Protocols for enhanced postoperative recovery, including multimodal analgesia and mobility strategies, can help optimize care and improve patient outcomes. Virtual reality, delivering three-dimensional immersive experiences, has been explored as a nonpharmacologic analgesic option, whereas wearable activity devices can be used to objectively evaluate postoperative ambulation.
At the 2024 American Rhinologic Society (ARS) meeting at the COSM, held on May 15th–16th, 2024 in Chicago, Vivek Pandrangi, MD from the Oregon Health & Science University (OHSU) presented data on the patterns of virtual reality and wearable activity device use among inpatients who underwent skull base surgery.
The data were obtained within the context of a prospective, 4-arm, randomized controlled trial investigating the use of virtual reality and wearable activity devices among patients undergoing inpatient surgery at a tertiary academic center between November 2021 and July 2022. The current study evaluated the patterns of device use in patients included in this trial who underwent skull base surgery.
The patients were randomized into four groups: control (standard of care), virtual reality, Fitbit, and virtual reality + Fitbit. Patients in the virtual reality groups were offered virtual reality headsets for daily use, whereas patients in the Fitbit groups were encouraged to walk 2,000 steps each day.
A total of 80 patients were included in the trial. Among them, 24 patients underwent skull base surgery. The mean age of the study participants was 49.2 years, and the majority of them (58.3%) were male. No patients had chronic pain or had utilized opioids within the 30 days preceding surgery.
Among the patients in the virtual reality and virtual reality + Fitbit groups, the virtual reality device was used 38% of the time it was offered, with higher utilization in the afternoons than in the mornings. The median reduction in pain scores after virtual reality device use was 1 point on a 10-point scale, whereas the median time of virtual reality device utilization was 24.5 minutes. Two mild adverse events, both involving nasal pressure from the virtual reality headset, were identified with its use, but they did not impede its employment and were resolved quickly. Among the patients in the Fitbit and virtual reality + Fitbit groups, 40 hospital days were included, and the median daily step count was 1,580 steps. A daily step count over 2,000 steps was achieved 32% of the time. Notably, patients in the virtual reality + Fitbit group had significantly reduced average daily pain scores compared to patients in the control group (1.2 compared to 3.7, p = 0.04).
Dr. Pandrangi concluded that virtual reality devices may be a feasible adjunct to multimodal analgesia in patients undergoing skull base surgery. However, their low utilization, which varied depending on the time of day, may pose challenges to their implementation. Considering the favorable safety profile of these devices, Dr. Pandrangi suggested that future evaluations of patients undergoing skull base surgery should consider the provision of individual virtual reality headsets for self-directed use.
In addition, the data of the current study support the incorporation of wearable activity devices in recovery protocols. They corroborate the idea that these devices are well tolerated and can facilitate both the creation and monitoring of objective mobility goals during postoperative recovery.
Overall, the findings of the study suggest that the use of virtual reality and wearable activity devices in postoperative recovery after skull base surgery is feasible and well tolerated and may aid pain control. Dr. Pandrangi emphasized that “Postoperative recovery protocols may benefit from the incorporation of these devices, but there are challenges, including patient compliance, that may impact optimal device utilization.”