This study is being conducted as a pilot to test the feasibility, usability, acceptability,
and clinical utility of using a virtual reality (VR) immersion experience in the inpatient
setting. In addition to determining whether the patients enjoy the experience and would like
to participate in a future more tailored immersion in virtual reality, we will be attempting
to determine whether there are any positive impacts on their visit, including a distraction
from their pain or anxiety associated with their procedures or the reason they have been
admitted to the hospital.
Because the inpatient population at Cedars-Sinai Medical Center (CSMC) is dynamic and
diagnostically diverse, we intend to develop a series of VR interventions that broadly
address patient concerns. VR has only been tested in select patient populations, so we are
equally interested in the feasibility of deploying VR across the inpatient hospital
environment as we are in demonstrating some effectiveness in reducing pain and anxiety, and
The present study has the following aims:
1. Adapting existing VR environments for inpatients with a variety of impairments,
utilizing cost-effective VR hardware (Phase 1).
2. Assess the usability and acceptability of the VR equipment and software by hospital
inpatients by conducting qualitative interviews (Phase 2).
3. Assess the clinical utility of the VR intervention by measuring patient reported
outcomes using a modified care satisfaction survey, administered to inpatients receiving
VR and a matched control sample (Phase 3).
Concerning Aims 2 and 3, we hypothesize the following:
1. Inpatients will find the VR intervention helpful and enjoyable, and will believe that
its benefits outweigh any difficulties encountered using the hardware or software.
2. Inpatients who are exposed to the VR intervention will report significantly improved
pain management, greater satisfaction with their inpatient visit, and greater overall
health compared to matched control inpatients that were not exposed to VR.
Recent advances in Virtual Reality (VR) technology have made it possible for researchers to
develop interventions for a wide variety of disease states, including obesity, pain, impaired
motor functioning, and anxiety. Over the last decade, improvements in software and hardware
design, as well as associated cost reductions, have made VR a practical tool for widespread
use, rather than an expensive novelty. Interventions that would not be possible or practical
in the real world have been developed in the virtual world, resulting in immersive
multi-sensory (primarily audio-visual) experiences that can distract patients from painful
experiences and motivate them to achieve personal goals.
VR environments allow patients to visualize non-disease states, and practice living more
healthily, whether the focus is stroke rehabilitation, exposure therapy for social anxiety,
or simply interacting with the world with reduced pain levels. A number of studies have
demonstrated the efficacy of VR interventions, and all of them are built around this basic
premise. For example, a meta-analysis of diagnosis-specific exposure therapies for anxiety
disorders - PTSD, agoraphobia/panic disorder, social anxiety, and animal phobias) reports
large effects (Cohen's Q-statistic >0.80) for VR interventions on symptom reports at therapy
termination.1 Similarly, a meta-analysis of post-stroke motor rehabilitation VR interventions
reports that, in observational studies, patients experience significantly reduced impairment
(14.7%) and improved motor functioning (20.1%).
Hospital inpatients will most likely benefit from VR as a distraction from acute pain during
procedures, painful drug infusions, adverse side effects of treatments, or from boredom and
inactivity, which could lead to increased reports of distress and reduced satisfaction with
care. Several areas of research may provide a useful model for bringing VR distraction
interventions to all types of hospital inpatients. A recent review by Li and colleagues
(2012) highlighted advances in these treatment areas.
To date, the most widely studied form of VR interventions is the reduction of pain and
anxiety associated with burn care. Compared to use of analgesic medication alone, patients
who use VR distraction interventions in combination with analgesic drugs have reported
reduced pain and distress during burn wound care across most studies, and both lower pain
ratings and increased range of motion during physical therapy in some studies. Use of a VR
distraction environment called SnowWorld - developed by H.G. Hoffman and colleagues, and
employed across many of these studies - allows burn patients to move through ice canyon and
play with snow. Additions of VR hypnosis and relaxation modules to SnowWorld have also been
tested in burn patients, with mixed results; patients undergoing hypnosis reported lower pain
and anxiety levels, but those undergoing relaxation while receiving morphine reported higher
Studies of cancer patients have demonstrated some efficacy for use of VR in patients
receiving chemotherapy and lumbar punctures. Although pain scores are often reduced in a
direction favoring the use of VR, studies to date have not demonstrated conclusive, long term
benefits for symptom reduction. However, patients do report short perceived time in
treatment, reduced physiological arousal during treatment, and lower perceived pain during
During routine medical procedures, VR delivered via a head-mounted display demonstrated some
promising effects. In a study of outpatients having blood drawn, those receiving the most
immersive VR reported lower levels of moderate to severe pain. In a similar study of patients
having an IV placed for CT scan contrast, those receiving VR reported no change in pain
level, compared to standard care patients who reported a four-fold increase in pain.
VR has also been used for the treatment of chronic pain. In a sample of adults with chronic
neck pain, use of a VR mirror visual feedback environment resulted in promising but
non-significant reported pain reductions. In another study of patients with chronic neck
pain, a single session of VR that encouraged increased range of motion (by spraying at
Notably, many of these studies (except for chronic neck pain patients) were conducted using
child and adolescent populations. This group may be more receptive to VR, given common
exposure to video games and screen-based entertainment. Nevertheless, the use of VR for all
patients should be studied further, as the intervention may present a novel and
cost-effective method of improving patient experiences and satisfaction.
VR interventions have been used as distractions or diversions during medical procedures. This
study will be one of the first to test the feasibility of deploying low-cost VR interventions
in a nonsurgical inpatient hospital setting. The VR hardware configuration and all software
is currently being developed by AppliedVR, a leader in the development of medical
applications for virtual reality technology, including interventions for weight loss and
health, safety training, education, and personal development.
- Able to understand the goals of the study and provide informed consent
- Any Inpatient at CSMC ISP, admitted between June 2015 and 31 December 2016, who is not
excluded due to criteria listed below.
- At least 18 years of age
- English speaking
- Unable to consent to study due to cognitive difficulty
- Current diagnosis of epilepsy, dementia, or other neurological disease that may
prevent use of VR hardware and software
- Vision requiring correction with eyeglasses (except nearsightedness, which can be
accommodated by the Gear VR goggles)
- Sensitivity to flashing light or motion*
- Recent stroke
- Transplant patient
- Patient on ventilator, BiPAP, or other breathing assistance equipment
- Recent injury to the eyes, face, neck, or arms that prevents comfortable use of VR
hardware or software*
- Non-English speaking