Immersive virtual reality for preoperative anxiety management in patients undergoing elective lumbar laminectomy: a randomized controlled trial

This study aimed to investigate the effectiveness of immersive virtual reality (VR)-based preoperative education compared with attention-matched routine in-person education in reducing preoperative anxiety and physiological stress responses among adult patients undergoing elective single-level lumbar laminectomy. We hypothesized that the immersive nature of VR would provide superior anxiety reduction beyond the informational content alone. Prospective, single-center, assessor-blinded, parallel-group randomized controlled superiority trial with 1:1 allocation. 90 eligible adult patients scheduled for elective single-level lumbar laminectomy were randomized into two groups. The VR group received an 8-minute immersive 360-degree virtual tour of the perioperative pathway using a head-mounted display and noise-cancelling headphones. The control group received an identical 8-minute educational program delivered via a routine face-to-face session using printed visual aids, matching the same content, narration, and duration. All participants received standard preoperative care. The primary outcome was state anxiety measured by the State-Trait Anxiety Inventory (STAI-State) one hour before surgery (T2). Secondary outcomes included change in anxiety scores, heart rate, systolic blood pressure, and patient satisfaction with the educational experience. Assessments were conducted at baseline (T0), immediately post-intervention (T1), and preoperatively (T2). All 90 participants completed the study with no loss to follow-up. Baseline characteristics were comparable between groups. At T2, the VR group demonstrated significantly lower STAI-State scores compared to the control group (adjusted mean difference − 7.4 points, 95% CI: −10.8 to − 4.0; p < 0.001; partial η² = 0.22). The anxiety reduction was evident immediately after the intervention and sustained until surgery. Linear mixed-effects modeling confirmed a significant group × time interaction ( p < 0.001). Heart rate was also significantly lower in the VR group at T2 (adjusted mean difference − 3.8 bpm; p = 0.032). Patient satisfaction was markedly higher in the VR group (median 5 [IQR 4–5] vs. 4 [IQR 3–4]; p < 0.001), with 66.7% reporting “very satisfied.” Immersive VR-based preoperative education effectively reduces preoperative anxiety and improves satisfaction compared with routine in-person education in patients undergoing elective lumbar laminectomy. https://irct.ir/ , IRCT20251125068108N1, 2025-12-01.