A new study in Hong Kong reveals that virtual reality (VR) could be a game-changer in alleviating preoperative stress in patients undergoing elective surgery.
The research, led by the Chinese University of Hong Kong (CUHK) in collaboration with Singapore General Hospital, demonstrated that a VR-based intervention significantly reduced anxiety, improved preparedness and enhanced overall patient outcomes.
The randomised clinical trial, published in the peer-reviewed journal JAMA Network Open, included 74 adult patients scheduled for elective surgery under general anaesthesia for the first time. Participants were aged between 18 and 69.
The study explored the impact of an eight-minute immersive 360° VR video tour of the operating theatre and post-anaesthesia care unit, delivered through a head-mounted display console.
Patients who underwent the VR experience reported decreased preoperative anxiety at the end of the clinical session and before the surgery compared to those who received standard pre-surgery care.
The VR group also exhibited lower stress levels and higher preparedness, as measured by the Amsterdam Preoperative Anxiety and Information Scale and Visual Analog Scale.
Jojo Wong Cho-lee, associate professor at the CUHK Nethersole School of Nursing, supervised the study.
She explained that the VR tour was a mental rehearsal for patients, helping them feel more at ease before the actual procedure.
Evidence suggests that stress from preoperative uncertainty could itself become a risk factor for patients.
Preoperative anxiety can contribute to complications such as hypertension, increased heart rates and increased risk of bleeding and post-operative complications such as nausea, vomiting, respiratory distress and heart attacks, according to the study.
A VR tour can therefore help to reduce this anxiety in patients unfamiliar with the medical setting, equipment sounds and repeated questions from staff to confirm their identity ahead of a surgical procedure, the study showed.
Jojo Wong Cho-lee said: ‘Patients might feel anxious to see staff with surgical gowns and hear sounds in the operating theatre for the first time. The exposure therapy served as a mental rehearsal so that patients felt more at ease before the actual procedure.’
Writing on X (formerly known as Twitter), she posted: ‘Our paper suggests that VR-based intervention is a feasible and effective way to reduce preoperative anxiety in adult patients undergoing elective surgery.’
Lead author Chiu Pak-lung, a doctoral graduate at the CUHK nursing school, said patients often experienced anxiety before other medical procedures such as vaccinations, chemotherapy and providing blood samples.
To simulate the VR experience of a patient about to undergo surgery, Chiu played the role of a patient in a video that depicted the surgical process from the patient’s perspective, with medical staff asking him questions commonly used in the operating theatre.
While more clinical trials with larger sample sizes are needed to confirm the efficacy of VR-based interventions, the research team is optimistic about the technology's potential.
The study highlights the potential broader applications of VR technology in healthcare, including training for healthcare professionals and therapy for patients.
Traditional methods of calming patients have included medication, music therapy and leaflets detailing the surgery process and aftercare information.
But the study authors write: ‘The evidence for their effectiveness in the adult population remains unclear. Patient education through multimedia information, such as audio-visual videos, multimedia-supported education and websites has also been studied, but the results of previous systematic reviews have been inconsistent in terms of their effectiveness in reducing preoperative anxiety, pain and length of hospital stay, compared with verbal or text-format education.
‘Most importantly, these traditional and noninteractive interventions may not be able to meet the demands and expectations of patients in the current era of rapid technological development.‘
While more clinical trials with larger samples are needed to confirm the effects of VR further, the research team said they hoped the technology could be implemented in public hospitals in Hong Kong in the near future, paving the way for a new era in patient care and anxiety management.
