Fully Immersive Virtual Reality for a Mindfulness-Based Intervention in Hemodialysis Patients: A Pilot Study Assessing Safety and End-User Perceptions

Background/Purpose: Virtual reality (VR) is an evolving technology that fully immerses end-users into a digitally fabricated, yet realist and lifelike environment. End-users wear a head-mounted display that uses tracking systems and physical motion, such as eye or head movement, to navigate the digitally created artificial world—which can replicate realistic settings (e.g., 360° video of a garden or private beach) or more complex sci-fi environments. VR technology is most exploited in the billion-dollar video gaming industry and for simulation training with clinicians and military personnel. More recently, VR technology has been included in treatment plans for pain management (e.g., burn victims), physical rehabilitation, and in treatment of psychological phobias (e.g., fear of heights), with evident improvements in emotional well-being and lessening of physical complaints.

The benefits of chairside exposure to VR remain unexplored in hemodialysis (HD) patients, even though it represents a promising delivery platform for patients spending ≥9 hours per week in outpatient clinics. Indeed, HD patients often report feeling burdened by the inordinate amount of time spent at these clinical sites during their treatment therapy. Current VR technology may provide distraction, entertainment, and engagement that allows these patients to escape from the mundane clinical settings.

Because HD treatment and immersive VR have similar potential adverse side effects (e.g., fatigue, nausea), the current pilot trial tests the initial safety, acceptability, and utility of VR during regularly scheduled hemodialysis treatment sessions. We expect patients will report high levels of spatial presence and low levels of nausea and discomfort as well as descriptions of the experience as enjoyable, understandable and clear, and beneficial for their dialysis experience.

Methods: HD patients (n=20) were enrolled in a single-arm pre-post pilot study. While undergoing dialysis, participants were exposed to our fully immersive Joviality^TM VR program, which delivered mindfulness training and guided meditation using the Oculus Rift head-mounted display. Participants experience the 25-minute program on two separate occasions during HD treatment sessions. Prior to the VR experience, participants recorded their level of motion-related symptoms and related discomfort, and immediately following the experience, we recorded these levels again using the Simulator Sickness Questionnaire. Validated utility measures included end-user’s ability to be fully immersed in the virtual space, interact with virtual objects, find hardware user-friendly, and easily navigate through the Joviality^TM program.

Results: Mean age was 55.3 years; 80% male; 60% African American; and mean dialysis vintage was 3.56 years. There were significant decreases in treatment and/or motion-related symptoms following VR exposure (22.6 vs. 11.2; p=0.03). HD end-users reported high levels of immersion in the VR environment [μ=5.60; range=1 (low) to 7 (high)] and they rated the software as easy to operate, with average System Usability Scores of 82.8/100.

Conclusions and Implications: HD patients routinely suffer from fatigue, nausea, dizziness, and headaches during dialysis. Our pilot trial provides promising findings regarding the safety and benefit of VR for HD-patients. Immersive VR programs may be a safe and enjoyable mode to improve patient experiences during dialysis. Future trials to test the efficacy of this intervention are now warranted.