Do Extended Reality Interventions Benefit Patients Undergoing Elective Cardiac Surgical and Interventional Procedures? A Systematic Review and Meta-analysis

Emma Harris; Steven Fenton; John Stephenson; Fiona Ewart; Salime Goharinezhad; Hyunkook Lee; Felicity Astin

doi:10.1111/jocn.17578

Do Extended Reality Interventions Benefit Patients Undergoing Elective Cardiac Surgical and Interventional Procedures? A Systematic Review and Meta-analysis

J Clin Nurs. 2024 Dec 12. doi: 10.1111/jocn.17578. Online ahead of print.

Authors

Emma Harris¹, Steven Fenton², John Stephenson³, Fiona Ewart¹, Salime Goharinezhad¹, Hyunkook Lee², Felicity Astin¹

Affiliations

¹ School of Health, Wellbeing and Social Care, Faculty of Wellbeing, Education and Language Studies, The Open University, Milton Keynes, UK.
² School of Computing and Engineering, University of Huddersfield, Huddersfield, UK.
³ School of Human and Health Sciences, University of Huddersfield, Huddersfield, UK.

PMID: 39668582
DOI: 10.1111/jocn.17578

Abstract

Background: Extended reality (XR) interventions have the potential to benefit patients undergoing elective cardiac surgical and interventional procedures. However, there are no systematic reviews with meta-analyses to guide clinical care.

Aim: To critically evaluate the evidence on the effectiveness of XR interventions on patient anxiety and pain and other associated outcomes.

Design: Systematic review and meta-analysis following the PRISMA 2020 statement.

Data sources: A systematic search of five databases (CENTRAL, CINAHL, MEDLINE, PsycInfo, Scopus) from inception to July 2023.

Methods: Screening and data extraction was conducted independently by multiple reviewers. Stata (Version 17) was used to conduct meta-analyses for patient anxiety and pain. Secondary patient outcomes were summarised in a synthesis. The Cochrane Risk of Bias (Version 2) tool was applied to trials and the NHLBI Study Quality Assessment tools to all other study designs.

Results: Of the 3372 records identified, 22 were included, 10 of which were eligible for inclusion in the meta-analyses. Fifty-seven percent of randomised trials were rated as high risk of bias. Virtual reality (VR) was the only XR technology evaluated. VR significantly reduced pre-procedural anxiety (standardised mean difference: -1.29; 95% confidence interval - 1.96, -0.62, p < 0.001), and peri-procedural anxiety (standardised mean difference: -0.50; 95% confidence interval - 0.83, -0.18, p < 0.003) but did not reduce pain levels, compared with usual care. VR increased pre-procedural knowledge and postsurgical physical and pulmonary function. VR interventions may also improve emotional wellbeing, care delivery and physiological outcomes, but evidence was inconsistent.

Conclusions: XR potentially benefits cardiac patients undergoing elective invasive procedures and surgery by reducing pre- and peri-procedural anxiety and increasing procedural knowledge and physical function.

Relevance to clinical practice: Cardiac nurses' role can be supported by VR interventions to improve the patient experience and several aspects of patient care.

Patient or public contribution: Not applicable as this is a systematic review.

Keywords: anxiety; extended reality; interventional cardiology; pain; patient experience; patient outcomes; systematic review; virtual reality.

Publication types

Review