Govert Veldhuijzen

136 Chapter 7 positional changes of the patient are sometimes necessary. Therefore, we set out on this pilot study to investigate the use of VR distraction during colonoscopy. The primary aim was to assess the patient acceptance of wearing VR glasses whilst undergoing colonoscopy. We were also interested whether VR reduces discomfort, pain, anxiety and satisfaction in patients compared to the standard practice. METHODS This experiment was designed as a pilot study to evaluate patient acceptance and practical feasibility. A control group was designed to allow evaluation of procedural and patient related outcomes. The sample size was set at 12 subjects per group. This computation was based on a rule of thumb for pilot studies. 30 Ethical permission from the Radboudumc Ethics Committee was obtained prior to commencement of the study (number 2016-2750). The trial was registered with the Dutch trial Registry (NTR6175). Patients We screened patients who were already scheduled for outpatient colonoscopy. The inclusion criteria of the study were adult age and any elective indication of colonoscopy. The exclusion criteria of the study were visual and/or auditory impairments, dementia, limited Dutch language skills, and a diagnosis of balance disorders or epilepsy. After evaluation of above criteria, informed consent was obtained from all participants and participants of the study were allocated to the VR (intervention) or non-VR (control) group. The allocation was based on the day the colonoscopy was planned. Participants were informed in which group they were allocated on the day of the procedure. Intervention The hardware we used to generate VR distraction was the Samsung® Gear VR (Consumer Edition - SM-R322, combined with Galaxy S7). This is an inexpensive ($172) of-the- shelf wide field-of-view 3-dimensional virtual reality headset that projects video and rendered graphics into 2 independent lenses. The current model is the size of a small pair of ski goggles, with a combined weight of 470 g, and is positioned on the head with elastic straps. The video content which was visualized on the VR hardware contained several short clips (with a total length of 19 minutes and 59 seconds) of moving 360- degree cameras featuring tropical islands and forests in the Caribbean (supported by VR firm Visyon, Eindhoven, The Netherlands). The VR content was without audio, to allow optimal communication with the patient. The authors considered the chosen VR content to be of a relaxing and not overly thrilling character, generating an adequate level of distraction for all participants.