Proposed Topic (Most preferred): :
Clinical Safety and Quality Service III (Projects aiming at quality service to patients and their carers)
Proposed Topic (Second preferred): :
Research and Innovations (new projects / technology / innovations / service models)
Authors (including presenting author) :
Lam WY (1), Chan KC (1), Cheung KW (1), Ho PY (1), Li YM (1), Lee HS (1), Hui N (1), Lam PT (2)
Affiliation :
(1) Occupational Therapy Department (2) Department of Medicine and Geriatrics, United Christian Hospital
Introduction :
Patients under Palliative Care (PC) encounter constant manifestation in physical symptoms and psychological distress. Conventional Occupational Therapy (OT) relaxation management such as mental imaging and progressive muscle relaxation, despite showing improvement in physical and psychological symptoms, only serves as general technique rather than individualised training. Owing to technology advancement, relaxation management with smart modality such as virtual reality (VR) arises to provide interactive and individualised intervention.
Objectives :
This programme applies a VR-based equipment - HeartMath Inner Balance, to provide “Smart Relaxation Management” to PC patients, and to investigate its feasibility and effectiveness on reduction of symptoms such as level of dyspnea, anxiety, stress, and depression.
Methodology :
HeartMath Inner Balance provides visual prompts and tailor-made content for relaxation management. It displays biofeedback data, such as real-time Heart Rate Variability, to facilitate positive emotions anchoring. This pilot study adopted a pre-post study design. Patients under PC in in-patient stay, day centre and clinic during September 2022 to September 2023 were eligible for recruitment. All participants either expressed subjective distress or reached a score beyond cut-off in DASS-21 or WHO-5. Participants received four intervention sessions with each last for 15 minutes. Pre and post vital sign parameters, including BP, HR, SpO2 and RR, and symptom scores, including Mood VAS, RPE (NRS) and RPD (NRS), were measured for each session and mean scores were calculated after programme completion. Assessment tools including DASS-21 and WHO-5 were conducted pre and post programme. All data were measured by Paired Samples T-Test except for Mood VAS, RPE (NRS) and RPD (NRS), which were measured by Wilcoxon Signed-Rank Test.
Result & Outcome :
13 participants with mean age of 72.7 (SD=11.06) were recruited. The average session number was 3.5 (SD=1.56). It was fewer than our plan because some recruited participants were unable to tolerate whole programme or passed away before programme completion. 46.1% (n=6) of participants was diagnosed with advanced cancer while 53.9% (n=7) was suffering from end stage organ failure. After programme completion, improvement in vital sign parameters, symptom scores and assessment tools were noted. For vital sign parameters, significant decrease in mean SBP by 3.75 mmHg (SD=3.96, P=0.005) and mean RR by 1.63 breaths per minute (SD=1.33, P=0.001), and significant increase in mean SPO2 by 0.69% (SD=0.95, P=0.022) were noted. For symptom scores, significant reduction in mean RPD (NRS) by 0.74 (P=0.012) and significant increase in mean mood VAS by 0.65 (P=0.008) were noted. For assessment tools, significant decrease in mean ‘Anxiety’ and ‘Stress’ subscales in DASS-21 by 3.23 (SD=3.00, P=0.002) and 4.00 (SD=5.03, P=0.014) were noted respectively. Increase in mean WHO-5 by 11.08 (SD=18.49, P=0.052) was also found with trend towards significance. The above result showed that VR-based relaxation management in palliative care is feasible and useful in improving vital sign parameters, symptom scores and assessment tools. Continuous utilisation of smart devices may lead the future trend of OT intervention in PC. Yet, a larger sample size with randomised controlled trial would be beneficial.
