Abstract
BackgroundBehavioural and psychological symptoms of dementia (BPSD) are difficult to manage, particularly in acute care settings. As virtual reality (VR) technology becomes increasingly accessible and affordable, there is growing interest among clinicians to evaluate VR therapy in hospitalized patients, as an alternative to administering antipsychotics/sedatives or using physical restraints associated with negative side effects.ObjectivesValidate and refine the proposed research protocol for a randomized controlled trial (RCT) that evaluates the impact of VR therapy on managing BPSD in acute care hospitals. Special attention was given to ascertain the processes of introducing non-pharmacological interventions in acute care hospitals.MethodsTen patients 65 years or older (mean = 87) previously diagnosed with dementia, admitted to an acute care hospital, were recruited over 3-month period into a prospective longitudinal pilot study. The intervention consisted of viewing 20-min of immersive 360° VR using a head-mounted display. Baseline and outcomes data were collected from the hospital electronic medical records, pre/post mood-state questionnaires, Neuropsychiatric Inventory (NPI) score, and standardized qualitative observations. Comprehensive process data and workflow were documented, including timestamps for each study task and detailed notes on personnel requirements and challenges encountered.ResultsOf 516 patients admitted during the study, 67 met the inclusion/exclusion criteria. In total, 234 calls were initiated to substitute decision makers (SDM) of the 67 patients for the consenting process. Nearly half (45.6%) of SDMs declined participation, and 40% could not be reached in time before patients being discharged, resulting in 57 eligible patients not being enrolled. Ten consented participants were enrolled and completed the study. The initial VR session averaged 53.6 min, largely due to the administration of NPI (mean = 19.5 min). Only four participants were able to respond reliably to questions. Seven participants opted for additional VR therapy sessions; of those providing feedback regarding the VR content, they wanted more varied scenery (animals, fields of flowers, holiday themes). Few sessions (4/18) encountered technical difficulties.ConclusionThe pilot was instrumental in identifying issues and providing recommendations for the RCT. Screening, inclusion criteria, consenting, data collection, and interaction with SDMs and hospital staff were all processes requiring changes and optimizations. Overall, patients with dementia appear to tolerate immersive VR, and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals.
Highlights
Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, in acute care settings
Patients with dementia appear to tolerate immersive virtual reality (VR), and with suggested protocol alterations, it is feasible to evaluate this non-pharmacological intervention in acute care hospitals
We report on the findings and provide recommendations for changes to the research protocol to achieve a feasible randomized controlled trial (RCT) that evaluates VR therapy in the acute care hospital, focusing on the processes, materials, and resources
Summary
Behavioural and psychological symptoms of dementia (BPSD) are difficult to manage, in acute care settings. An earlier review of the literature [7] which studied the effectiveness among seven types of nonpharmacological interventions for agitation in older adults with dementia (sensory intervention, social contact, activities, environmental modification, caregiver training, combination therapy, and behavioural therapy) found only “sensory interventions” (aromatherapy, thermal bath, and calming music and hand massage) to be statistically significantly effective in reducing agitation. These have not been widely adopted; usually due to difficulties in implementation across the spectrum of care [10]. Their authors provide suggestions such as having multiple researchers and adding a qualitative component to record the participant’s reactions [10]
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