Low-cost virtual reality-based patient education for outpatient hysteroscopy: A prospective comparative observational study

OBJECTIVE: Procedural pain and pre-procedural anxiety are the most frequently cited barriers to acceptability and completion of outpatient hysteroscopy. Virtual reality (VR) offers immersive patient education, but clinical adoption has been constrained by the cost of proprietary VR systems. We aimed to evaluate the feasibility, acceptability, and clinical impact of a bespoke, low-cost VR educational module delivered through a bring-your-own-device (BYOD) smartphone pathway in women undergoing outpatient hysteroscopy. STUDY DESIGN: Prospective, single-centre, three-arm comparative observational study at Airedale General Hospital. Ninety women undergoing outpatient hysteroscopy were enrolled into sequential cohorts (n = 30 each) according to the educational modality in routine departmental use at the time of their pre-procedural correspondence: written information leaflet; standard 2D educational video; or immersive 360° VR delivered via personal smartphone with a £1.50 cardboard headset. Primary outcome was procedural pain (Visual Analogue Scale, VAS 0-10). Secondary outcomes, measured identically in all three cohorts, included state anxiety (State-Trait Anxiety Inventory-State, STAI-S), patient satisfaction, subjective preparedness, and procedure completion. Cybersickness, BYOD feasibility metrics, and delivery-preference acceptability were assessed in the VR cohort. Intervention cost was calculated from procurement and staff-time data. RESULTS: Mean VAS pain scores were lower in the VR cohort (3.2, SD 1.4; 95 % CI 2.7-3.7) than in the 2D video (4.5, SD 1.6; 95 % CI 3.9-5.1) and leaflet cohorts (5.8, SD 1.9; 95 % CI 5.1-6.5) (p < 0.001). Mean STAI-S reduction from baseline was greatest in the VR cohort (-17.4 points, 95 % CI - 20.2 to - 14.6), intermediate in the 2D video cohort (-10.5 points, 95 % CI - 13.4 to - 7.6), and smallest in the leaflet cohort (-3.5 points, 95 % CI - 6.1 to - 0.9; p = 0.003). Procedure completion was 97 %, 87 %, and 73 % in the VR, video, and leaflet cohorts respectively (p = 0.04); the absolute difference between VR and leaflet was 24 % (95 % CI 7-41 %). All non-completions were attributable to procedural pain or patient distress; none was due to technical failure, cervical stenosis, or other anatomical or equipment factors. All eligible VR participants completed the BYOD pathway without requiring technical support, and 28 of 30 (93 %) rated home-based delivery on their own device as preferable to in-clinic delivery. Satisfaction was higher in the VR cohort (4.6, SD 0.5) than in the video (3.9, SD 0.7) and leaflet (3.1, SD 0.9) cohorts (p < 0.001). Three VR participants (10 %) reported mild, self-limiting cybersickness. Total intervention development cost was £334.99 (£3.72 per patient amortised). CONCLUSION: A bespoke, low-cost VR educational intervention delivered via a smartphone-based BYOD model was feasible and acceptable in this cohort, and was associated with substantially improved patient experience and procedure completion in outpatient hysteroscopy, at a per-patient cost orders of magnitude below proprietary VR systems. These non-randomised findings require confirmation in a formally powered randomised trial.