Patient recruitment and characteristics
A total of 53 women were approached for 6 weeks between August 2018 and
October 2018. Of these, 8 declined to participate and 5 did not meet
eligibility criteria. Finally, forty of 48 (83%) women agreed to
participate and were randomised. (Figure 1). Reasons for exclusion of
the 5 patients included 4 patients being over the age of 70, of which
one patient had hearing difficulty and 1 patient did not need a
hysteroscopy. Eight patients declined to participate of which 2 patients
wanted to see the procedure, 2 patients had used virtual reality before
for gaming and were queasy, 2 patients were very anxious about the
procedure and declined participation, 1 patient couldn’t wait for the
procedure as there were delays in the clinic and 1 patient had brought
her own headphones with an audio track to keep herself distracted. All
patients completed the procedure except one having standard care who did
not tolerate the procedure and needed to be booked for an outpatient
hysteroscopy under general anaesthetic. Data for all 40 patients was
considered for statistical analysis.
Baseline characteristics (Table 1) show that groups were balanced for
features including age, parity, menopausal status, previous experience
of outpatient hysteroscopy, anticipated pain and anxiety scores, and
analgesic intake prior to the procedure. Before the procedure, the mean
expected pain and anxiety scores were 6.7 and 5.98 respectively and
there were no significant differences in either score between standard
care and virtual reality groups. The procedures were performed in a
single centre by 4 clinicians of consultant grade and a nurse and a
healthcare assistant supported the clinics. Vaginoscopic approach was
possible in 90% (36/40) of all the procedures. The mean duration of the
procedure was 4.82 minutes (Range 1.5 minutes to 14 minutes). Local
anaesthetic infiltration was required for pain management in 15% (6/40)
of the 18% (7/40) of women had cervical stenosis. Eighteen percentage
of the patients (7/40) had an experience of an outpatient hysteroscopy
in the past.
Nausea was experienced by one patient in the virtual reality
intervention arm, however she kept the headset on until the end of the
procedure; one patient had previous history of claustrophobia and
decided to removed the headset when the procedure started as she felt
claustrophobic.