UCSF

Background: Given the complexities in managing postoperative pain in the older adult demographic, there is mounting interest in exploring innovative nonpharmacological methods for pain. Among these emerging solutions, immersive virtual reality (IVR) has garnered significant interest. Recent studies have indicated possible efficacy of IVR in reducing postoperative pain in pediatric and young to middle-aged adults following various surgical operations. However, the feasibility, and acceptability of IVR for postoperative pain among older adults across a spectrum of major operations remains largely underexplored.Objectives: The primary aim of this mixed-methods single-arm study was to investigate the initial feasibility and acceptability of IVR use among adults aged 55 years and older during the initial two days following inpatient elective abdominal surgery. Secondary aims were to: 1) observe the preliminary impact of IVR on postoperative pain and relaxation levels, and 2) explore and describe the older adult’s overall user experience with IVR. Methods: Individuals aged 55 and older undergoing elective inpatient abdominal surgery at an academic medical center in Northern California were recruited from October 2023 to February 2024. Feasibility was evaluated through accrual rate, intervention completion, and questionnaire compliance; acceptability via the system usability scale (SUS), a user experience survey, and by monitoring self-reported side effects. The preliminary impact of IVR on self-reported pain intensity and relaxation levels was evaluated through pre-to post IVR changes. A subgroup of participants from the parent feasibility study who had completed at least one IVR session, were additionally recruited to complete a one-time 15-minute. Semi-structured interviews, aimed at qualitatively capturing the user experience. Purposeful sampling was employed until no new themes were captured during interviews. An inductive thematic analysis approach was used to identify emerging themes though line by line coding of manuscript transcripts. Results: A total of 29 participants, with a median age of 73 years (range 55-81), were enrolled and completed one IVR session, with 19 additionally completing a second session. Perceived usability and overall acceptance of IVR was high, with minimal side effects reported. In terms of preliminary impact of IVR, statistically significant improvements were observed in both pain and relaxation levels from pre- to post-IVR changes on both Day 1 and Day 2. Of the original 29 participants in the parent feasibility, 21 additionally completed a recorded interview. Semi-structured interviews revealed four themes: 1) IVR was a positive distraction from variety postoperative symptoms, including pain; 2) IVR provided a sense of escape from the hospital environment or worrisome medical conditions; 3) There was an expressed need to further tailor virtual reality content and equipment specifically for older surgical adults; and 4) Older adults endorsed the possibility of IVR use throughout perioperative care. Conclusions: This study supports the feasibility and acceptability of IVR as a potential tool for postoperative pain management and enhancing relaxation among older adults following elective inpatient abdominal surgery. The positive preliminary results suggest the need for large scale studies across additional complex inpatient abdominal surgeries to confirm acceptance and efficacy of IVR as a postoperative pain management intervention across a wide range of diverse older demographics, including individuals from underrepresented minority groups and those facing physical and cognitive limitations. As related to the user experience interview findings, despite minor critiques of the technology, participants verbally expressed that IVR following surgery helped to divert their attention away from pain and other symptoms. IVR also offered a temporary escape from hospitalization and concerns about underlying health issues, like cancer. This highlights the multifaceted potential of IVR in addressing a broad spectrum of postoperative symptoms, including pain. Thus, further tailoring IVR to the specific needs of older surgical patients could potentially improve overall well-being, suggesting a novel approach to improving not only postoperative pain, but also in promoting patient-centered care.