Postoperative recovery after head and neck surgery is complex, and often requires utilization of narcotic medications. The aim of this study is to evaluate reduction in pain and use of opioid medications through Virtual Reality (VR) and Fitbit wearable activity devices.
Enhanced Recovery After Surgery (ERAS) protocols were introduced as a method to optimize perioperative patient care. Narcotic medications are frequently utilized in postoperative care, but these have risks including sedation or dependence. Non-pharmacologic measures for postoperative pain control may help limit the need for opioids in postoperative pain control. Early mobilization is also important after surgery, however postoperative mobility is rarely monitored and relies on subjective reports. The investigators will seek to examine the implementation of an ERAS protocol using VR and Fitbit wearable activity devices on postoperative recovery after head and neck surgery. This is a prospective, 4-arm, randomized controlled trial.
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
SUPPORTIVE_CARE
Masking
NONE
Enrollment
80
Use of any virtual reality experiences available
Use of a Fitbit wearable activity device to track daily step goals.
Oregon Health and Science University
Portland, Oregon, United States
Mean daily opioid use
Mean daily opioid use will be assessed converted into milligram morphine equivalents (MME).
Time frame: through study completion, an average of 10 days
Pain scores
The Numeric Rating Scale (NRS) from 0 to 10 will be used to determine pain scores collected in the morning and evening each day. Scores will be averaged to obtain the daily pain score. We will also look at differences between AM and PM pain scores among the different cohorts. Scores will range from 0 (no pain) to 10 (worst pain)
Time frame: through study completion, an average of 10 days
Anxiety
The Generalized Anxiety Disorder 7-Item scale (GAD-7) will be used to determine preoperative and postoperative level of anxiety. Cut points of 5, 10, and 15 may represent mild, moderate, and severe levels of anxiety.
Time frame: Before surgery and at study completion, an average of 10 days
Depression
The Patient Health Questionaire-9 (PHQ-9) will be used to determine preoperative and postoperative level of depression. PHQ-9 scores can represent mild (\<4), moderate (5-14), and severe (\>20) depression.
Time frame: Before surgery and at study completion, an average of 10 days
Sleep Quality
The Insomnia Severity Index (ISI) will be used to determine preoperative and postoperative sleep quality. The ISI is a 7-item questionnaire evaluating severity of difficulty with sleep onset, sleep maintenance, early morning awakening, sleep dissatisfaction, interference in daytime functioning, noticeability of sleep difficulties by others, and distress from sleep difficulty. Items are rated on a 5-point Likert scale, and a total score ranges from 0 to 28.
Time frame: Before surgery and at study completion, an average of 10 days
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Patient experience and satisfaction
A Visual Analogue Scale (VAS) will used to analyze patient satisfaction during hospitalization, and will be provided to patients on day of discharge. The VAS is a horizontal line that is 100-mm long, with no satisfaction (0) on the very left and extreme satisfaction on the very right (100).
Time frame: at study completion, an average of 10 days
Disposition on discharge
Data regarding disposition on discharge to home, home with home health, skilled nursing facility, inpatient rehabilitation facility, or other facility will be determined from the electronic medical record on the day of discharge.
Time frame: at study completion, an average of 10 days
Length of hospital stay
Length of stay will be calculated beginning from postoperative day one and will include the day of discharge.
Time frame: at study completion, an average of 10 days