The Efficacy of a Mindfulness-Based Virtual Reality Intervention to Reduce Pain in Postoperative Patients

This tool assesses both pain intensity and its impact on daily functioning (e.g., sleep, work, social interactions). The BPI consists of 9 items, each rated on a 0-10 scale, where 0 indicates no pain or interference and 10 represents the worst possible pain or interference.

Participants will rate their pain intensity on a 0-10 scale, where 0 indicates no pain and 10 represents the worst imaginable pain. NRS assessments will be conducted at four postoperative time points. This approach helps minimize the influence of analgesics and anesthetics on reported pain levels. By spreading out the measurements, we reduce the risk that a single time point reflects only the temporary effects of medication, thus allowing for more reliable and valid comparisons between treatment groups.

State-Trait Anxiety Inventory - state version (STAI-S) Measures state anxiety (how the participant feels "at this moment"). Contains 20 items rated on a 4-point Likert scale (from "Not at all" to "Very much").

The scores range between 20 (no anxiety) and 80 (high anxiety)

The STAI-T measures trait anxiety, referring to how the participant generally feels. It consists of 20 items rated on a 4-point Likert scale, ranging from "Almost never" to "Almost always." Total scores range from 20 to 80, with higher scores indicating greater levels of anxiety.

Hospital Anxiety and Depression Scale (HADS):

Evaluates anxiety and depression symptoms in hospitalized patients. Consists of 14 items divided into two subscales (anxiety and depression), each rated from 0 (absent) to 3 (severe).

Total anxiety scores range from:

0-7 (normal) 8-10 (borderline abnormal) 11-21 (abnormal)

Quality of life will be assessed using the EUROHIS-QOL 8-Item Index, a validated short-form version of the WHOQOL-BREF, designed for rapid assessment of subjective well-being.

EUROHIS-QOL Scale Details:

Consists of 8 items covering four key domains:

Physical health (e.g., energy levels, ability to perform daily activities) Psychological well-being (e.g., satisfaction with life, emotional balance) Social relationships (e.g., satisfaction with personal relationships) Environment (e.g., financial security, living conditions)

Each item is rated on a 5-point Likert scale, where higher scores indicate better quality of life.

SQI Scale Details:

Consists of 19 items grouped into 7 components: Subjective sleep quality, Sleep latency (time taken to fall asleep), Sleep duration, Sleep efficiency, Sleep disturbances, Use of sleep medication, Daytime dysfunction.

Each component is scored from 0 to 3, where higher scores indicate greater sleep impairment.

The total PSQI score ranges from 0 to 21, with a score ≥5 indicating poor sleep quality.

Emotional balance will be assessed using the Equanimity Scale-16 (ES-16), a validated self-report instrument designed to measure the ability to accept internal experiences (thoughts, emotions, bodily sensations) without reacting impulsively.

ES-16 Scale Details:

Contains 16 items divided into two subscales:

Experiential acceptance - Measures the ability to acknowledge and accept emotional experiences.

Non-reactivity - Assesses the capacity to refrain from impulsive reactions to emotions.

Each item is rated on a Likert scale from 1 (strongly disagree) to 5 (strongly agree).

Higher scores indicate greater emotional balance and equanimity.

Pain catastrophizing will be assessed using the Pain Catastrophizing Scale (PCS), a self-report instrument designed to measure exaggerated negative responses to pain experiences.

PCS Scale Details:

Contains 13 items assessing three subdomains:

Rumination - Persistent focus on pain-related thoughts. Magnification - Exaggeration of the perceived threat of pain. Helplessness - Feelings of being unable to manage pain. Items are rated on a Likert scale from 0 (never) to 4 (all the time). The total PCS score is obtained by summing individual item scores, with higher scores indicating greater pain catastrophizing.

The Mindful Attention Awareness Scale (MAAS) is a validated instrument designed to assess individual differences in mindfulness, specifically the frequency of present-moment awareness and attention. It consists of 15 items, each rated on a 6-point Likert scale ranging from 1 (almost always) to 6 (almost never), with higher scores indicating greater mindfulness and present-moment awareness. Changes in MAAS scores will be analyzed to determine whether the VR mindfulness-based relaxation intervention enhances mindful awareness, potentially contributing to improved emotional regulation and pain perception.

Montreal Cognitive Assessment (MoCA) is a 30-point cognitive screening tool designed to detect mild cognitive impairment. The assessment evaluates multiple cognitive domains, including attention, concentration, executive functions, memory, language, visuoconstructional skills, conceptual thinking, calculations, and orientation. The test comprises various tasks that collectively contribute to the total score of 30 points. Administration time is approximately 10 minutes, and a score of 26 or above is generally considered normal.

The Presence Questionnaire (PQ) is a validated instrument designed to assess the degree to which individuals feel immersed and engaged in a virtual environment. It evaluates multiple dimensions of presence, including involvement, sensory fidelity, adaptation/immersion, and interface quality. The questionnaire consists of 32 items rated on a 7-point Likert scale, with higher scores indicating a stronger sense of presence. This measure will be used to explore how engagement in the VR mindfulness relaxation intervention influences participants' perception of presence and its potential relationship with anxiety reduction, pain perception, and psychological well-being.

The Simulator Sickness Questionnaire (SSQ) consists of 16 symptoms grouped into three components: Nausea (e.g., increased salivation, stomach awareness), Oculomotor (e.g., eyestrain, blurred vision), and Disorientation (e.g., dizziness, vertigo). Each symptom is rated on a 4-point Likert scale ranging from 0 (none) to 3 (severe). Subscale scores and a total score are calculated using standardized weighting formulas, with higher scores indicating more severe symptoms of simulator sickness.