141 VR for pain relief in HSG 6 Table 3. Primary outcome. Outcome Intervention (n=69) Control (n=65) p-value^ Overal pain (VAS) (mean (SD))1 5.0 (2.10) 4.9 (2.13) 0.915 Peak pain (VAS) (mean (SD))1 6.8 (2.25) 6.6 (2.40) 0.574 Time spend thinking about pain (mean (SD)* 3.3 (0.99) 3.5 (1.10) 0.159 Pain medication used within 24h (%) # 0.360 Yes 9 (18.8) 10 (21.3) No 37 (77) 37 (78.7) Unknown 2 (4.2) 0 Type of pain medication used (%) $ Paracetamol 3 (33.3) 6 (60) 0.317 NSAIDs 8 (88.9) 6 (60) 0.779 Pain scores (in VAS) immediately after HSG, measured in peak pain and overall experienced pain. ^statistics with use of Fisher’s exact test or Chi-square test *Reported for n=68 intervention group, n=63 control group, measured using a 5-point Likert scale. # Reported for n=48 intervention group, n=47 control group. $ Reported for n=65 intervention group, n=62 control group. 1measured using a VAS-ruler, scale 0.0 – 10.0cm To explore whether other factors might have influenced both peak and overall pain scores, multiple regression was performed that included anxiety levels prior to HSG, tubal patency, VR expectations, previous experience with VR, the type of instruments used (i.e. cervical vacuum cup, a hysterophore or a balloon catheter) and the type of contrast used (i.e. water-based contrast, oil-based contrast). The results of these multiple regression models are presented in Supplementary Table 1. Overall pain scores only seemed to be influenced by the expectation that VR would be a good distraction prior to the HSG procedure, with a standardized coefficient of 2.995 (p=0.005). Patients who expected a greater distraction by VR, reported a higher overall pain score. No other factors were found to have influenced overall pain scores. Secondary outcomes: Satisfaction, Virtual Reality expectations and experience Satisfaction Women in the intervention group reported a mean satisfaction score on the 5-point Likert Scale (scale 1-5) of 4.07 (SD 0.84), whereas women in the control group reported a mean satisfaction score of 3.74 (SD 1.02) (p-value 0.197). While women in the intervention group reported similar willingness to undergo another HSG with VR, compared to the control group (3.43 (SD 1.35) versus 3.61 (SD 1.37) respectively, p-value 0.608), women in the intervention group reported significant less willingness to undergo another HSG without VR than the control group (2.72 (SD 1.25) versus 3.63 (SD 1.38) respectively, p-value 0.005) (Table 4).
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