Randomized Controlled Trial
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Apr 21, 2015; 21(15): 4707-4714
Published online Apr 21, 2015. doi: 10.3748/wjg.v21.i15.4707
Visual distraction alone for the improvement of colonoscopy-related pain and satisfaction
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima
Shotaro Umezawa, Takuma Higurashi, Shiori Uchiyama, Eiji Sakai, Hidenori Ohkubo, Hiroki Endo, Takashi Nonaka, Atsushi Nakajima, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, Yokohama 2360004, Japan
Author contributions: Umezawa S and Higurashi T contributed equally to this work; Umezawa S drafted the article and revised it critically for important intellectual content; Higurashi T designed the study and analyzed the data; Uchiyama S, Sakai E, Ohkubo H, Endo H and Nonaka T collected data; Nakajima A finally approved the article and is the corresponding author; Umezawa S and Higurashi T equal contributions to this manuscript.
Ethics approval: The study protocol was approved by the Yokohama City University Hospital Ethics Committee.
Clinical trial registration: This study is registered at University Hospital Medical Information Network (UMIN) Clinical Trials Registry. The registration identification number is UMIN 000009009 (http://www.umin.ac.jp/ctr/index-j.htm).
Informed consent: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest: All authors of this study have no conflicts of interest.
Data sharing: Technical appendix, statistical code, and dataset available from the corresponding author at http://ycuhepabiligi.wix.com/home. Participants informed consent for data sharing was not obtained, but the presented data are anonymized and the risk of identification is low. No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Atsushi Nakajima, MD, Professor, Department of Gastroenterology and Hepatology, Yokohama City University School of Medicine, 3-9 Fuku-ura, Kanazawa-ku, Yokohama 2360004, Japan. nakajima-tky@umin.ac.jp
Telephone: +81-45-7872640 Fax: +81-45-7843546
Received: September 26, 2014
Peer-review started: September 29, 2014
First decision: November 17, 2014
Revised: December 2, 2014
Accepted: December 19, 2014
Article in press: December 22, 2014
Published online: April 21, 2015
Abstract

AIM: To evaluate the effect of a relaxing visual distraction alone on patient pain, anxiety, and satisfaction during colonoscopy.

METHODS: This study was designed as an endoscopist-blinded randomized controlled trial with 60 consecutively enrolled patients who underwent elective colonoscopy at Yokohama City University Hospital, Japan. Patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. All of the colonoscopies were performed without sedation. We examined pain, anxiety, and the satisfaction of patients before and after the procedure using questionnaires that included the Visual Analog Scale. Patients were also asked whether they would be willing to use the same method for a repeat procedure.

RESULTS: A total of 60 patients were allocated to two groups. Two patients assigned to group 1 and one patient assigned to group 2 were excluded after the randomization. Twenty-eight patients in group 1 and 29 patients in group 2 were entered into the final analysis. The groups were similar in terms of gender, age, history of prior colonoscopy, and pre-procedural anxiety score. The two groups were comparable in terms of the cecal insertion rate, the time to reach the cecum, the time needed for the total procedure, and vital signs. The median anxiety score during the colonoscopy did not differ significantly between the two groups (median scores, 20 vs 24). The median pain score during the procedure was lower in group 1, but the difference was not significant (median scores, 24.5 vs 42). The patients in group 1 reported significantly higher median post-procedural satisfaction levels, compared with the patients in group 2 (median scores, 89 vs 72, P = 0.04). Nearly three-quarters of the patients in group 1 wished to use the same method for repeat procedures, and the difference in rates between the two groups was statistically significant (75.0% vs 48.3%, P = 0.04). Patients with greater levels of anxiety before the procedure tended to feel a painful sensation. Among patients with a pre-procedural anxiety score of 50 or higher, the anxiety score during the procedure was significantly lower in the group that received the visual distraction (median scores, 20 vs 68, P = 0.05); the pain score during the colonoscopy was also lower (median scores, 23 vs 57, P = 0.04). No adverse effects arising from the visual distraction were recognized.

CONCLUSION: Visual distraction alone improves satisfaction in patients undergoing colonoscopy and decreases anxiety and pain during the procedure among patients with a high pre-procedural anxiety score.

Keywords: Colonoscopy, Photic stimulation, Patient satisfaction, Colorectal cancer screening, Anesthesia

Core tip: We conducted a randomized controlled trial to test the effect of relaxing visual distraction during colonoscopy. Sixty patients were randomly assigned to two groups: group 1 watched a silent movie using a head-mounted display, while group 2 only wore the display. Patients in group 1 reported a significantly higher post-procedural satisfaction. Among those with a high pre-procedural anxiety score, the scores for anxiety and pain during the procedure were significantly lower in the group with the visual distraction. Visual distraction alone improves satisfaction during a colonoscopy and decreases anxiety and pain among patients with a high pre-procedural anxiety score.