Intraoperative VR for Older Patients Undergoing TKA

NCT ID: NCT04748549

Last Updated: 2025-06-04

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

131 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-04-11

Study Completion Date

2027-12-30

Brief Summary

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The objective of this study is to investigate whether the use of virtual reality (VR) during total knee arthroplasty (TKA) can facilitate reductions in intraoperative sedative requirements while maintaining high levels of patient satisfaction as compared to both a music and sham VR + usual care control.

Detailed Description

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The investigators will conduct a three-armed randomized controlled trial with the following aims:

Specific Aim 1: Evaluate whether the use of VR during TKA can facilitate a reduction in intraoperative propofol dose required for patient comfort as compared to music and sham VR + usual care controls.

Hypotheses: Patients in both the VR and music groups will demonstrate reductions in propofol dose compared to sham VR + usual care controls. A reduction in propofol dose between the VR and music group will be smaller in magnitude.

Specific Aim 2: Assess the effect of VR during TKA on patient reported outcomes including overall satisfaction, pain, and anxiety as compared to music and sham VR + usual care controls.

Hypotheses: Patients in the VR group will report significantly higher satisfaction and better control of pain and anxiety than those in the music group and usual care group.

Specific Aim 3: Explore the potential effects of VR during TKA on other key secondary outcomes of perioperative efficiency, postoperative cognition, and functional recovery.

Hypotheses: Patients in the VR group will have shorter post-anaesthesia care unit (PACU) length of stay as compared to sham VR + usual care controls. The effect of VR on postoperative delirium, postoperative cognitive decline, postoperative opioid use and functional recovery will be exploratory endpoints.

Conditions

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Total Knee Arthroplasty

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Research participants will be randomized to one of three groups (2:2:1 allocation):

1. Immersive VR group
2. Music group
3. Sham VR + usual care control

The first 6 patients enrolled will be assigned to the VR group for the purposes of a pilot phase with the objective of identifying and refining any issues with the intervention. Data for these patients will not be included in the statistical analysis.
Primary Study Purpose

TREATMENT

Blinding Strategy

SINGLE

Outcome Assessors
Assessors of the Confusion Assessment Method (CAM) and Montreal Cognitive Assessment (MoCA) will be blinded to group assignment.

Study Groups

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Immersive VR group

Patients in the Immersive VR group will don a VR headset connected to a software platform on a tablet, as well as noise cancelling headphones. Patients can choose their desired experience within the VR software from a selection of immersive environments and/or video content. Examples include sitting in a canoe on a river, on a peaceful meadow or in a forest. Patients also have the option to listen to guided meditation or select from a library of videos to watch on a web-based user interface.

To reduce the influence of the anesthesia provider on the determination of sedative requirements, patients will administer their own sedation according to their needs for relaxation and comfort using a patient controlled system.

Group Type EXPERIMENTAL

Virtual Reality Immersive Relaxation

Intervention Type OTHER

The VR software developed allows patients to select from scenery such as mountains, the beach or from a selection of short videos, which are intended to promote relaxation.

Music group

Patients randomized to the Music group will be equipped with VR headsets but won't view any content. They will also be equipped with noise cancelling headphones in the same fashion as the immersive VR group. A study team member will play from a library of music or other audible content (audiobook, podcast) that was preselected by the patient. Patients in the Sham VR group will also use patient controlled sedation.

Group Type ACTIVE_COMPARATOR

Immersive Audio Experience

Intervention Type OTHER

A study team member will play from a library of music or other audible content (audiobook, podcast) that was preselected by the patient.

Sham VR + Usual Care Control Group

Subjects in the control group will wear VR headsets and headphones but will not view any content or listen to any audible content. They will undergo Monitored Anesthesia Care (MAC) according to a prespecified protocol targeting light or moderate sedation with a propofol infusion.

Group Type SHAM_COMPARATOR

Sham Virtual Reality Experience

Intervention Type OTHER

Subjects will wear VR headsets and headphones but will not view any content or listen to any audible content.

Interventions

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Virtual Reality Immersive Relaxation

The VR software developed allows patients to select from scenery such as mountains, the beach or from a selection of short videos, which are intended to promote relaxation.

Intervention Type OTHER

Immersive Audio Experience

A study team member will play from a library of music or other audible content (audiobook, podcast) that was preselected by the patient.

Intervention Type OTHER

Sham Virtual Reality Experience

Subjects will wear VR headsets and headphones but will not view any content or listen to any audible content.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients age 60 or older undergoing primary total knee replacement surgery at BIDMC and receiving spinal/regional anesthesia
* English or Spanish speaking patients

Exclusion Criteria

* Complex or revision surgeries
* Patients scheduled for "same day" TKA
* Open wounds or active infection of the face or eye area
* History of seizures or other symptom linked to an epileptic condition
* Patients who plan to wear hearing aids during the procedure
* Patients with a pacemaker or other implanted medical device
* Droplet or airborne precautions (as determined by local infection control policy)
* Non-English speaking or Non-Spanish speaking
* Moderate to severe dementia

Drop-Out Criteria:

* MoCA \<10 (this test will be administered on Day of Enrollment)
Minimum Eligible Age

60 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

No

Sponsors

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Israel-United States Binational Industrial Research and Development Foundation

UNKNOWN

Sponsor Role collaborator

XRHealth

UNKNOWN

Sponsor Role collaborator

Beth Israel Deaconess Medical Center

OTHER

Sponsor Role lead

Responsible Party

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Brian O'Gara

Assistant Professor of Anaesthesia

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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Brian P O'Gara, MD,MPH

Role: PRINCIPAL_INVESTIGATOR

Beth Israel Deaconess Medical Center

Locations

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Beth Israel Deaconess Medical Center

Boston, Massachusetts, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Brian P O'Gara, MD,MPH

Role: CONTACT

617-754-3189

Anna Fratello, B.S.

Role: CONTACT

Facility Contacts

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Brian P. O'Gara, MD, MPH

Role: primary

617-754-3189

References

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Espinosa-Leon JP, Mathura R, Chen G, Joseph M, Sadhwani T, Beydoun N, Hernandez ER, Riley T, Kunze LJ, Goodspeed V, O'Gara BP. Intraoperative virtual reality for older patients undergoing total knee arthroplasty: study protocol for a randomized clinical trial. Trials. 2024 Dec 18;25(1):830. doi: 10.1186/s13063-024-08551-6.

Reference Type DERIVED
PMID: 39695824 (View on PubMed)

Other Identifiers

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2020P001176

Identifier Type: -

Identifier Source: org_study_id

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