Patient Augmented Reality and Vibratory Array Otorhinolaryngology Procedures

NCT ID: NCT06227039

Last Updated: 2024-01-26

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

80 participants

Study Classification

INTERVENTIONAL

Study Start Date

2022-10-01

Study Completion Date

2024-12-31

Brief Summary

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In-office procedures (IOPs) are a cost-effective, and safe alternative to many operating room procedure, with benefits such as reduced anesthesia risk. One of the major causes of failed in-office procedures or requirement of conversion to the operating room is poor patient tolerance. Vibration and augmented reality (AR) can be used as non-pharmacologic treatment options to treat patient anxiety and pain by using the physiology proposed by the gate-way theory of pain as well as distraction. This study seeks to compare anxiety and pain perception with patient reported survey data, as well as physiologic indicators of stress such as heart rate variability (HRV) within patients undergoing IOPs in a laryngology office with and without vibration and AR treatment.

Detailed Description

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In-office procedures (IOPs) represent a cost-effective and safe alternative to operating room procedures for a myriad of disease processes across medical and surgical specialties. IOPs are performed under local anesthetic without general anesthesia or sedation, resulting in faster and often safer procedures by eliminating risks associated with general anesthesia. IOPs are primarily limited by patient tolerance, as there is a lack of currently available non-pharmacologic treatment options for patient anxiety, stress, discomfort, and pain during these procedures.

The Gate Control Theory of Pain postulates that only a limited amount of simultaneous sensory stimuli can be processed by the central nervous system and therefore non-painful stimuli, such as vibration or virtual distraction (i.e. virtual or augmented reality), can eliminate or lessen the perception of concurrent painful stimuli. The use of these non-painful stimuli has been shown to have clinical utility in the setting of procedures such as percutaneous injections and wound dressing changes.

However, the coupling of multiple sensory distraction techniques has not been described for IOPs. Furthermore, no investigation of sensory distraction techniques to reduce patient discomfort within the field of otolaryngology has been conducted. The focus of the proposed project is to improve patient experience during IOPs by coupling a novel vibroacoustic stimulation device with original AR software applications.

In-office otolaryngology procedures specifically involve using a rigid endoscope or a flexible nasolarynogoscopy to visualize the inside of a patient nose, sinus, posterior oropharynx, and vocal cords. Using these imaging modalities, awake, in-office procedures can be performed. However, these procedures are often very uncomfortable and anxiety producing.

The goal of the study is to determine whether or not wearing an augmented reality headset with a novel game and vibroacoustic simulation device can help reduce anxiety and improve the patient experience of in-office otolaryngology procedures. The device consists of an augmented reality headset worn by the patient, a vibration device that is applied to the patient's neck to help reduce the sensation of the procedure, and a clicker that allows the patient to interact with the augmented reality game environment.

Patients who are undergoing in-office laryngology procedures (procedures on their vocal cords) will be randomized into a control group augmented reality (AR) group, vibration group, and combined AR and vibration group. The control group will wear a sham augmented reality head set during the procedure. The AR group will have a game played on the head set to distract them during the procedure. The patient will interact with the game use a hand held clicker.

Each participant will answer a survey before and after the procedure assessing their anxiety. Each participant will also wear a one-lead EKG to measure their heart rate through the procedure. The subjective and physiological level will be compared between the two groups

Conditions

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Pain, Acute Vocal Fold Polyp Vocal Cord Paralysis Laryngeal Neoplasms

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SUPPORTIVE_CARE

Blinding Strategy

SINGLE

Outcome Assessors

Study Groups

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No treatment

This arm will be the current standard of care

Group Type NO_INTERVENTION

No interventions assigned to this group

Vibroacoustic

This arm will use the vibroacoustic device to provide a mechanical stimulus to the patient as treatment to reduce pain and anxiety. Augmented reality glasses will be worn but will be turned off.

Group Type EXPERIMENTAL

Vibroacoustic stimulation on

Intervention Type OTHER

Mechanical stimulus is provided to the patient through a vibroacoustic device via vibration around the neck.

Augmented reality off

Intervention Type OTHER

Augmented reality glasses are worn but turned off.

Augmented Reality

This arm will use the augmented reality game to provide a visual stimulus to the patient as treatment to reduce pain and anxiety. Vibroacoustic device will be worn but will be turned off.

Group Type EXPERIMENTAL

Augmented Reality on

Intervention Type OTHER

Visual stimulus is provided through augmented reality glasses in the form of a game.

Vibroacoustic stimulation off

Intervention Type OTHER

Vibroacoustic device is worn but turned off.

Combination vibroacoustic and augmented reality

This arm will use both the augmented reality game and vibroacoustic device to provide a visual stimulus to the patient as treatment to reduce pain and anxiety.

Group Type EXPERIMENTAL

Vibroacoustic stimulation on

Intervention Type OTHER

Mechanical stimulus is provided to the patient through a vibroacoustic device via vibration around the neck.

Augmented Reality on

Intervention Type OTHER

Visual stimulus is provided through augmented reality glasses in the form of a game.

Interventions

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Vibroacoustic stimulation on

Mechanical stimulus is provided to the patient through a vibroacoustic device via vibration around the neck.

Intervention Type OTHER

Augmented Reality on

Visual stimulus is provided through augmented reality glasses in the form of a game.

Intervention Type OTHER

Vibroacoustic stimulation off

Vibroacoustic device is worn but turned off.

Intervention Type OTHER

Augmented reality off

Augmented reality glasses are worn but turned off.

Intervention Type OTHER

Eligibility Criteria

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Inclusion Criteria

* Patients undergoing office-based laryngology procedure performed at home institution.

Exclusion Criteria

* None
Minimum Eligible Age

18 Years

Eligible Sex

ALL

Accepts Healthy Volunteers

Yes

Sponsors

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University of Virginia

OTHER

Sponsor Role lead

Responsible Party

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James Daniero, MD

Associate Professor, Division Director, Laryngology and Voice Care

Responsibility Role PRINCIPAL_INVESTIGATOR

Principal Investigators

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James J Daniero, MD

Role: PRINCIPAL_INVESTIGATOR

University of Virginia

Locations

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UVA Fontaine Research Park Building 415

Charlottesville, Virginia, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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James J Daniero, MD

Role: CONTACT

4349242040

Elena Miller, MPH

Role: CONTACT

4342433607

Facility Contacts

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James Daniero, MD

Role: primary

434-924-2040

References

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Reference Type BACKGROUND
PMID: 12907006 (View on PubMed)

Rice T, Rosenau P, Unruh LY, Barnes AJ, Saltman RB, van Ginneken E. United States of America: health system review. Health Syst Transit. 2013;15(3):1-431.

Reference Type BACKGROUND
PMID: 24025796 (View on PubMed)

Hoffer EP. The American Health Care System Is Broken. Part 7: How Can We Fix It? Am J Med. 2019 Dec;132(12):1381-1385. doi: 10.1016/j.amjmed.2019.10.003. Epub 2019 Oct 24.

Reference Type BACKGROUND
PMID: 31668898 (View on PubMed)

Young S, Shapiro FE, Urman RD. Office-based surgery and patient outcomes. Curr Opin Anaesthesiol. 2018 Dec;31(6):707-712. doi: 10.1097/ACO.0000000000000655.

Reference Type BACKGROUND
PMID: 30148715 (View on PubMed)

Saini AT, Citardi MJ, Yao WC, Luong AU. Office-Based Sinus Surgery. Otolaryngol Clin North Am. 2019 Jun;52(3):473-483. doi: 10.1016/j.otc.2019.02.003. Epub 2019 Mar 22.

Reference Type BACKGROUND
PMID: 30905564 (View on PubMed)

Shah PD. Patient Safety and Quality for Office-Based Procedures in Otolaryngology. Otolaryngol Clin North Am. 2019 Feb;52(1):89-102. doi: 10.1016/j.otc.2018.08.015. Epub 2018 Sep 22.

Reference Type BACKGROUND
PMID: 30249445 (View on PubMed)

Braz J, Solorzano C, Wang X, Basbaum AI. Transmitting pain and itch messages: a contemporary view of the spinal cord circuits that generate gate control. Neuron. 2014 May 7;82(3):522-36. doi: 10.1016/j.neuron.2014.01.018.

Reference Type BACKGROUND
PMID: 24811377 (View on PubMed)

Treede RD. Gain control mechanisms in the nociceptive system. Pain. 2016 Jun;157(6):1199-1204. doi: 10.1097/j.pain.0000000000000499.

Reference Type BACKGROUND
PMID: 26817644 (View on PubMed)

Zhang Y, Liu S, Zhang YQ, Goulding M, Wang YQ, Ma Q. Timing Mechanisms Underlying Gate Control by Feedforward Inhibition. Neuron. 2018 Sep 5;99(5):941-955.e4. doi: 10.1016/j.neuron.2018.07.026. Epub 2018 Aug 16.

Reference Type BACKGROUND
PMID: 30122375 (View on PubMed)

Smith KC, Comite SL, Balasubramanian S, Carver A, Liu JF. Vibration anesthesia: a noninvasive method of reducing discomfort prior to dermatologic procedures. Dermatol Online J. 2004 Oct 15;10(2):1.

Reference Type BACKGROUND
PMID: 15530291 (View on PubMed)

Mally P, Czyz CN, Chan NJ, Wulc AE. Vibration anesthesia for the reduction of pain with facial dermal filler injections. Aesthetic Plast Surg. 2014 Apr;38(2):413-8. doi: 10.1007/s00266-013-0264-4. Epub 2014 Jan 24.

Reference Type BACKGROUND
PMID: 24464122 (View on PubMed)

Sharma P, Czyz CN, Wulc AE. Investigating the efficacy of vibration anesthesia to reduce pain from cosmetic botulinum toxin injections. Aesthet Surg J. 2011 Nov;31(8):966-71. doi: 10.1177/1090820X11422809. Epub 2011 Oct 14.

Reference Type BACKGROUND
PMID: 22001341 (View on PubMed)

Legrain V, Damme SV, Eccleston C, Davis KD, Seminowicz DA, Crombez G. A neurocognitive model of attention to pain: behavioral and neuroimaging evidence. Pain. 2009 Aug;144(3):230-232. doi: 10.1016/j.pain.2009.03.020. Epub 2009 Apr 18. No abstract available.

Reference Type BACKGROUND
PMID: 19376654 (View on PubMed)

Other Identifiers

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HSR210111

Identifier Type: -

Identifier Source: org_study_id

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