.000)9.145(0.003)   
      SpO2       29.329 (0.000)2.389 (0.123)1.010 (0.397)
      VR group (n=176)98.58±1.0198.47±1.1198.38±1.4298.21±1.5098.40±1.3399.02±0.77   
      Control group (n=175)98.62±1.4098.29±1.3898.21±1.1697.92±1.7598.33±1.0798.90±0.70   
      F(P-value)0.110(0.740)1.805(0.180)1.475(0.225)2.875(0.091)0.360(0.549)2.096(0.149)   

      Bold values indicate a significant difference between VR and control groups (p<0.05). VR: virtual reality, OT: operating theatre, VR: virtual reality, SBP.: systolic blood pressure, DBP: diastolic blood pressure, SpO2: peripheral oxygen saturation, HR: heart rate

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