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Virtual Reality in Clinical Research: Potential, Implementation and Challenges

Virtual reality devices present new possibilities in clinical trials. From helping patients to manage anxiety and pain to providing key training for researchers, VR has big potential. 

Studies using VR devices are growing in number and, so far, the results are heartening. In this post, we explore how virtual reality is being used in clinical trials along with some of the challenges that the technology still needs to overcome to maximize its impact.

The Impossibility of Living In Two Realities Simultaneously 

The first time Dr. Brennan Spiegel, director of health services research at Cedars-Sinai in Los Angeles, donned a VR headset, he plummeted to his virtual death. The experience was a powerful confirmation for Brennan that VR can significantly shift a person’s mindset, even when that person knows that they are sitting safely indoors.

“We’ve never evolutionarily had a requirement to live in two realities at once; we just take for granted the reality that we’re in. My whole reaction was that if we can use this for evil, we must be able to use this for good,” he explained to Kevin Truong at Medcity News.

These good uses can empower patients. Spiegel identifies two key areas in which virtual reality may be of use: “High exteroception —  where too much attention is paid to the outside world as in anxiety or phobia — and high intraception, where too much attention is being turned inward as in the case of chronic pain or IBS,” writes Truong.

VR has already been successful in hundreds of clinical trials. In fact, Cedars-Sinai is home to the largest clinical VR program in the world, treating more than 3,000 patients, says news writer Makenzie Holland.

VR can create an environment for patients in which they can heal, Spiegel tells Holland. For example, with convincing 3D depictions of an alternative reality, patients can be transported from the clinical setting into a more comforting context. These new places may be helpful to reduce stress, but Spiegel says VR worlds can also teach patients new skills that they can apply in real-world scenarios.

Virtual Reality For Trial Patients

First let’s focus on the benefits that VR can bring to patients in clinical research settings. From improved pain management to rehabilitation of stroke victims, exciting work is being done with the technology.

Virtual reality isn’t real, but it feels like it is. The mind knows VR is not real, but it’s such a convincing experience that the body responds to the new reality. This is positive news for patients with mental health issues, says Dr. Lucia Valmaggia, a reader in clinical psychology and digital mental health at King's College London and head of the virtual reality lab at the NIHR/Wellcome Trust King’s Clinical Research facility. 

With high-quality portable VR headsets, such as the Oculus Rift system, the technology can be used more widely than before. And, as Valmaggia explains, a key area is to facilitate patients revisiting traumatic experiences or intense contexts. While the virtual reality environment is difficult, therapists equip the patient with coping strategies before each immersion.  

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Virtual reality may be able to ease the pain of childbirth. VR could be a powerful ally to alleviate pain during labor, reports Nick Hartley at BBC News. A clinical trial testing the efficacy of VR for pain relief is underway at the University Hospital of Wales in Cardiff.

Virtual reality is being used to assist women through breathing and relaxation techniques in early labor, and it might also be effective in treating those who have suffered traumatic childbirths previously.

It might also help manage pain in children. HypnoVR has developed virtual reality hypnosis solutions to manage pain and stress in young patients. One of three clinical trials was a six-month study at the Hospital Hautepierre in Strasbourg, France. VR hypnosis was used on children to manage their post-operative pain and reduce opioid consumption following scoliosis surgery. 

Hypnosis lasted 20 minutes a day in the first three days after surgery. Hypnosis resulted in patients requiring less supplemental treatment for anxiety and a 45 percent reduction of morphine use. They also recovered faster than the control group, reducing bed-time by 21 hours.

VR could help with rehabilitating stroke survivors. Traditional rehabilitation methods for patients who have suffered strokes are not sufficiently motivating. This is why neuroscientist Tej Tadi founded MindMaze — a neurorehabilitation company using VR to reconnect parts of the brain and retrain body movements in stroke patients. 

Early treatment of stroke victims is vital, Tadi explains, because the window for recovery is so small. Patients can use MindMaze’s MindMotion Pro four days after a stroke. Studies have shown that those patients that use the technology doubled their training intensity — key to better recovery — in the first 10 sessions. 

Plus it can be used at home, which Tadi says is vital to maintaining patients motivation to continue rehabilitation exercises. MindMotion Pro was approved by the FDA in 2017 and has since helped more than 1,300 patients.

VR improves patient engagement. The number of patients seeking neurosurgery at California’s Hoag Memorial Hospital has increased because of its use of virtual reality. The reason is because patients are more engaged, says neurosurgeon Robert G. Louis

Virtual reality helps patients understand the treatment they will receive. “Patients who used to rely on black-and-white images (MRI and CT slices) now can do a 3-D fly through of their own brains,” Louise explains.

VR For Researchers and Physicians

It’s not just patients who have a lot to gain from VR — researchers do too. Chiefly, the technology allows them to enter realistic simulations so they can better understand best practices and techniques in treating patients. VR, in fact, becomes a powerful training tool.

Virtual reality can improve diabetes care. Healthcare professionals in the UK are testing a VR system to help treat patients with diabetes when admitted to the hospital. The clinicians essentially learn how to deal with patients in emergency diabetes situations through experiencing virtual simulations.

Developed by Oxford Medical Simulation, the training teaches doctors and nurses to recognize extreme cases, such as very high or low blood sugar levels. Dr. Mayank Patel, a consultant diabetologist at University Hospital Southampton, says non-specialists don’t always recognize signs of emergency diabetes situations. VR training helps them to spot signs of potential problems early on. 

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Virtual reality can be useful in kidney surgery. Patients undergoing partial nephrectomies have been shown to benefit from surgeons using VR equipment. Researchers at Jama Network investigated whether 3D VR models for planning robotic-assisted partial surgical removal of kidneys would improve surgical outcomes. 

In a single-blind randomized clinical trial with 92 patients, 3D VR modeling in surgery reduced operative time operation, blood loss and length of patient stay in the hospital. The researchers tested a control group that underwent the usual preoperative planning with computed tomography and/or MRI against the study group that also had the 3D VR model. 

Virtual reality and DNA analysis. Free software now exists to explore DNA in 3D VR. Created by computational scientist Stephen Taylor at the MRC Weatherall Institute of Molecular Medicine, the software allows scientists to make use of algorithms for analyzing biological data.

CSynth enables researchers to enter a genome in VR through genome sequencing data. The result is an ability to interact with elements of DNA molecules so researchers can examine DNA control switches, which can turn genes in specific diseases on and off. 

By seeing where the switches are in 3D, they are better understanding the role of their structures in disease, and how to fix them when they go wrong.

VR Challenges to Overcome

VR has been used successfully to treat patient pain, anxiety, phobias and eating disorders, while also helping with stroke rehabilitation. Research published in JMIR Serious Games set out to highlight what types of considerations are required when implementing VR in clinical research.

The authors say some of the VR challenges that need to be overcome include theoretical immaturity, inadequate technical standards, lack of clarity when assessing the effects of the media as opposed to the medium, study design, conducting in vivo research and cost. Another consideration is the difference between immersion and presence. Researchers need to be able to design trials that do not confuse the effects of VR and other potentially confounding factors

So they call for cautious optimism when rolling out VR in clinical trials. More studies need to be done on VR research outside of laboratory settings and more pilot studies are required to set up a rigorous body of clinical results. Paying attention to the patient experience will also be key. VR equipment will need to be unobtrusive, mobile and easy to operate for patients to feel at ease with the technology. 

VR is an exciting addition to the use of digital tools in clinical research. While operational challenges persist, there’s a growing body of evidence showing the efficacy of using VR in clinical trials. Improved patient experience and more effectively trained researchers will certainly lead to large-scale developments in VR.

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